What Is EMFACE? A Toning Specialist Clinic Explains Who It Suits and How to Choose Other Treatments

EMFACE is a treatment device for sagging that moves the facial muscles with electrical stimulation while warming the skin with radiofrequency energy. Developed by BTL, headquartered in the Czech Republic, it is offered by cosmetic dermatology and cosmetic surgery clinics in Japan as elective treatment. You simply apply adhesive pads and lie down; no needles, incisions, or anesthesia are used.

Unlike conventional devices that deliver heat, EMFACE's key difference is that it directly moves the muscles themselves. Because it works on the underlying support rather than the skin's surface, it is also chosen by people who want to minimize downtime.

HIFES (High-Intensity Facial Electrical Stimulation) is a technology that sends electrical stimulation to the facial muscles responsible for lifting the face, repeatedly contracting them at an intensity that cannot be produced voluntarily. The facial muscles are thin muscles connecting the bones and skin. As they weaken with age, they can no longer adequately support the fat and skin.

Repeatedly moving the muscles is thought to restore their firmness and increase their ability to support sagging fat again. This is why the treatment is often compared to facial strength training.

Synchrowave RF is a technology that emits radiofrequency energy from the same pads as HIFES, warming the skin and the tissue beneath it. Warming the skin makes it easier for collagen and elastin—the fibers that maintain skin elasticity—to be produced.

Because EMFACE emits HIFES and RF simultaneously, it can work on both the muscle layer and the skin layer in a single treatment. Its distinctive feature is the ability to target both lifting and skin firmness at the same time.

EMFACE pads (applicators) are available for four areas: the forehead, eye area, cheeks, and under the chin. Because the pad placement and muscles stimulated differ by area, the treatment area is selected according to your concerns. Treatment takes approximately 20 minutes per area, or about one hour including preparation.

It is common to combine areas—for example, the cheeks for nasolabial folds, or the cheeks and under the chin for concerns about the facial contour.

The changes expected with EMFACE differ depending on where the pads are applied. On the forehead, it lifts the position of the eyebrows and helps make horizontal forehead lines less noticeable. The eye area targets under-eye sagging, fine lines at the outer corners of the eyes, and dark circles. The cheek area lifts the cheeks and aims to reduce the appearance of nasolabial folds.

Under the chin, the goals are a more defined facial contour and improvement of a double chin. Because muscle development and the condition of the fat vary from person to person, some clinics determine the treatment area after checking with ultrasound.

The under-chin pad is set to a higher radiofrequency output than the other three areas. As a result, heat reaches not only the muscles and skin but also the fat layer. EMFACE applied to the forehead, eye area, and cheeks does not change the amount of fat, whereas the under-chin treatment also works on the fat contributing to a double chin.

For people whose fullness under the chin is caused by both muscle laxity and fat, this may be a treatment area worth considering.

The results of EMFACE vary depending on where the pads are placed. This is because even a shift of a few millimeters can change which muscles are stimulated. Since muscle development and face size vary from person to person, whether the physician determines the placement after examining the face may also affect the results.

During your consultation, it is reassuring to confirm who determines the placement and how it is decided.

EMFACE is not a treatment completed in a single session. It is generally performed as a course of around four treatments at one- to two-week intervals. As with strength training, changes in the muscles build up as stimulation is repeated.

The number and interval of treatments are determined by the clinic's policy and the condition of your skin and muscles. Some clinics recommend four to six treatments, and the number may increase for people with more advanced muscle weakness.

Some people feel tighter immediately after the first treatment, but changes are generally said to become more noticeable several weeks after completing the course. It takes time for changes in the muscles and skin to build up.

Some clinics state that the effects become easier to notice over the one to three months after completing four treatments. Even if the effects are difficult to see during the course, assess them after completing all four treatments.

The effects of EMFACE are expected to last approximately six months to one year. After completing one course, many clinics recommend maintenance once every three months to one year. If maintenance is discontinued, the condition of the muscles gradually returns toward its age-related state.

If you want to preserve the effects for longer, it is reassuring to discuss the maintenance interval and cost with your physician before completing the course.

EMFACE is a treatment associated with little pain and almost no downtime. During the procedure, you may feel your muscles tightening involuntarily and a gentle warmth. Under the chin, you may experience a sensation that seems to reach the teeth, but the output can be adjusted if the stimulation feels too strong. No anesthesia is used, and makeup can be applied immediately afterward, so most people return directly to work or shopping.

The following sensations may occur after EMFACE treatment:

Most subside within several hours to about one day, and generally settle within two days at the longest.

Rarely, scabs, blisters, or burns may occur. If redness does not subside after several days or blisters develop, do not apply medication on your own; contact the clinic where you received the treatment.

EMFACE applied to the cheeks, forehead, and eye area works on the facial muscles and skin; it does not reduce the amount of fat. When muscle support is restored, sagging fat may move upward, making the facial contour appear more defined.

However, if the main cause of fullness is the amount or weight of cheek fat, some of the fullness may remain even after strengthening the muscles. If cheek fullness concerns you, consider a treatment that works on fat first.

