Neuromuscular Electrical Stimulation in Facial Aging: an Integrative Literature Review

Consulin, Márcia Cristina Dias; Vasques, Louise Idalgo; Leonardi, Gislaine Ricci

doi:10.1590/1809-2950/e21008423en

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INTEGRATIVE REVIEW • Fisioter. Pesqui. 30 • 2023 • https://doi.org/10.1590/1809-2950/e21008423en copy

Neuromuscular Electrical Stimulation in Facial Aging: an Integrative Literature Review

Estimulación Eléctrica Neuromuscular en el Envejecimiento Facial: Revisión Integradora della Literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Despite of being a natural physiological process, aging is considered a degenerative process with evident effects on aging skin, such as reduced elasticity, wrinkles, reduced facial fat and muscle tone, sagging, changes in facial contour, and sarcopenia on the face. These changes can generate social stigma, suffering, and psychological discomfort for the patient. Thus, this study aimed to evaluate the effectiveness of Neuromuscular Electrical Stimulation (NMES), a technique used in physical therapy for muscle training, in attenuating the signs of facial aging. For this purpose, a scientific survey of publications indexed on the Medline (PubMed), CINAHL, Embase, PEDro, Lilacs, ERIC, Scopus, Web of Science, and Google Scholar databases was conducted and, based on pre-established criteria, two relevant publications for the topic were selected for discussion. The scientific literature regarding the use of NMES to attenuate the signs of aging is still very scarce. The survey showed the need to discuss the current state of knowledge. Our results suggest that, theoretically, NMES could be a promising method to attenuate the signs of aging; however, there are still no conclusive results regarding the clinical effectiveness of using NMES in the facial muscles since few studies relate NMES to facial rejuvenation. More studies are needed, with greater methodological rigor and low level of bias, using precise techniques in the evaluation and allowing to interpret with greater scientific commitment of the physiological mechanism of the muscular stimulus and its interrelation with the integumentary system, proving its effectiveness in the improvement of skin appearance.

Keywords:
Neuromuscular Electrostimulation; Muscle Training; Skin Aging; Physical Therapy

Author/year	Category	Population	Procedures	Intervention and analysis instruments	Main results
Kavanagh et al., 2012¹⁵15. Kavanagh S, Newell JN, Hennessy M, Sadick N. Use of a neuromuscular electrical stimulation device for facial muscle toning: a randomized, controlled trial. J Cosmet Dermatol. 2012;11(4):261-6. doi: 10.1111/jocd.12007. https://doi.org/10.1111/jocd.12007...	Randomized, controlled, and partially blinded clinical study.	108 healthy women, aged 32 to 55 years, and with visible signs of facial aging; participants were randomly divided into intervention and control group.	The intervention group was trained in the use of the device, and the first treatment session was performed under supervision and the others were self-administered at home. A stimulation intensity that provided minimal visible muscle contraction was selected. The treatment was performed for 12 weeks with the NMES facial device, for 20min/day, five days per week. The control group received no intervention.	A 70Hz NMES facial device was used; psychometric surveys were applied for the determination of facial condition and appearance, including tone, firmness, support, brightness, and complexion; and ultrasonography of the zygomaticus major muscle was performed using a scanner with a linear transducer of 7.5-9.0MHz.	The intervention group showed thicker zygomaticus muscle major and subjective improvements in facial attributes, such as firmness, tone, and support, while the control group showed no improvements. The differences between the two groups were statistically significant at 6 and 12 weeks.
Nakaya et al., 2022²⁸28. Nakaya K, Muto H, Matsuura K, Sudo S, Yamanaka A. The effects of electrical muscle stimulation on facial muscles: volume change of facial muscles measured with magnetic resonance imaging. Journal of JART [Internet]. 2022 [cited 2023 Mar 23];69(831):40-7. Available from: https://3medgroup.com/wp-content/uploads/2022/09/EMS.pdf https://3medgroup.com/wp-content/uploads...	Clinical study. There is no mention of all study criteria, such as whether or not a control group was present or whether the study was blinded.	10 healthy women, aged 21 to 22 years. There is no description of the inclusion and exclusion criteria.	The participants were trained in the use of the device and self-administered eight NMES procedures for 20min/day, two days per week.	The Pearl Face Esthe Sonic EX (ITO CO. LTD., Saitama, Japan) was used. The masseter and buccinator muscles were evaluated by magnetic resonance imaging using the ECHELON 1.5T scanner (Hitachi, Ltd., Ibaraki, Japan) before the first procedure and 2 or 3 days after the last day of intervention.	There was no significant difference in the volume of the right and left buccinator muscles before and after the use of the EMS facial device. There was a significant decrease in the volume of the right and left masseter muscles after the use of the EMS facial device, suggesting that the device can generate a beneficial effect on the masseter muscle in a short time.

Evaluative criteria	Kavanagh et al., 2012¹⁵15. Kavanagh S, Newell JN, Hennessy M, Sadick N. Use of a neuromuscular electrical stimulation device for facial muscle toning: a randomized, controlled trial. J Cosmet Dermatol. 2012;11(4):261-6. doi: 10.1111/jocd.12007. https://doi.org/10.1111/jocd.12007...	Nakaya et al., 2022²⁸28. Nakaya K, Muto H, Matsuura K, Sudo S, Yamanaka A. The effects of electrical muscle stimulation on facial muscles: volume change of facial muscles measured with magnetic resonance imaging. Journal of JART [Internet]. 2022 [cited 2023 Mar 23];69(831):40-7. Available from: https://3medgroup.com/wp-content/uploads/2022/09/EMS.pdf https://3medgroup.com/wp-content/uploads...
1. Eligibility criteria were specified	Yes	Yes
2. Subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received)	Yes	No
3. Allocation was concealed	Yes	No
4.The groups were similar at baseline regarding the most important prognostic indicators	Yes	Yes
5. There was blinding of all subjects	No	No
6. There was blinding of therapists who administered therapy	No	No
7. There was blinding of all assessors who measured at least one key outcome	Yes	No
8. Measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups	Yes	Yes
9. All subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome was analysed by “intention to treat”	Yes	Yes
10. The results of between-group statistical comparisons are reported for at least one key outcome	Yes	Yes
11. The study provides both point measures and measures of variability for at least one key outcome	Yes	Yes
Score*	8	5

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[1] Corresponding address: Gislaine Ricci Leonardi - Rua Cândido Portinari, 200 - Campinas (SP), Brazil - ZIP Code: 13083-871 - E-mail: gislaine.leonardi@fcf.unicamp.br