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THE EFFECT OF ELECTRIC STIMULATION
OF FACIAL MUSCLES WITH “TUA VISO”
FOR THE TREATMENT OF WRINKLES
Ugo DeSantis, Paolo Gottarelli, Luciano Merlini, Giuseppe
Monetti, Stefano Righini.
INTRODUCTION
There are no wrinkles on the faces of newborn
babies; wrinkles disappear when a face is
Paralyzed, but wrinkles remain after death. This therefore
represents a process linked with the face’s muscular
activity, which people find particularly unattractive from
the age of forty onwards. It is well-known that electric stimulation
can increase the muscular tone of the trunk and limbs and
reduce the layer of subcutaneous fat more than physical exercise
and massages (Heyters & Spierckel, 1987).
VUPIESSE ITALIA has manufactured a battery-powered electric
stimulator unit (“TUA”) which generates a 80 cycles/sec.
electronically modulated current in which the pulse length
is the same as that of high frequency current (over 4500 cycles/sec.),
so muscular contraction (motor/stimulant effect) is achieved
before pain is felt. It is a compact portable unit specifically
designed for the stimulation of facial muscles, which can
be done safely and effectively without causing pain.
It is believed that this type of treatment is effective when
used constantly for a long period of time and that results
are only noticeable after months. This delay between
starting treatment and the appearance of the desired effect
is a possible obstacle when choosing this non-invasive technique
instead of wrinkle treatment methods, which are “invasive”
but have a potentially more rapid effect. We wanted
to find out if controlled stimulation of facial muscles with
this particular current could give results even after just
a 3-week course of treatment, so therefore investigated the
effects of the treatment using highly sophisticated quantitative
assessment methods* musculocutaneous *ultrasonography and
computerized image analysis.
SUBJECTS
14 female subjects aged between 38 and 52 years (average age
39.5), all with sedentary jobs and regular habits were chosen
for the tests. Their height and weight was no more than
20% over “ideal weight” for their age, calculated
with current methods.
Among the patients, only one had a pathological medical history
worth note, having had an episode of poliomyelitis at pre-scholastic
age, but without any evident commemorative signs. One
of the patients had a partial removable denture. All
patientshad normal occlusion of the teeth.
CONDITIONS
3 times a week for three weeks (a total of 9 sessions per
person), their facial muscles (orbicularis oculi, orbicularis
oris, and major zygomatic) were stimulated so as to obtain
visible contraction. In the same sessions, contraction of
the following muscles were caused:
-right orbicularis oris and zygomatic for 5 minutes.
-left orbicularis oris and zygomatic for 5 minutes.
-right orbicularis oculis for 5 minutes.
-left orbicularis oculis for 5 minutes.
To ensure that the muscles were always stimulated
in the same position, the unit was applied to the muscles
under medical control. The intensity of the contraction
on the other hand was decided by each patient, who turned
the control knob until she felt the stimulus and caused contraction,
which the doctor could see.
At the end of the series of sessions, an anonymous questionnaire
was submitted.
Immediately before the start of the tests, an ultrasound test
of their facial muscles was done and photographs taken.
Immediately after the tests, another muscular ultrasound test
was done and more photographs taken to enable comparison.
Ultrasonographic documentation
The study was carried out with real-time equipment, using
a 7.5 MHz linear probe, scanning on the *sagittal planes at
the level of the zygomatic muscle, using the distal part of
the *zygomatic bone as a reference point.
The exam was carried out immediately before and after the
treatment, taking into consideration both the morphology and
the thickness of the layer of subcuntaneous adipose tissue
and muscle and measuring the *anteroposterior diameter of
both at numerous well-defined points.
The ultrasonographic anatomy of the subcutaneous adipose tissue
consists of parts with low/medium visibility divided by visible
parts making up the fibrous connective structures and the
adipose tissue itself, which in normal patients are parallel
and regular.
The average anteroposterior diameter of subcutaneous
tissue in a normal female patient is 1.8mm. In an ultrasound
test, the muscular tissue of a normal patient shows a uniform
distribution of echos of average intensity, with visible parallel
striations, which make up the muscles’ tertiary fasciae:
the normal average thickness of the zygomatic muscle is 3.5mm.
Photographic documentation
Tests of the effectiveness of a treatment which aims at giving
vigor and tension to the face’s skin by stimulating
facial muscles must also include in its analysis images of
the faces before and after treatment. Although these
differences may be appreciated at a subjective level by merely
comparing photographs taken at various stages during treatment,
to ensure scientific precision, it is essential to ascertain
the morphological differences in the body’s surface
objectively. Objective evaluation has always involved
numerous difficulties of a technical nature which have been
overcome only recently with the use of computers. Computers
in fact enable to transform a photographic image, fundamentally
made up of a series of colored dots, into a set of vectors
which, when suitably filtered and processed, can be used for
calculation and comparison. For images to be processed
by the computer, it is also indispensable that the photographs
are taken in such a way as to avoid even small artificial
differences between those taken before and after the therapy,
optimizing the use of camera and flashes as well as the position
of the face and any corrective cosmetics used by the patient.
To ensure this, a special “photographic studio”
was set up, with a tripod firmly mounted on a table together
with a face-holder based on those used with Micro Nikon 105mm
lenses, with a distance of 1 meter between film surface and
focus point (patients’ pupils). Lighting was supplied
by two flashes with different power set in front of the patients
and 30cm. from the camera. The patients’ position
was checked each time by means of a special “chequered”
focusing screen, in which the pupils were always positioned
at exactly the same point. The 35mm. Slides obtained
were then fed into a Macintosh VX computer by means of a digitizer
board and a Tamron slide scanner. After the digitization
of the images using special Adobe software, the next step
was to check and correct any possible artifacts, both foreseeable
ones caused by the methods used (basically very small differences
in shots and lighting) and those caused by patients’
behavior. The images were then recomposed and “before”
compared with “after”.
