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* Corresponding author, Address: Dept.of Physiotherapy, School of Rehabilitation, Shahid Beheshti
University of Medical Sceinces, Damavand St, Tehran, Iran
Email: k_khademi@sbmu.ac.ir Tel: +98 912 2197138
Saniee F1, Khademi Kalantari Kh*2, Yazdanpanah P3, Rezasoltani A2, Dabiri N3,
Ghafarian Shirazi HR3,4
Received: 06/08/2011 Revised: 12/22/2011 Accepted: 01/10/2012
1. Dept. of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, International
Branch, Tehran, Iran
2. Dept. of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3. Dept, of Dermatology, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
4. Dept. of Epidemiology and Statistics, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
Journal of Jahrom University of Medical Sciences, Volume 10, Number 2, Summer 2012
Abstract
Introduction:
Beauty is an important concern of today’s people and the facial wrinkles are among these cosmetic
problems. Recently, non-invasive treatments such as using microcurrents in treatment of wrinkles and
skin renewal have been recommended. This study aimed to determine the effect of micro-current's on the
improvement of facial wrinkles.
Materials and Methods:
In this before and after clinical trial, thirty subjects were recruited with three inclusion criteria: having
less than 45 years of age, significant facial wrinkles and no other skin problems.Facial wrinkles were
treated with micro-currents for twenty minutes for thirty consecutive sessions. Photos were taken from
patients’ face at the beginning, end and one month after treatment. Three independent and blinded
reviewers scored the wrinkles according to the photos.
Results:
The most improvement was seen in the forehead area with about 18.37% in the first step (before and after
treatment) and 21.18% in the second step (after treatment and one month later) and the least improvement
was observed at the nose and mouth regions (7.61% in first step and 5.85% in second step). The patients’
satisfaction about treatment was reported to be over 70%.
Conclusion:
Microcurrents could improve the facial wrinkles and this improvement is more significant at the frontal
compared with the nose and mouth areas. Besides, according to the scores given to the photos,
immediately after treatment and one month later, not only the effect of treatment was acceptable but also
the improvement sustained for at least a month post-treatment.
Keywords: Beauty, Face, Wrinkling, Skin
Introduction:
Beauty is of great concern for contemporary
human being and facial wrinkles are
common cosmetic complaints associated
with ageing, stress, inappropriate nutrition,
smoking, sun exposure, fat deposition and
The effect of microcurrents on facial wrinkles
J Jahrom Univ Med Sci 2012; 10(2):8-15
8
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The effect of microcurrents on facial wrinkles Saniee, et al
Journal of Jahrom University of Medical Sciences, Volume 10, Number 2, Summer 2012
9
inflammatory lesions. Ageing is associated
with breakdown of the collagen and elastin
components and presentation of apparent
ageing marks in the skin. This process is
further aggravated by exposure to UV light,
gravity, air pollution, smoking, sedentary
life, and inappropriate nutrition. With
chronicity the epidermis is thinned, and the
connective tissue is weakened, the facial
muscles become loose, and the epidermis is
hung. Meanwhile, the normal wrinkling
transforms into abnormal fat deposition in
the cheek, chin, and neck. Constriction of
the small vessels and reduced circulation
result in reduced freshness and darkening of
the skin (1,2).
There are many therapeutic approaches for
rejuvenation or resolving facial wrinkles.
These are classified as invasive, semi-
invasive, and non-invasive.
Invasive methods such as skin pulling or
other cosmetic surgeries require
hospitalization and in addition to costs and
convalescent period may be complicated. Of
the semi-invasive approaches, the laser
therapy is used for resurfacing which not
only does need specialist postop care but
also requires relatively prolonged
convalescent period, complications, and
associated expenditures (3). Botulinium
(BOTOX) injection is also used for treating
wrinkles. However, its inexperienced
utilization may result in severe effects and
should be administered by a well-trained
specialist staff (4).
Non-invasive methods were always
appreciated because of fewer complications.
For instance, preservative, strengthening, or
resolving creams containing antioxidants,
vitamin A, hydroxyl acids, alpha lipoic acid,
coenzyme Q-10, copper peptides, growth
factors, soya isoflavins, tea concentrates,
vitamin C, vitamin E, and collagen are
noticeable (5).
