Fifteen times a week on average, Robert Schwarcz, MD, a New York City–based cosmetic surgeon, injects patients with Botox. "I like the idea of providing a plumpness to a nonactive muscle and generating controlled muscular activity", says Schwarcz.
This same youthful fullness is what everyone who opens a jar of hyaluronic acid cream or books a filler session is attempting to retain or replicate. And it's not that the botulinum toxins—Botox, Dysport, and the recently FDA-approved Xeomin—are in direct opposition to that end. In fact, the toxins do not act directly on muscles—they bind to neurotransmitters, preventing them from signaling muscles to contract. Initial medical use for the toxins wasn't even related to wrinkles or anti-aging. In 1980, doctors began using it to quiet uncontrollable blinking and relax muscles that cause eyes to cross. The cosmetic neurotoxin revolution began in 1987, when two Vancouver-based doctors discovered the neurotoxin's smoothing effect on "the elevens," the frown lines between the eyebrows. Derms and nonderms alike promptly took it one better, using injections to create lift. When a neurotoxin is shot into a muscle that pulls downward, say, in the brow area, the antagonist muscle that pulls upward is left unopposed to dominate. Add to that carefully placed injections to relax the frontalis muscle, which creates the "worry lines," those horizontal ones across the forehead, and doctors could mimic the effect of a brow lift without picking up a scalpel.
If a muscle is immobilized, even temporarily, "it will use less energy and have a tendency to atrophy," says skin physiologist Peter Pugliese, MD, author of the textbook Physiology of the Skin, who notes that researchers soon figured out how to make this atrophy yield short-term aesthetic benefits. Dermatologist Fredric Brandt, MD, whose New York and Florida–based practice is the largest user of Botox in the world, explains that one can, like a sculptor, dramatically slim the jawline by injecting a large amount of a neurotoxin into the masseter, the primary "chewing muscle" that runs along the side of the face. "It is reversible," Brandt says. "But one treatment will last for a year."
However, atrophy can have a downside—which is where, for some doctors, electric facials come in. These doctors believe that, in the wrong hands over time, neurotoxins could cause the face to lose desired fullness, and so they are prescribing microcurrent as a noninvasive companion to neurotoxin injections to diminish any loss in muscle tone. In fact, dermatologist Nicholas Perricone, MD, steers his patients away from using neurotoxins at all, believing microcurrent, plus the right diet and topicals, to be the best antiwrinkle strategy. Electric facials, whether done at home or in a spa, he argues, help build "convexities" in the face. "Convexities are what make you youthful," he says. "That is critical. If you look at the cheekbones, the forehead, the temples, the jawline of someone young, they come out in an arc away from the face. They bulge out. Around the age of 40 to the midfifties, the convexities go flat. From 60 up, they can go concave. Electrostim keeps the muscles plump and active, preventing or correcting loss of the convexities."
The idea of using electric current to stimulate muscles sounds both high-tech and barbaric, but in truth it has been in practice for hundreds of years. For that we can thank Jean Jallabert, a professor in Geneva, Switzerland, for credibly reporting in 1748 that he alleviated paralysis in a locksmith's right arm by using a 90-minute series of electric shock sessions over the course of several months. In 1982, researcher Ngok Cheng, MD, at the Catholic University of Leuven, Belgium, led a study that provided hard evidence of microcurrent's role in cellular vitality by proving that microcurrent increased levels of ATP—the fuel a cell needs to function—in lab-rat skin cells by 500 percent. Orthopedic surgeon Robert Becker, MD, compiled multiple studies in his 1985 tome The Body Electric, citing the role of electricity in cell regeneration. For decades, microcurrent has been used in different frequencies and waveforms to treat everything from wounds to migraines to chronic pain. Professional athletes and anyone who has had physical therapy have often experienced an electrostim machine, as orthopedists routinely prescribe microcurrent to aid in the repair of ligaments and muscles.
On a muscular level, the microcurrent acts like a personal trainer to tone and shorten muscle fibers. On a dermal level, as Pugliese, the skin physiologist, notes, there is serious anti-aging action going on. Pugliese has spent more than five years analyzing microcurrent's effect on fibroblasts by biopsying skin before and in between microcurrent treatments, and has found a statistically significant increase not only in the production of collagen and elastin, the skin's main structural proteins, which degrade with age, but in that of glycosaminoglycans, or "GAGs," the viscous material in which the proteins are embedded. "When you see a nice plump cheek like a baby's and you pinch it and it feels very good and snappy," he says, "that's GAGs." And, according to Perricone, the long-term benefits are more than skin-deep: If you have a microstimulation machine, "you don't have to have perfect genes," Perricone says. "When I first started working with celebrities, I assumed they were genetically gifted and had perfect symmetry." But now he knows that symmetry can be made: "Not only can we use electrostim to increase our muscle mass, we can accentuate one side of the face by working it harder than the other to give a more symmetrical appearance.
The exact protocol for combining Botox and microcurrent has yet to be written, but most proponents agree to wait a few weeks post-injection before getting a facial. According to Charles Boyd, MD, a plastic surgeon with practices in Michigan and New York, "In the first 24 hours after an injection, you could potentially move the Botox from a muscle where you injected it into a muscle you did not intend," he says. "That doesn't mean it's going to move from your forehead to your neck, but maybe from your eyebrow to your upper eyelid." Simon's clients wait two weeks post-Botox for an electric facial, then return for monthly follow-ups (per skin's renewal cycle, which is 28 days). "Botox and electric facials are great companions. I could spend hours smoothing lines out and then my clients will walk out the door and make the expression that caused the wrinkle 1,000 times that night," Simon says. "Botox is very efficient at knocking out expression wrinkles. Electric current fixes everything else—it's the cherry on top."