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Effects, downtime and risks of high-frequency RF machine EVOKE




Yoshio Ikeda
Dr. Yoshio Ikeda

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 aims to improve the sagging around the cheeks and chin by warming the skin with the heat generated by the high frequency and causing a tightening effect.

EVOKE puts less strain on the body, so there is almost no downtime, and the machine can automatically adjust the temperature of the heat generated by the high frequency, so you can get a higher lift-up effect by receiving multiple treatments. You can expect it .

Therefore, when considering treatment , it is important to know in advance the mechanism by which EVOKE causes the tightening effect, as well as the effective frequency and number of treatments . Also, understanding the risks and precautions of the treatment, and the differences from other treatments will help you choose the treatment that you are satisfied with.

Dr. Yoshio Ikeda of Tokyo Dermatology and Plastic Surgery is the leader of EVOKE.

EVOKE that leads to improvement of facial sagging with high frequency

EVOKE that leads to improvement of facial sagging with high frequency By generating "high frequency", which is a type of electromagnetic wave, and applying heat to the skin , it contracts skin proteins such as collagen, bringing about a tightening effect on the face line such as cheeks and under the chin, improving sagging. The leading machine is EVOKE .

EVOKE is a high-frequency treatment machine developed by an Israeli medical device manufacturer, and it can be expected to improve the sagging of the cheeks and face line mainly caused by aging . In addition, since 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 safety and effectiveness of the machine have been recognized by public institutions.

The high-frequency energy used in EVOKE is also called "RF", which is an acronym for "radio waves" and radio frequency (radio frequency) because it is also in the radio frequency band. In the field of aesthetic medicine, machines that generate high frequencies like EVOKE are sometimes collectively called high frequency machines or RF machines.

Main causes of sagging skin

Main causes of sagging skin

Human skin has a layered structure of the epidermis and dermis from the outside. About 70% of the dermis layer, which is deeper than the epidermis, is collagen, which is a fibrous protein. Collagen is bundled by elastic protein, elastin, and hyaluronic acid, a jelly-like substance, absorbs water in between. It fills your skin as you hold it, supporting the firmness and elasticity of your skin.

Collagen, which occupies most of the dermis layer, deteriorates and decreases mainly due to ultraviolet rays, aging, stress, hormone imbalance, etc. When the thickness of the dermis becomes thin, the skin loses its firmness and elasticity, resulting in sagging. In addition to being the cause , fine wrinkles may become noticeable.

There are cases where skin sagging occurs in addition to the decrease in collagen, and other main causes include drooping subcutaneous fat that exists around the cheeks and around the cheeks, and loosening of tissues such as muscles and ligaments that exist under the skin of the face. is mentioned. In order to improve sagging, it is necessary to receive treatments that match each cause.

EVOKE, a machine that uses high frequencies, can be expected to improve skin sagging caused by collagen reduction due to aging and external stimuli such as ultraviolet rays .

Characteristics of high frequency and mechanism of tightening action by EVOKE

High frequency waves that shrink proteins with heat generated by friction between molecules

"Frequency" in electromagnetic waves such as high frequency means that waves (vibrations) with the same width of waveform circulate in a constant cycle. Depending on whether it appears, "〇 Hz (Hertz)" and the frequency are shown.

For example, the frequency of the electromagnetic waves that generate 2 million waves per second is 2 MHz (2 megahertz), and the high frequency used in high-frequency machines for aesthetic medicine generally has a frequency of 3 MHz to 300 MHz. I'm here.

High frequency is an electromagnetic wave energy that has the property of reaching deep into the skin. Since the heat generated by high frequency waves is generated deep inside the skin rather than on the surface, it can heat collagen, a protein in the dermis that supports the firmness and elasticity of the skin.

For example, just as meat shrinks when heated during cooking, proteins have the property of denaturing and shrinking when heated by the heat generated by high frequency waves . Therefore, by applying EVOKE to areas where sagging is a concern, such as around the cheeks and chin, you can expect a tightening effect that tightens the collagen in the dermis with the heat generated by the high frequency.