Electrical microcurrent is a new non-
invasive method. The current is about
1:1,000,000 A. They have been shown to be
effective in resistant diabetic ulcer and
fractures. This effect is a result of activated
biologic system, increased ATP, increased
cell proliferation ,increased DNA
transcription and protein synthesis,
proliferation and growth of the stratum
corneum, increased blood flow and
transportation of the O2, antioxidants, ions,
and nutrients in the epidermis,
subcutaneous, lipid layer, and blood and
lymph capillaries of the skin. This process
results in energy release in the
corresponding tissues and inhibits further
reduction in elasticity and protein
degradation as a consequence of inhibition
of free radical formation and enhancing
production of collagen type I, II, III (6).
Collagen is the most abundant animal
protein (40%) formed from a sheath and a
band of fascia. It supports neural tissue,
brain, and nervous system and offers a
suitable and powerful elastic resistance (7).
Collagen also is involved in wound repair in
a complex process (8-10). In the maturation
and renewal phase, the collagen is deposited
along the stretch lines and the redundant
cells are removed via phagocytosis in order
to leave a healed wound (11).
Electrical microcurrents are free from
adverse effects and are used for pain relief,
and resistant ulcers or fractures in current
clinical practice. The aim of this study was
to examine theeffects of electrical
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The effect of microcurrents on facial wrinkles Saniee, et al
Journal of Jahrom University of Medical Sciences, Volume 10, Number 2, Summer 2012
10
microcurrents on the treatment of the facial
wrinkles.
Materials and Methods:
In this before-after type clinical trial,
volunteer women included after disclosure
of the study and acquisition of informed
consent. Sampling was based on availability
of cases and the sample size was calculated
to be 15 according to similar studies and
limitations of the current study but 30
participants were included overwhelm the
possible fall of during treatment course (12-
14).
All individuals underwent photography at
the beginning and at the end of the treatment
and one month later from right eye and left
eye profile views, frontal view, and mouth,
nose, and eyes opposite view. Photos were
taken by a professional photographer by
means of a canon digital camera, 5D, 24105
macro lens, under same light and
environmental condition.
Just before the treatment session, the patient
was asked to wash her face with soap and
clean water and lying supine on a bed. Each
side of the face was treated for 10 minutes.
The treatment points were frontal area,
around eyes, perioral area, cheeks, and chin.
The positive electrode was fixed while the
negative electrode was sliding toward the
positive electrode along the treatment area.
For each area, this procedure was repeated
five times. The electrodes were two positive
and negative bars and covered at their tips
by a soft wet textile in order to become
conductive.
Treatment course consisted of 30 successive
sessions except for holidays, Thursdays, and
Fridays.
The device was A6, China, CE certificate
from England and Europe currently in
market in the northern European countries
and United States of America. The currents
used in this study were rectangular micro-
pulses with the frequency of 70-80 Hz and
0-640 mcA (15-17).
At the end of the treatment course all
patients filled up a form assessing
satisfaction with the results of treatment,
therapeutic center, staff, and environment.
This questionnaire was designed based on
standard forms and its reliability and validity
were calculated to be acceptable (18). The
items were based on 5-option Likert’s scale
and scores 4 or more were regarded as
satisfaction. After the clinical conduct, the
photographs were coded and sent for
assessment by two dermatologists and a
plastic surgery fellow and scored from 0 to
10 based on the size, number, and depth
of wrinkles. In other words, the scores were
based on the effect of wrinkles on the
appearance in an individual manner. The
judges were blind as to the timing of
photographs or the patient’s identification.
This kind of assessment was used in most of
similar studies because of its reliability and
validity (19).
The inclusion criteria were age less than 45
years, suffering wrinkles, and the absence of
dermatologic disease acknowledged by a
dermatologist examination. In case of any
complication, the patient was referred to
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The effect of microcurrents on facial wrinkles Saniee, et al
Journal of Jahrom University of Medical Sciences, Volume 10, Number 2, Summer 2012
11
dermatologist and excluded from the study
accordingly. Weight gain in excess of 500
gams was considered an exclusion remark.
