Tokyo Dermatology / Plastic Surgery Ginza Hospital
Japan Society of Plastic and Reconstructive Surgery Specialist Japanese Society of Aesthetic Surgeons Specialist Chairman of the Japan Anti-Aging Surgery Society Chairman of the Medical Art Make Society Director of Kanto Beauty Medical Association Director of Japan Medical Association Director of International Cosmetology Study Group Part-time Lecturer, Plastic Surgery, Tokai University
EVOKE is a machine that warms the skin with the heat generated by high frequencies and causes a tightening action to improve the sagging around the cheeks and chin .
EVOKE is a "non-cutting face lift technique" that does not require an incision in the skin , and since it does not burden the body, there is almost no downtime, and the machine can automatically control the temperature of the heat generated by high frequencies. , You can expect a higher lift-up effect by receiving multiple treatments .
Therefore, when considering treatment, it is important to know in advance the mechanism by which EVOKE causes a tightening effect, as well as an indication of the frequency and frequency of effective treatment . In addition, understanding the risks and precautions of the procedure and the differences from other procedures will help you to select a procedure that you are comfortable with.
Table of contents
By generating "high frequency", which is a type of electromagnetic wave, and applying heat to the skin, it contracts skin proteins such as collagen, which brings about a tightening action on the face line such as the cheeks and under the chin, and improves sagging. The leading machine is EVOKE .
EVOKE is a high-frequency treatment machine developed by Israeli medical device manufacturer InMode, and can be expected to improve the sagging of the cheeks and face line , which is mainly caused by aging . In addition, because it has been approved by the US FDA (US Food and Drug Administration), which is the Ministry of Health, Labor and Welfare of Japan, it can be said that the machine has been recognized as safe and effective by public institutions.
The high frequency of energy used in EVOKE is also called "RF", which is an acronym for "radio wave" or Radio Frequency (radio frequency) because it is also the frequency band of radio. Machines that generate high frequencies, such as EVOKE, in the field of cosmetology are sometimes collectively referred to as high-frequency machines and RF machines.
Human skin has a layered structure of epidermis and dermis from the outside. About 70% of the dermis layer deeper than the epidermis is collagen, which is a fibrous protein, and elastin, an elastic protein, bundles collagen, and hyaluronic acid, which is a jelly-like substance, absorbs water between them. It fills while holding and supports the firmness and elasticity of the skin.
When collagen, which occupies most of the dermis layer, deteriorates and decreases mainly due to ultraviolet rays, aging, stress, hormonal imbalance, etc., the thickness of the dermis becomes thin, and the skin loses its elasticity and elasticity , causing sagging. In addition to causing it, fine wrinkles may become noticeable.
There are cases where skin sagging occurs in addition to the decrease in collagen, and other major causes include sagging of subcutaneous fat on the cheeks and around the cheeks, and loosening of tissues such as muscles and ligaments under the skin of the face. Can be mentioned. In order to improve the slack, it is necessary to receive treatment suitable for each cause.
The targets that can be expected to be improved by EVOKE, a machine that uses high frequencies, are mainly skin sagging caused by a decrease in collagen due to external stimuli such as aging and ultraviolet rays .
"Frequency" in electromagnetic waves such as high frequencies means that waves (vibrations) with the same width circulate in a certain cycle, and when the electromagnetic waves are represented by waveforms, how many waves per second Depending on whether it appears, the frequency is indicated as "○ Hz (hertz)".
For example, the frequency of electromagnetic waves in which waveform waves appear 2 million times per second is 2 MHz (2 MHz), and the high frequencies used in high-frequency machines for cosmetology are generally electromagnetic waves with frequencies around 3 MHz to 300 MHz. I am.
High frequencies are the energy of electromagnetic waves that have the property of reaching deep into the skin, and when they are radiated to the skin, they transmit minute vibrations that cause the molecules in the body to rub against each other and generate heat . Since the heat generated by high frequencies is generated deep inside the skin, not on the surface, it can heat collagen, which is a protein in the dermis that supports the firmness and elasticity of the skin.