The day before treatment began, photographs
were taken in three fundamental positions: full frontal, at
an angle of 45* and profile. Each patient filled out
a personal form with her medical history and was allocated
a number to ensure the anonymity of the images’ analysis.
The day after treatment finished, the same photographs were
taken with the equipment (which had not been touched in the
meantime). Regarding cosmetic make-up, it was preferred
to photograph the patients with their own day-to-day make-up,
ensuring that it was the same at the two photographic sessions.
Results
All 14 women finished the experiment, which lasted 3 weeks.
The electric stimulation of their facial muscles was judged
(Tab. No. 1) “painless by all patients and even pleasant
by more than 2/3 of them. According to half of the patients,
both facial muscle tone and appearance had already improved
at the end of this short treatment. Lastly, all insisted
on being allowed to continue stimulation at home with TUA
after the experiment. No undesirable effects were noted
on their facial skin during or at the end of the treatment.
As far as subcutaneous adipose tissue was
concerned, the ultrasound test carried out before the treatment
showed an uneven distribution of visibility, with irregular
fibrous connective parts, in the context of which clearly
visible spaces due to lipodystrophic tissue were noted.
The average thickness of the subcutaneous tissue was 2mm.
(range: 1.7-2.4mm). The muscular tissue had a uniform
average visibility with parallel, quite uniform distribution
of the tertiary fasciae. The anteroposterior layer of
muscular tissue was on average 3mm. (range: 2.5-3.5).
In 80% of the patients, the ultrasound test
done after treatment showed a reduction in the thickness of
subcutaneous adipose tissue, quantized as 0.2mm. In
particular, a more homogeneous state of the fibrous connective
sections with partial or total loss of the areas of liposclerosis.
The muscular tissue on the other hand had a modest increase
of visibility, due to improved muscular tone, with an average
increase in thickness of 0.3mm. The greatest difference
obtained during the tests was with patient No. 8, with whom
we had the following results: value of the adipose layer
before therapy was 4.4mm. and 1.6mm.after therapy: the
value of the muscular layer before therapy 2.8mm. and after
therapy 3.2mm.
Preliminary photographic analysis of the
14 groups of tracings of the patients carried out in the 3
positions enabled to note an increase in skin tension and
in some cases a measurable increase in the dimension of some
muscles.
By overlaying Bezier curves on the profiles of the various
muscles (a function which enables to calculate the variable
angle curves), it can already be concluded that for six patients
there was an increase in the dimension of the muscles of the
masseteric region, noticeable with the muscles contracted
in four of them.
For the other regions of the face under treatment, although
comparison and superimposing the tracings would suggest a
greater skin tension, no “quantization” of the
changes has been reached.
Study being carried out on the tracings will
enable to accurately define the amount of change, which took
place, allowing a statistic analysis of the results.
Conclusions
Stimulation of the muscles of the face with Vupiesse Italia’s
“TUA VISO” enabled to obtain in 14 female subjects
an appreciable increase in muscular tone, after a period of
controlled treatment of just three weeks. The stimulation
of the muscles of the face was referred by 100% of the subjects
as being painless and even pleasant by more than 2/3 of them.
The women who participated in the experiment had high hopes
and after just three weeks’ treatment, half of them
reported that their faces muscular tone and appearance had
improved. The ultrasound method proved very useful in
showing the pathological aspects of the layer of subcutaneous
tissue and muscles before the treatment and their partial
regression at the end of the cure. The reshaping of
the face was adequately studied by means advanced methods
for the acquisition, processing and analysis of the photographic
images.
This test enabled to state that the treatment of facial muscles
with electric stimulation is safe and painless and even after
just three weeks is able to improve the tone and appearance
of the muscular and subcutaneous tissue. It can be expected
that longer (or even continual) treatment, such as that which
can be carried out at home with the tested unit, would have
greater, longer lasting results, using effective painless
stimulation to fight the regressive phenomena of the subcutaneous-muscular
complex which in conclusion are to blame for the anti-aesthetic
“wrinkles”.
TUA VISO
QUESTIONNAIRE RESULTS
1-Found the stimulation:
a) Painful
0/14 (0%)
b) Painless
14/14(100%)
2- The stimulation is:
a) Pleasant
10/14 (71.4%)
b) Unpleasant
3/14 (21.4%)
Rather annoying
l/14 (7.2%)
(Not on the list)
3- The tone and appearance of the facial muscles are:
a) Improved
7/14 (50%)
b) Unchanged
7/14 (50%)
c) Worse
0/14 (0%)
Glossary
Musculocutaneous- Pertaining both to muscles and skin; as,
the musculocutaneous nerve
Ultrasonography- A laboratory
examination, which uses ultrasonic energy to control and graphically
reproduce the volume of muscles or other tissues or cavities
.
Sagittal - Of or relating to
the suture uniting the two parietal bones of the skull.
Orbicularis oculi - eye muscle
Lipodystrophic- A disorder of
adipose (fatty) tissue characterized by a selective loss of
body fat.
Anteroposterior -From front
to back
Zygomatic- Of, relating to,
or located in the area of the zygoma: a zygomatic muscle.
Quantized- To limit the possible
values of (a magnitude or quantity) to a discrete set of values
by quantum mechanical rules. Echos- A repetition or an imitation
Masseteric- A thick muscle in
the cheek that closes the jaws during chewing
Bezier- Curves and surfaces
are defined by a set of "control points"
which can be moved interactively making Bezier curves and
surfaces convenient for interactive graphic design.
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