Patients were not allowed to use anti-
wrinkle treatment of any kind and were free
to leave the study ad libitum.
Data description was performed via central
and peripheral parameters and data analysis
was done using student’s t-test.
We complied with current codes of clinical
research by full description of the study
goals for each participant and acquired
informed consent. On the other hand,
microcurrents are common practice in
physiotherapy and are universally
considered safe. All the photographs were
coded and were not identifiable for referees.
All the information gathered was kept
confidential and the participants were
charged nothing for the course of treatment.
Results:
The aim of this before-after study was to
evaluate the effects of electrical
microcurrents on facial wrinkles conducted
over 30 volunteer women resident in Yasouj
city and suburbs. The duration of the study
was 7 months and it started from November
2010. Only 25 individuals completed the 30
planned sessions and only 19 returned for
follow up visit one month later. The age was
varied from 25 to 45 years with the mean ±
SD of 37.5 ± 4.6. The assessment of the
facial wrinkles in frontal area, right and left
eye profile, both eyes from opposite view,
nose, mouth, and total face implied
effectiveness of treatment. Table 1 and
figure 1 represent more details.
The rate of improvement in facial wrinkles
at the end of treatment was 18 percent for
frontal area, 15.6 percent for right eye, 13.5
percent for left eye, 8 percent for nose and
perioral area, 11 percent for both eyes from
opposite view, and 14 percent for total face
(P<0.05). The improvement at the end of the
first month after treatment ranged from 4
percent in eyes from opposite view to 21.2
percent for frontal area. The improvements
were significant except for eyes from
opposite view and mouth and nose area
(P<0.04).
Also of interest is that 70 percent of patients
were satisfied with their treatment results
(see table 2 for details). Although the
treatment was satisfactory for patients, they
were bothered by the prolongation of the
treatment course and also by the length of
each session. In decreasing order the most
satisfactory results were reported about the
softening and smoothness of the skin (89%),
skin clearance (79%), and reduction of the
depth of the wrinkles (63%). The least
satisfaction belonged to the sense of
rejuvenation (41%).
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Journal of Jahrom University of Medical Sciences, Volume 10, Number 2, Summer 2012
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Table 1. Comparison between scores and estimates of improvement of wrinkles in participants; stage one (before
treatment and after treatment) and stage two (after treatment and one month later)
area
Stage
Before
Mean ± SD
After
Mean ± SD
Number
Stage
improvement
Total
improvement
Frontal
Stage 1
3.92 ± 1.80
3.20 ± 1.55
25
18.37%*
35.46%**
Stage 2
3.21 ± 1.59
2.53 ± 1.68
19
21.18%*
Right eye
profile
Stage 1
3.76 ± 1.56
3.17 ± 1.49
25
15.69%*
25.8%**
Stage 2
3.11 ± 1.58
2.79 ± 1.32
19
10.29%*
Left eye
profile
Stage 1
3.56 ± 1.49
3.08 ± 1.54
25
13.48%*
19.94%**
Stage 2
3.07 ± 1.67
2.81 ± 1.46
19
8.46%*
Mouth
and nose
Stage 1
3.68 ± 1.41
3.40 ± 1.38
25
7.61%*
12.50%**
Stage 2
3.42 ± 1.43
3.22 ± 1.40
19
5.85% NS
Eyes from
opposite
view
Stage 1
3.96 ± 1.77
3.52 ± 1.69
25
11.11%*
14.89%**
Stage 2
3.51 ± 1.70
3.37 ± 1.64
19
3.98% NS
Face in
general
Stage 1
3.78 ± 1.77
3.27 ± 1.69
25
13.73%*
22.22%**
Stage 2
3.25 ± 1.70
2.94 ± 1.64
19
10.61%*
*Significant (P<0.05), **Significant (P<0.001), NS: not significant
2. after treatment 1. Before treatment
3. one month later
Figure 1. wrinkles in one patient: 1. Before treatment. 2. After treatment. 3. One month later.