For example, proteins have the property of deteriorating and shrinking when heated by the heat generated by high frequencies , just as meat shrinks when heated during cooking. Therefore, by applying EVOKE to areas where sagging is a concern, such as around the cheeks and chin, you can expect a tightening effect in which collagen in the dermis is tightened by the heat generated at high frequencies.
By tightening collagen, which has the role of maintaining the firmness and elasticity of the skin, it is possible to improve the sagging of the cheeks, chin, and face line that become noticeable with age .
In addition, there are fibroblasts (senigasaibo) in the dermis layer that have the function of producing collagen. By stimulating and activating fibroblasts with the high-frequency heat generated by EVOKE treatment, it is possible to promote the growth of collagen, so it is possible to aim for a skin quality with a firm and youthful impression. Will be done.
EVOKE is performed by attaching a dedicated applicator that generates high frequencies, which is connected to the machine body with a cable. The applicator has different sets of positive and negative electrodes, and it is an electrode that sends high frequency and an electrode that collects it (counter electrode), and these electrodes generate heat on the skin by passing high frequency to the treatment site. is.
EVOKE's applicator, which generates high frequencies that give heat to the skin, is a bipolar type with multiple electrodes on each side, "1 set of 3 electrodes x 4 locations", and works by passing high frequency energy to the shallow layer of the skin. It is possible to bring about a thermal effect.
In addition, when performing EVOKE treatment, high frequencies are generated at all three electrode sets x 4 locations on each side, and the skin is rotated in order so that the lift-up effect is uniform. I will raise the temperature. However, if the original face size is small, the treatment may be performed with 3 high frequencies on each side.
By applying heat to the skin for about 30 minutes with high frequencies generated from multiple electrodes to cause collagen contraction, lift-up due to tightening action can be expected immediately after the treatment . In addition, you will be able to feel the effect more by receiving multiple treatments.
EVOKE, which automatically controls the skin temperature by the machine, is called "ACE technology", which is an acronym for Acquire, Control, and Extend in order to realize safe treatment with high frequency. It has a function.
EVOKE's applicator, which touches the skin at the treatment site, is equipped with something like a temperature sensor called an RF thermistor that automatically reads the temperature of the skin surface 1000 times per second . The skin temperature information measured by the applicator's RF thermistor is always displayed on the machine's display (screen) and is also notified by sound.
Therefore, it is possible to measure the temperature change during the treatment in real time, such as which part is heated at what temperature, so there is almost no risk of burns.
Since high frequency has the effect of generating heat by rubbing molecules in the body, in general high frequency machine treatment, if strong high frequency energy is continuously applied for a long time, the skin temperature rises excessively and the treatment site is burned. There was a risk such as.
On the other hand, EVOKE can set the "cutoff temperature" that automatically controls the temperature of the skin surface so that it does not exceed the set temperature within the range of 35 ° C to 43 ° C due to the heat generated by high frequencies . The machine automatically adjusts the high-frequency energy so that the skin temperature does not rise above the set temperature, so it is possible to prevent excessive temperature rise during the procedure .
There is clinical data that it is effective to keep the temperature of the skin surface at 41 ° C to 43 ° C in order to obtain the tightening effect by high frequency treatment, and EVOKE keeps the temperature of the skin surface by high frequency from 41 ° C based on the clinical data. It can be maintained at 43 ° C.
Since the high frequencies reach deep into the skin, the heat generated by the procedure acts not only on the surface of the skin but also on the dermis, which is deeper than the epidermis. When the temperature of the skin surface is maintained at 41 ° C to 43 ° C by EVOKE treatment, the temperature inside the skin such as the dermis is maintained at around 55 ° C to 60 ° C, which is the temperature suitable for collagen contraction (tightening). I will hang down .
EVOKE employs a technology in which the machine automatically applies high frequency waves for a certain period of time to generate heat, and the machine automatically manages the skin temperature, so the doctor changes the direction of the applicator and adjusts the temperature setting during the treatment. It is a hands-free design that basically does not require operations such as .
When receiving the treatment, it is performed with one of the two types of dedicated applicators attached for each desired part such as the cheeks and under the chin as follows.
