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"  Fifteen times a week on average, Robert Schwarcz, MD, a New York City\u2013based cosmetic surgeon, injects patients with Botox. For certain individuals he also writes down a phone number on a piece of paper and tells them to make an appointment. It&amp;#039;s not for a dermatologist or a colorist with a flair for youthful-looking highlights. The number is for Angela Kulangi, a facialist at Total Skin, a day spa that specializes in electric facials that deliver, via small wet sponges, low levels of microcurrent\u20141/1,000,000 of an amp (a light bulb runs on less than one ampere)\u2014to stimulate the muscles of the face and neck. &amp;quot;If the patient has been using neurotoxins for more than three years, and if she has genetically thin skin and slim facial musculature, I&amp;#039;ll make a gentle suggestion for her to see Angela,&amp;quot; says Schwarcz. &amp;quot;I like the idea of providing a plumpness to a nonactive muscle and generating controlled muscular activity.&amp;quot; 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&amp;#039;s not that the botulinum toxins\u2014Botox, Dysport, and the recently FDA-approved Xeomin\u2014are in direct opposition to that end. In fact, the toxins do not act directly on muscles\u2014they bind to neurotransmitters, preventing them from signaling muscles to contract. Initial medical use for the toxins wasn&amp;#039;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&amp;#039;s smoothing effect on &amp;quot;the elevens,&amp;quot; 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 &amp;quot;worry lines,&amp;quot; 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, &amp;quot;it will use less energy and have a tendency to atrophy,&amp;quot; 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\u2013based 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 &amp;quot;chewing muscle&amp;quot; that runs along the side of the face. &amp;quot;It is reversible,&amp;quot; Brandt says. &amp;quot;But one treatment will last for a year.&amp;quot; However, atrophy can have a downside\u2014which 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 anti\u00ADwrinkle strategy. Electric facials, whether done at home or in a spa, he argues, help build &amp;quot;convexities&amp;quot; in the face. &amp;quot;Convexities are what make you youthful,&amp;quot; he says. &amp;quot;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.&amp;quot;          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&amp;#039;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&amp;#039;s role in cellular vitality by proving that microcurrent increased levels of ATP\u2014the fuel a cell needs to function\u2014in 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&amp;#039;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&amp;#039;s main structural proteins, which degrade with age, but in that of glycosaminoglycans, or &amp;quot;GAGs,&amp;quot; the viscous material in which the proteins are embedded. &amp;quot;When you see a nice plump cheek like a baby&amp;#039;s and you pinch it and it feels very good and snappy,&amp;quot; he says, &amp;quot;that&amp;#039;s GAGs.&amp;quot; And, according to Perricone, the long-term benefits are more than skin-deep: If you have a microstimulation machine, &amp;quot;you don&amp;#039;t have to have perfect genes,&amp;quot; Perricone says. &amp;quot;When I first started working with celebrities, I assumed they were genetically gifted and had perfect symmetry.&amp;quot; But now he knows that symmetry can be made: &amp;quot;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.&amp;quot; Electric facials are on the menu everywhere from Perricone&amp;#039;s New York flagship spa to Four Seasons hotels to Elizabeth Arden&amp;#039;s Red Door salons. Professional-grade microcurrent machines emit a positive and a negative current via two wands, probes, or sponges. When the probes are placed a few inches apart on the face, a circuit of current travels from one point to the other and &amp;quot;stimulates&amp;quot; the tissue in between, Perricone says. The current is subsensory, which means all one feels is the gliding of the rods and perhaps a slight tingle. Customers often fall asleep midfacial. The other option is to DIY with an at-home device. Suzanne Somers teamed up with engineer Rodger Mohme, who previously led the team at Apple to shrink a desktop computer down to laptop size, to create the FaceMaster, a vanity-table version of a large in-spa machine. The only handheld microcurrent device with FDA approval is the NuFACE, created by Carol Cole, a SoCal facialist who got tired of lugging her gigantic machine up into the Hollywood Hills. It emits the same level of current as a pro machine (you can get a 30-minute poolside NuFACE treatment at the Four Seasons Maui for $125), but the micro-amps deliver via two fixed metal probes.  ELLE editors tested both the FaceMaster and NuFACE in our offices and found they instantly increased circulation for that glowy, plump-but-not-puffy look that lasted for a few hours. But, in our untrained hands, the DIY could not provide microcurrents&amp;#039; more sophisticated, bespoke effects. With the right expertise, microcurrent can be used to dramatically, if temporarily, shape the face. It&amp;#039;s no wonder celebrities have become insatiable consumers of electric facials, especially during awards season. &amp;quot;The pop lasts for about five hours,&amp;quot; says facialist Melanie Simon, whose skin-care company, Circ-Cell, is partially backed by Lynn Harless, aka Justin Timberlake&amp;#039;s mom. Madonna and Kate Winslet are outspoken fans of Tracie Martyn&amp;#039;s trademarked Red Carpet Facial, a proprietary treatment that incorporates mild electrical current. Regular microcurrent sessions were rumored to be Princess Di&amp;#039;s beauty secret. And according to an industry source, J.Lo just spent $22,900 on her own professional-grade CACI Ultra (no word on whether she&amp;#039;s administering them herself). Depending on where the probes are placed, either above the origin or insertion point of a muscle, and how many seconds they&amp;#039;re held there, users can smooth a furrowed area by stretching the muscle or add lift by shortening the muscle. &amp;quot;If you lift from the cheekbones toward the hairline, it will make your eyes more almond shaped,&amp;quot; says makeup artist Kristin Hilton, who travels between New York and L.A. to work on clients including Uma Thurman and Milla Jovovich. &amp;quot;You can even create an arch in the eyebrows.&amp;quot; Hilton keeps NuFACE in her makeup kit so she can &amp;quot;sculpt and lift&amp;quot; before she applies a client&amp;#039;s makeup. &amp;quot;I&amp;#039;m a skeptical person,&amp;quot; Hilton says. &amp;quot;For me to like something like this is unusual. But I use it for five minutes on each side, pulling upward. Everything&amp;#039;s tighter. You look more awake. People know something&amp;#039;s different, but they don&amp;#039;t know what. Usually they say, `Did you get your hair cut?&amp;#039;&amp;quot;  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, &amp;quot;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,&amp;quot; he says. &amp;quot;That doesn&amp;#039;t mean it&amp;#039;s going to move from your forehead to your neck, but maybe from your eyebrow to your upper eyelid.&amp;quot; Simon&amp;#039;s clients wait two weeks post-Botox for an electric facial, then return for monthly follow-ups (per skin&amp;#039;s renewal cycle, which is 28 days). &amp;quot;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,&amp;quot; Simon says. &amp;quot;Botox is very efficient at knocking out expression wrinkles. Electric current fixes everything else\u00AD\u2014it&amp;#039;s the cherry on top.&amp;quot; "^^<http://www.w3.org/2001/XMLSchema#string>
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