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The effect of microcurrents on facial wrinkles Saniee, et al
Journal of Jahrom University of Medical Sciences, Volume 10, Number 2, Summer 2012
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Table 2. Reported views of the participants regarding the effects of the treatment.
Mean ± SD
Other—less than 4
Satisfied—4 or more
1
Are you satisfied with depth of wrinkles?
3.95 ± 1.05
37%
63%
2
Are you satisfied with length of wrinkles?
3.60 ± 1.04
50%
50%
3
Are you satisfied with distance of
wrinkles?
3.85 ± 0.74
44%
56%
4
Are you satisfied with clearance of
pigmented lesions?
3.90 ± 0.91
37%
63%
5
Are you satisfied with skin softness in
comparison to pre- treatment?
3.45 ± 1.36
52%
48%
6
Are you satisfied with lightening of your
face?
3.95 ± 0.83
31%
69%
7
Are you satisfied with the resolution of the
acne or acne scars?
3.35 ± 0.87
57%
43%
8
Are you satisfied with the scar clearance?
3.35 ± 0.87
60%
40%
9
Are you satisfied with closure of the
openings in your face?
3.60 ± 0.82
46%
54%
10
Are you satisfied with softness and
smoothness of your skin?
4.30 ± 0.73
11%
89%
11
Are you satisfied with clearance of your
face?
4.20 ± 0.76
21%
79%
12
How younger do you feel you are?
3.35 ± 0.74
59%
41%
Discussion:
In this study we evaluated the effects of
electrical microcurrents after 30 sessions of
treatment on improvement of wrinkles in
frontal area, left and right eye profile, both
eyes from opposite view, and nose and
mouth area and the results demonstrate that
the effect was significant. The amount of
improvement was more prominent in the
frontal area and less noticeable in mouth and
nose area which may be attributed to the
better handling of the device over the frontal
area and more difficult application of the
device in the nasolabial area. Furthermore,
the structural characteristics of the frontal
skin provide better improvement.
In the frontal area, the course of
improvement was continued after one
month. Also, in the left and right eye profile
and eyes from opposite view the
effectiveness of treatment was significant at
both stages; however, the second stage
effectiveness was less prominent. In total,
the treatment was effective in both stages.
Comparing the scores immediately after
treatment and one month later demonstrates
that not only the efficacy of treatment does
persist, but also a process of skin
rejuvenation and improvement has begun
and continued already. Some of our findings
are similar to that of Mueller, Lin,
Poltawski, and Ghayebi Mehmandost (6, 14,
16, 20).
Conclusion:
It appears that microcurrents cause clearance
and lightening of the skin by inducing cell
proliferation and renewal and formation of a
new layer onto the skin. This is why the
participants were satisfied with softness,
smoothness, and clearance of their skin
(70%).
In some with deeper wrinkles it seems that
the result would be even better with more
therapeutic sessions. The treatment was
satisfactory for patients with respect to skin
softness and smoothness, skin clearance, and
reduction of the depth of wrinkles. However,
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Journal of Jahrom University of Medical Sciences, Volume 10, Number 2, Summer 2012
14
participants were not happy with the length
of each session and the prolongation of the
treatment course.
Suggestion: Considering the limitations in
this study and lack of similar studies at
national level, we propose to conduct more
studies in this field.
Limitaions:
1. Regarding cultural conditions of the state,
photography by professional photographers
was not possible. Thus, the pictures were
taken by the researcher after a course of
education. However, the quality of pictures
was not desirable.
2. Prolonged treatment course and each
session, which could take 40 minutes,
caused delay in progression of the study.
Acknowledgement: This study is derived
from MSc thesis and performed by the
cooperation and support of Shahid Beheshti
University of Medical Sciences and Yasouj
University of Medical Sciences. We
sincerely thank the members of the clinical
ethics council, members of the research
council, advisory and consultant professors,
managers and staff of the colleague
universities. We are especially grateful to
Doctor Stewart Titus for his generous
cooperation in collecting literature.
Moreover, we appreciate the participants
who were patiently endured the study
requirements.
References:
1. Oikarinen A. Connective tissue and aging.
Int J Cosmet Sci 2004; 26(2): 107.