EVOKE cheek: cheek, face line
EVOKE chin: under the chin
EVOKE cheek has a structure that can cover both cheeks like headphones , and EVOKE chin has a structure that can cover both cheeks from below in order to more effectively deliver high frequency energy and cause heat action according to each treatment site. It has a structure that fits to support it .
Both have the same principle of generating high frequencies by the electrodes provided in the applicator to bring heat to the skin, but for example, EVOKE cheek if you want to improve cheek sagging, EVOKE chin if you want to make double chin less noticeable. Select according to each purpose.
EVOKE has an emergency stop button that the patient can press during the procedure. By pressing the emergency stop button during the procedure, it is possible to immediately stop the generation of high frequency energy by the machine .
During the EVOKE procedure, the cheeks and chin feel warm, and no anesthesia is required. However, it can be said that the machine is designed with safety in mind because it has a function to stop the machine by itself if it feels hotter than expected or if something goes wrong.
EVOKE can be expected to tighten and lift up the cheeks and chin area immediately after receiving the treatment due to the tightening action that causes collagen contraction due to high frequency heat. There is a tendency to feel the effect even with one treatment, but it is recommended to receive multiple treatments at regular intervals in order to improve the effect.
Although there are individual differences depending on the degree of sagging of the skin, the recommended frequency of EVOKE treatment to obtain a sufficient effect is once a week, and the total number of treatments is 6 . In addition, the treatment takes about 30 minutes, there is almost no downtime, and makeup is possible after the treatment, so it can be said that it is a high-frequency treatment that allows you to receive the treatment in your spare time and aim for lift-up.
It is said that EVOKE treatment causes almost no pain, and basically no anesthesia is used . When performing the treatment, the applicator is attached with the gel to protect the skin applied to the cheeks and around the chin, and high frequency is applied to give heat, but during the treatment it is only to feel warmth. In the meantime, you can spend time reading or looking at your smartphone.
If you feel strong pain during the procedure, press the emergency stop button or do not stand it and consult with the practitioner. In addition, EVOKE is a treatment with a high-frequency machine that does not involve a procedure that puts a burden on the body such as incision of the skin, and since there is no scab after the procedure and there is almost no downtime, it is possible to apply makeup immediately after the procedure. It is possible .
Since EVOKE is a treatment in which heat from high frequency is applied for 30 minutes, slight redness tends to appear on the cheeks, chin area, and other areas exposed to high frequency after the treatment, but even if redness occurs, it usually takes several hours to the day. Will be less noticeable .
In addition, a slight tingling sensation may appear immediately after receiving the treatment, but it usually tends to settle down within a few hours. No serious risks or side effects have been reported from EVOKE treatment, but if you feel any other abnormalities, please consult a medical institution.
|・ Aim for tightening around the cheeks and chin ・ Expected to lift up the face ・ Almost no pain during the procedure ・ No surgical procedure and almost no downtime ・ From the day of the procedure It is possible to make up||・ Multiple treatments may be required to obtain a higher effect ・ Free medical treatment not covered by insurance ・ Other treatments may be indicated depending on the cause of skin sagging|
In addition to high-frequency machines such as EVOKE, "face lift surgery", which is a surgical treatment, and special threads with catches are also available as cosmetological treatments that can improve the sagging of the face. There is a "thread lift" that obtains a lift-up effect by inserting the skin under the skin.
Each procedure has a different mechanism of lift-up and the tissue of the skin that acts on it, so you need to see a doctor at a medical institution to determine which procedure is right for you.
|Treatment||With or without incision||Outline of treatment|
|Face lift||Yes||Pull up the skin by performing treatments such as peeling, partial excision, and suturing of tissues such as skin and fascia that cause sagging.|
|Thread lift (thread lift)||Nothing||Insert a special thread (thread) with a hook under the skin and pull up the subcutaneous tissue|
|HIFU machine||Nothing||The heat generated by the concentration of ultrasonic waves causes the SMAS of the fascia, which is the foundation of the skin, to contract and cause a lift-up effect.|
Facelift is an operation that cuts the skin from the ear to the inconspicuous area around the temple and pulls up the skin to improve the slack . Sagging by surgically returning the tissues that cause sagging of the face, such as age-related drooping subcutaneous fat, loosened skin and subcutaneous fascia (SMAS), and ligaments. Can be expected to improve.