The appropriate treatment for facial sagging depends on which of the three layers—skin, fat, or muscle—is the main cause. Changes in the bone structure may also be involved, but these are the three layers that devices can target. Identifying the cause before asking which device is best can reduce the risk of spending time and money on an unsuitable treatment. EMFACE is most effective when weakening of the facial muscles is the primary cause of sagging.

Sagging caused by the skin layer occurs when the skin itself becomes thinner, loses firmness, and appears to sag. Noticeable changes may include an increase in fine lines or a thin feeling when pinching the skin. Because EMFACE also works on the skin with RF, it can address this layer.

However, if skin firmness is your only concern, ultrasound or RF treatments that deliver heat to the dermis may also meet your goals. When there are few changes in the muscles, you can choose based on cost and the number of visits.

Sagging caused by the fat layer occurs when the cheeks contain a large amount of fat or sag under its weight, making the facial contour appear less defined. A sign is feeling substantial thickness when pinching the area below the cheeks with your fingers.

Because EMFACE does not change the amount of cheek fat, addressing it first with microwave or RF treatment that delivers heat to the fat layer may help avoid unnecessary costs. If support remains insufficient after that, adding EMFACE is a rational next step.

Sagging caused by the muscle layer occurs when the facial muscles weaken, making the cheeks, corners of the mouth, and eyebrows all appear to sit lower. If you feel that the center of gravity of your face has shifted downward compared with older photographs, despite no change in skin firmness or the amount of fat, muscle changes may be significant.

EMFACE's strength is that it works on the facial muscles, which other devices cannot move directly. In practice, multiple layers overlap, so it is best to confirm the cause during an examination before deciding.

EMFACE, HIFU, and RF are all non-surgical treatments for sagging, but they work on different layers and are suited to different types of sagging. Understanding the differences makes it easier to choose the treatment that is right for you. Let's take a closer look.

HIFU (high-intensity focused ultrasound) delivers focused points of ultrasound heat to the fascia—the membrane surrounding the muscles—beneath the skin, causing it to contract and tighten. While EMFACE moves the muscles themselves, HIFU tightens the fascia with heat.

Some people feel changes with fewer treatments than EMFACE, but HIFU tends to cause pain that may resonate through the bone. For people who have avoided HIFU because they are sensitive to pain, EMFACE may be an option.

RF (radiofrequency) treatment warms the skin broadly to improve firmness and make fine lines less noticeable. EMFACE also uses RF, but differs in that it combines RF with muscle contractions. Depending on the RF device, heat may reach the fat layer, so RF may be closer to the goal for people concerned about fullness caused by cheek fat.

Choose based on whether you are seeking skin firmness alone or also want to improve the support provided by the muscles.

EMFACE is not suitable for everyone; it is a treatment with clear indications and limitations. Depending on your physical condition, you may not be able to receive it. It is reassuring to determine which category applies to you before treatment.

EMFACE may be suitable for people who meet the following criteria:

Conversely, people whose main concern is the thickness of cheek fat or who want a major change from a single treatment may find it difficult to be satisfied with EMFACE alone.

People who meet the following criteria may be unable to receive EMFACE or may require a physician's assessment:

Conditions vary by clinic, so be sure to fully disclose your treatment history, medical conditions, and medications during your consultation.

Before treatment, confirm the following points regarding the number of sessions, how to spend your time after treatment, and combining EMFACE with other procedures.

Some people do notice changes. However, EMFACE works by repeatedly stimulating the muscles to change their condition, so if you stop after one treatment, the change will be small and will not last long. If you want to assess the effects, it is realistic to plan your budget and schedule on the assumption of one course of around four treatments. Consider the first treatment an opportunity to experience the sensation of the muscles moving and understand the treatment process.

You can apply makeup immediately after treatment. Policies vary: some clinics allow bathing from the same day, while others instruct patients to avoid bathing, saunas, and alcohol for 24 hours. If you experience pronounced redness, it is reassuring to avoid activities that excessively warm the body. Many clinics consider face-washing and showering acceptable from the same day. Since the skin may be prone to dryness after treatment, take care to moisturize.

Treatment cannot be performed on areas containing metal, such as gold threads. For dissolvable threads or hyaluronic acid, the decision varies depending on how long ago they were placed and the treatment area. Some clinics combine EMFACE with injectable treatments, and it may be possible depending on your condition. Tell your physician about your treatment history and ask them to determine whether you can receive EMFACE.

The expected duration is approximately six months to one year. Because muscle condition changes with age, those who want to maintain the effects should continue maintenance once every three months to one year after completing the course. Decide the maintenance interval with your physician based on your muscle condition and preferred results.

EMFACE is a treatment for sagging that works on the facial muscles and skin simultaneously, with little pain and downtime. It can be a useful option for sagging caused by weakening muscles, but it does not change the amount of cheek fat.

At LIVELY CLINIC, we select from devices that work on different layers, including ONDA Lift, Sofwave, Alltite, and Quantum RF, identify the layer causing sagging during your examination, and propose a suitable treatment. Appointments are available via the web, LINE, or telephone at our Hamamatsucho, Funabashi, and Osaka clinics.