2. Rejahn MS. Color atlas of practical histology and tissue.
Tehran: Soroush Publ; 1991: 63, 69-192. (Persian)
3. Berson D. Lupo M. Cosmeceuticals: practical
applications. Dermatol Clin 2009; 27(4): 401-16.
4. Kukreja R, Singh BR. Botulinum neurotoxins –
structure and mechanism of action. In: Proft T (ed).
Microbial toxin, current research and future trends,
illustrated. 1st ed. Nortfolk, UK: Caister Acad Press; 2009:
15-40.
5. Huang CK, Miller TA. The truth about over-the-counter
topical anti-aging products: a comprehensive review.
Aesthet Surg J 2009; 27(4): 402-12.
6. Mueller J, Kapeller B, Losert U, et al. Electrical
microcurrent application modifies the inflammatory
response in the failing myocardium. Clin
Immunol 2006; 119(1): S128.
7. Grinnell F. Fibroblast mechanics in three-dimensional
collagen matrices. J Bodyw Mov Ther 2009; 12(3): 191-3.
8. Nguyen DT, Orgill DP, Murphy GF. The
pathophysiologic basis for wound healing and cutaneous
regeneration. Biomaterials for treating skin loss. Boca
Raton, Florida: CRC Press; 2009; 25-57.
9. Stadelmann WK, Digenis AG, Tobin GR. Physiology
and healing dynamics of chronic cutaneous wounds. Am J
Surg 1998; 176(2): 26-38S.
10. Midwood KS, Williams LV, Schwarzbauer JE. Tissue
repair and the dynamics of the extracellular matrix. Int J
Biochem Cell Biol 2004; 36(6): 1031-7.
11. Chang HY, Sneddon JB, Alizadeh AA, et al. Gene
expression signature of fibroblast serum response predicts
human cancer progression: similarities between tumors and
wounds. PLoS Biol 2004; 2(2): E7.
12. Most BA. Prospective examination of the efficacy of 2
noninvasive devices for treatment of the aging face. Arch
Facial Plast Surg 2006; 8(1): 66-8.
13. Mueller J, Kapeller B, Losert U, et al. Electrical
microcurrent application modifies the inflammatory
response in the failing myocardium. Clin Immunol 2006;
119(S1): 128.
Downloaded from jmj.jums.ac.ir at 12:06 +0430 on Saturday April 7th 2018 [ DOI: 10.29252/jmj.10.2.9 ]
The effect of microcurrents on facial wrinkles Saniee, et al
Journal of Jahrom University of Medical Sciences, Volume 10, Number 2, Summer 2012
15
14. Lin YL, Moolenaar H, van Weeren PR, et al. Effect of
microcurrent electrical tissue stimulation on equine
tenocytes in culture. Am J Vet Res 2006;
67(2): 271-6.
15. Lenox AL. Shafer J. Pilot study of impedance-
controlled microcurrent therapy for managing radiation
induced fibrosis in head-and- neck cancer patient. Int J of
Radiat Oncol Biol Phys 2002; 54(1): 23-34.
16. Poltawski L, Watson T. Bioelectricity and microcurrent
therapy for tissue healing – a narrative review. Phys Ther
Rev 2009; 14(2): 104-14.
17. Lee BY, AL-Waili N, Stubbs D, et al. Ultra-low
microcurrent in the management of diabetes mellitus,
hypertension and chronic wounds: report of twelve cases
and discussion of mechanism of action. Int J Med Sci 2010;
7(1): 29-35.
18. Ghaibi Mehmandost F,Torkaman G, Firozabadi M.
Effects of cathodic and anodic direct current
stimulation on the withdrawal process of
wound healing in guinea pigs. Daneshvar
2005; 12: 37-44. (Persian)
19. Ricanek A, Patterson K. A review of the
literature on the aging adult skull and face:
implications for forensic science research and
applications. Forensic Sci Int 2007; 172(1): 1-9.
20. Talebi G, Torkaman G, Firoozabadi M. Effect of anodal
and cathodal microamperage direct current electrical
stimulation on injury potential and wound size in guinea
pigs. J Rehab Res Develop 2008; 45(1): 153-60. (Persian)
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