There are various surgical methods, and depending on the degree and cause of the sagging, each person removes the ligaments and tissues such as SMAS in the area where the sagging is excessive, and removes excess subcutaneous fat. I will . The range of indication varies slightly depending on the medical institution, but generally it is from the entire face excluding the forehead, eyelids, nose and mouth to the upper part of the neck including the face line.
Unlike EVOKE, it involves a skin incision, so downtime such as swelling and swelling after surgery is long-term, and it tends to take more than 3 months for scars to become inconspicuous. In addition, although hospitalization may be required for several days after surgery, the lift-up effect is high because it physically lifts the tissue causing sagging, and the effect can be expected to last for several years or more .
Thread lift (thread lift) is a lift-up technique that lifts the slack on the face and neck by inserting a special thread called "thread" under the skin . Use a needle to insert multiple threads into areas of concern such as the cheeks and neck, and hook the protrusions on the threads to the subcutaneous tissue to lift them up, leading to a sharp face line.
In addition, it can be expected to improve wrinkles such as fluffy cheeks that have lost volume due to a decrease in collagen and elastin due to aging, and nasolabial folds caused by sagging. Thread lift is a procedure that does not involve an incision in the skin, but the material and structure of the thread varies depending on the product, and there are various types such as those that dissolve after being inserted subcutaneously and those that do not.
|Main absorbent (melting type) threads||Thread features|
|Silhouette soft||Three-dimensional cones called bio-cones attached to the thread catch the subcutaneous tissue 360 degrees around the thread.|
|Shopping thread||Nearly 50 to 100 short threads called short threads are inserted like beauty acupuncture, and the tension of the threads supports the skin from the inside.|
|Happy lift||Subcutaneous tissue is hooked by fine hair-like thorns that are symmetrical toward the center of the thread.|
|Mint lift||It has a structure with thorns attached to the thread, and is said to be stronger than conventional notch type thorns.|
In the case of the melting type thread used in many medical institutions these days, the duration of the effect varies depending on the product, but it is about 8 to 18 months as a guide . After the procedure, slight swelling and discomfort when opening the mouth may occur for several days to a month, and EVOKE tends to have shorter downtime .
HIFU is an abbreviation for the English word "High lntensity Focused Ultrasound," which means high-intensity focused ultrasound. HIFU is a single point of high-frequency ultrasound that we cannot hear. It refers to the method of collecting and irradiating . Medical machines that can irradiate HIFU are generally called "HIFU machines".
The principle of HIFU is to collect heat and raise the temperature by concentrating ultrasonic waves on a certain part of the body, just as black paper burns when sunlight is concentrated on one point with a magnifying glass. Since proteins have the property of contracting due to heat, they can be expected to have a tightening effect by applying heat with HIFU.
The major difference from high frequency is that HIFU can exert a thermal effect on the thin membranous fascia called SMAS, which is a type of protein in the deeper layers of the skin, which has a three-layer structure of epidermis, dermis, and subcutaneous tissue . SMAS acts as a foundation to support the skin, and when it becomes loose due to aging, the strength to support the skin weakens and it may cause sagging.
By tightening the looseness that occurs in SMAS, which is the foundation of the skin, with a thermal stimulus, it is said that a lift-up effect can be expected from under the skin . Therefore, if the cause of sagging is loosening of SMAS, HIFU sagging treatment may be an option instead of treatment with a machine using high frequency such as EVOKE.
In addition, by replacing the tip of the handpiece where HIFU is irradiated during the procedure , heat energy is delivered to skin layers with different depths such as the dermis and subcutaneous tissue (mainly fat) in addition to SMAS. It is possible . For example, by exerting a heat effect on the subcutaneous tissue, the effect of partial thinning can be expected by destroying fat cells with heat and promoting metabolism.
