HIFES Plus Synchronized RF Boosts Filler OutcomesHIFES Plus Synchronized RF Boosts Filler Outcomes

Injectable dermal fillers are a staple in basic facial aesthetic treatments, popular because of convenience and patient satisfaction. As our understanding of the aging face has evolved, so has the armamentarium for treating it, including novel combination approaches that lead to significantly enhanced global outcomes. “All layers of the face age, so we should be treating all of them to get the best overall outcomes,” stated dermatologist Robyn Siperstein, MD (Boynton Beach, Fla.). “We use fillers in the superficial and deep fat pads, and lasers and topical medications for the skin, but we were missing an important layer: the muscle.”

Enter Emface® from BTL Aesthetics (Marlborough, Mass.), with a revolutionary combination of synchronized radiofrequency (RF) and high-intensity facial stimulation (HIFES™) brand energy that selectively tones underlying musculature to restore facial topography to a more functional and youthful-looking state. “Emface addresses this layer by stimulating our muscles and rejuvenating them as shown in clinical studies,”¹ Dr. Siperstein continued. “Muscle laxity and loss of volume exacerbate the appearance of aging, so to properly rejuvenate a more youthful appearance in a holistic way, you need to address both of those.” This echoes explanations from a 2023 paper by Dr. Chilukuri² delving deeper into the rationale for combining Emface with injectable fillers and neurotoxin: bone, connective tissue, facial muscles and the fatty layer, as well as the overlying skin, all age independently. Twelve-month data for a recent study presented by Yael Halaas, MD, at the American Society for Laser Medicine and Surgery (ASLMS) April 2024 conference in Baltimore, Md., evaluated three study patients via 3D photography to document persistence of volume changes. Sustained improvement was noted in both the zygomatic area (+3.8 mL at three months, +2.6 mL at 12 months) and the jowl (-4.0 mL at three months, -2.7 mL at 12 months), further strengthening this case.

Unsurprisingly, fillers and Emface work better together. For example, a study³ of Emface patients (n=47) from four trials using two different imaging and 3D analysis systems saw an average volume increase in the upper cheeks of 1.65 mL and an average volume reduction of 1.08 mL in the lower face, three months after a course of treatment. Intuitively, increases in volume from another source (in this case Emface) allow for reduced and/ or more strategic placement of filler material. “While Emface does not replace fillers, it does restore facial topography to some degree,” commented facial plastic surgeon Jennifer Levine, MD (New York, N.Y.). “It will provide a better, more natural-looking overall result, and may allow us to inject more sparingly because of the way Emface has been shown to augment volume in the cheeks, a common filler implantation site.”

A Synergistic Combination

But experts wondered: Would Emface cause issues with fillers? Dermatologist Bruce Katz, MD of JUVA Skin & Laser Center (New York, N.Y.) presented study⁴ outcomes at the 2024 Annual Meeting of the American Society for Dermatologic Surgery (October 2024). “When we originally saw what Emface could do, many of us realized its potential but also saw possible contraindication with implanted filler. Would Emface cause issues with fillers, such as breakdown of filler material, already implanted in the face?” he asked. “I suspected this would not be a problem and BTL was eager to do the study.”

Patients (n=6) were injected using hyaluronic acid fillers in the mid-face, and then underwent a course of four 30-minute sessions with Emface. Both two-dimensional (2D) and three-dimensional (3D) photographs were taken for comparison at baseline as well as after treatments and follow up at one, three and six months. “We were surprised that not only were there no problems with the fillers, Emface seemed to visibly enhance the filler effect. Patients who might have needed more filler became completely corrected, in my opinion. Also, I noted that the skin over the treated areas had greater luminosity. We only did six patients because overall improvement was a secondary endpoint, the primary focus was on the integrity of implanted fillers after a full course of Emface, and it passed with flying colors.” Dr. Katz added that use of fillers after a full course of Emface was not studied but would be an obvious and valuable next step. “Emface is a significant, new technology that is transforming how we treat the aging face in general,” Dr. Katz added. “It works incredibly well with injectables and has become a staple in our facial armamentarium.”

Dr. Levine sees the rationale both ways. After comprehensive full-face analysis, treatment protocol depends on the patient’s individual needs and time constraints. “In my mind it is better to do Emface, then implant fillers strategically – for the most part just as you would without Emface, but with a better overall result. But it is extremely advantageous to be able to do both, concurrently. Many patients are busy or have an event coming up, so we can confidently compress the overall treatment time without sacrificing outcomes.”

Natural Enhancement

According to Melanie Palm, MD, director of Art of Skin MD (Solana Beach, Calif.), Emface delivers next-level results in combination because enhancement is so natural. “By augmenting the patient’s existing facial topography in a way that never existed before, whatever else we do will automatically look better and more natural for that individual.” As one of the first adopters of the technology in California, she saw and capitalized on this potential, especially for long-term injectables patients. “There are natural vectors of lift where structural muscle support plays a daily role in our facial expressions. To be able to fortify them and restore those natural contours with Emface, such as the Ogee curve of the cheek, has been amazing. Our goal should be to maintain facial shape and authenticity of the person that we are treating, and not alter overall proportions of the face dramatically in an unpleasing way. Emface’s unique correction helps us achieve those ends more effectively when we use fillers.”

“Whether it is injectable fillers, collagen-stimulating agents or neuromodulators, Emface is a key player in providing patients with the best, most natural-looking overall result,” Dr. Palm added. “You can think of Emface as physical therapy for your face, but I like to think of it as providing a better canvas for the artist.”

References:

1. Kinney BM, Bernardy J, Jarošová R. Novel technology for facial muscle stimulation combined with synchronized radiofrequency induces structural changes in muscle tissue: porcine histology study. Aesthet Surg J. 2023 Aug. 43(8):920–927.

2. Chilukuri S. Holistic approach for noninvasive facial rejuvenation by simultaneous use of high intensity focused electrical stimulation and synchronized radiofrequency: a review of treatment effects underlined by understanding of facial anatomy. Facial Plast Surg Clin North Am. 2023 Nov;31(4):547-555.

3. Halaas Y, Boyd CM, Gentile R, Chilikuri S, Clark-Loeser L. Novel HIFES and RF technology for comprehensive facial enhancement and volume improvement in patients. Data on file. BTL Aesthetics.

4. Katz BE. E  ect of combined HIFES and synchronized radiofrequency in patients with fi llers. Presented at the Annual Meeting of the American Society for Dermatologic Surgery. October 17-20, 2024: Orlando, FL.