Abstract
BACKGROUND: Effects of upper facial aging can present as static forehead and periorbital rhytids as well as soft tissue volume loss. The latter can occur in conjunction with bony changes of the calvarial eyebrow and eyelid ptosis. Injection-based treatments can yield positive outcomes but are not free of procedural risks. OBJECTIVES: The goal of this study was to assess the clinical outcome of synchronized radiofrequency (RF) and high-intensity facial electrical stimulation (HIFES) when targeting the upper face, with special focus on effects on the musculature, subcutaneous fatty layer, and eyebrow position. METHODS: This nonrandomized, prospective study included 37 patients with a mean age of 45.46 years and a mean BMI of 21.84 kg/m2. Patients received 4 synchronized RF and HIFES treatments spaced 7 days apart. Efficacy measurements were taken at 4, 16, and 24 weeks posttreatment with 3-dimensional surface imaging, surface electromyography (EMG), and high-resolution facial ultrasound. RESULTS: Forehead and lateral canthal line severity showed statistically significant improvement at each follow-up visit when compared to baseline, all P < .001. At week 24, the position of the medial/central/lateral eyebrow increased by 3.18/3.02/2.27 mm, respectively, when compared to baseline, with P < .001. At week 24, no statistically significant changes were observed in the thickness of frontalis muscle or the overlying fatty layer. CONCLUSIONS: The application of synchronized RF and HIFES to the frontal region reduced frontal and lateral canthal rhytids and elevated the position of the eyebrow until week 24 after the initial treatment. Based on the results obtained, this noninvasive energy-based treatment option may be a viable alternative to injectable treatments of the upper face when trying to ameliorate the signs of upper facial aging.