The downtime after treatment varies depending on the machine, but it tends to be slightly longer than that of high-frequency machines such as EVOKE, and swelling and redness of the treatment site may occur for about a week . There are mainly the following types of machines that can treat sagging with HIFU.
Also, please note that minors need to obtain the consent of their parent or guardian before undergoing the treatment, and if they do not have the consent, they will not be able to receive the treatment.
After undergoing EVOKE treatment, the skin tends to dry due to heat stimulation by high frequency, so it is recommended to moisturize with lotion or milky lotion on a daily basis. Also, since it is easily stimulated by UV rays, please take measures against UV rays by wearing a hat or using sunscreen when you go out for 2 to 3 days.
Makeup and face washing are possible from the day of the treatment, but please refrain from stimulating the treatment area such as rubbing or scratching for several days. In order to prevent swelling and redness after the treatment due to the promotion of blood circulation, it is necessary to refrain from bathing or drinking alcohol on the day of the treatment, but showering is possible from the day of the treatment.
EVOKE has been approved by the FDA, which is the Ministry of Health, Labor and Welfare of Japan, but it is an unapproved medical device in Japan. Therefore, please understand that there are the following points to be noted when considering the treatment, and receive sufficient explanation about the risks and side effects at the medical institution.
|EVOKE is a domestic unapproved medical device.|
| Medical device acquisition route: The acquisition route is individual import from the manufacturer by the doctor of each medical institution.|
Drugs to be aware of when importing personally (Ministry of Health, Labor and Welfare page)
|Approval in Japan: There is no other medical device that has the same performance and operation as EVOKE and has been approved in Japan.|
|Information on safety in other countries: No serious side effects or complications have been reported from EVOKE treatment, but the main risks that can occur are transient redness, heat sensation, and slight redness at the treatment site. Rarely, there are minor burns.|
(1) Medical examination and counseling
After completing the questionnaire on the medical device, you will receive medical examination and counseling from the doctor, tell you the problems you want to improve such as sagging cheeks and double chin, and receive a diagnosis such as whether EVOKE treatment is suitable. If you have any concerns or doubts about the procedure, please consult your doctor at this time.
(2) Face wash / application of gel
If you have applied makeup on the day of the procedure, cleanse and wash your face to clean the area. After that, in order to protect the skin at the treatment site from the heat generated by high frequencies, a protective gel is applied to the cheeks and around the chin.
(3) Installation of applicator and high frequency irradiation
Depending on the part you want to treat, attach either EVOKE cheek or EVOKE chin applicator and irradiate with high frequency. It is said that you will feel warmth about 3 minutes after you start irradiating with high frequency, and the time required for each treatment is about 30 minutes.
(4) Wipe off and finish the gel
Wipe off the rest of the gel applied to protect the treatment area from heat, check the finish, and receive explanations such as precautions after the treatment. If you receive multiple treatments for better results, most medical institutions provide counseling only for the first time, and make reservations for the next treatment day as needed.
EVOKE's sagging treatment using high frequency is a free medical treatment for the purpose of beauty, and insurance is not applied, so you will be responsible for the entire fee. In addition, since it is possible to set a fee for the free medical treatment menu at each medical institution, the EVOKE treatment fee differs for each medical institution, but the market price is as follows as a guide.
|Treatment site||Estimated price (1 time)|
|Cheek (EVOKE cheek)||20,000 yen to 50,000 yen (excluding tax)|
|Under the chin (EVOKE chin)||20,000 yen to 50,000 yen (excluding tax)|
The slack that can be expected to be improved by high frequency using EVOKE is mainly the slack around the cheeks and chin caused by the decrease in collagen. Depending on the degree and cause of the sagging, other treatments may be suitable, so it is important to first get counseling at a medical institution and ask for advice on your own sagging condition and the corresponding treatment .
Therefore, when looking for a medical institution to receive EVOKE treatment, EVOKE is tailored to the medical institution where a doctor who has a large number of sagging treatments and is familiar with the characteristics of high-frequency machines is enrolled, or to his or her own improved problems. It is safe to receive the treatment under the guidance of a doctor who proposes a treatment method that combines and other treatments .