By tightening collagen, which plays a role in maintaining the firmness and elasticity of the skin, it is possible to improve the sagging of the cheeks, under the chin, and the face line, which become more noticeable with age .

In addition, the dermis layer contains fibroblasts that produce collagen. By stimulating and activating fibroblasts with the high-frequency heat generated by EVOKE treatment, it is possible to promote the growth of collagen, making it possible to aim for a firm and youthful skin quality. will be

EVOKE with multiple electrodes that generate high frequency

EVOKE performs treatment by attaching a special applicator that generates high frequency waves and is connected to the main body of the machine with a cable. The applicator has a set of different positive and negative electrodes, one for sending high frequency and the other for collecting (counter electrode). These electrodes generate heat on the skin by sending high frequency to the treatment site. is.

EVOKE's applicator, which generates high frequency waves that heat the skin, is a bipolar type with multiple electrodes on each side, "one set of 3 electrodes x 4 places", and works by passing high frequency energy to the shallow layers of the skin. can produce a thermal effect.

Also, when performing the EVOKE treatment, a high frequency is generated at all 4 points of 1 set of 3 electrodes on each side, and the 4 points are rotated in order so that the lift-up effect is uniform. We will raise the temperature. However, if the original size of the face is small, the treatment may be performed with three high-frequency waves per side.

By applying heat to the skin for about 30 minutes with high frequencies generated from multiple electrodes to cause contraction of collagen, you can expect a lift-up due to a tightening action immediately after the treatment . In addition, you will be able to feel more effective by receiving multiple treatments.

Problems that can be expected to improve with EVOKE treatment

  • sagging cheeks
  • Sagging around the chin (face line)
  • Double chin (sagging under the chin)
  • Lack of firmness and elasticity around the cheeks and chin

Features of EVOKE that automatically maintains the temperature suitable for tightening

Features of EVOKE that automatically maintains the temperature suitable for tightening

EVOKE's ACE technology for safe treatment

EVOKE, in which the machine automatically controls the skin temperature, is called "ACE technology", which stands for Acquire, Control, and Extend, in order to realize safe treatment with high frequency. Features.

"Acquire" that reads skin temperature 1000 times per second

The EVOKE applicator, which touches the skin at the treatment site, is equipped with a temperature sensor called an RF thermistor that automatically reads the temperature of the skin surface 1000 times per second . Skin temperature information measured from 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 temperature changes during treatment in real time, such as which part is heated at what temperature, so there is almost no risk of burns.

"Control" to prevent excessive temperature rise during treatment

High frequency has the effect of generating heat by causing molecules in the body to rub against each other, so in general high frequency machine treatment, if strong high frequency energy continues to flow for a long time, the treatment site will burn due to an excessive rise in skin temperature. There was a risk of

Display image of "Control"_EVOKE to prevent excessive temperature rise during treatment

On the other hand, EVOKE can set a "cutoff temperature" that automatically controls the skin surface temperature so that it does not exceed a set temperature within the range of 35 ° C to 43 ° C due to the heat generated by the high frequency . 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 treatment .

"Extend" to keep the skin temperature effective for tightening

There is clinical data that it is effective to keep the skin surface temperature between 41℃ and 43℃ in order to obtain a tightening effect with high frequency treatment . It can be maintained at 43°C .

Since high frequency waves reach deep into the skin, the heat generated by the treatment 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 suitable for collagen contraction (tightening). It will drip .

EVOKE applicator that can be used for each treatment site

EVOKE uses a technology in which the machine automatically emits high frequency waves for a certain period of time to generate heat, and the machine automatically manages the skin temperature, so the doctor can change the direction of the applicator and adjust the temperature setting during the treatment. It is a hands-free design that basically does not require any operation .

When undergoing treatment, it is performed with one of two types of dedicated applicators attached for each desired part, such as cheeks and under the chin, as follows.

EVOKE applicator that can be used for each treatment site EVOKE cheek: Cheek, face line

EVOKE applicator that can be used for each treatment site EVOKE chin: under the chin

The EVOKE cheek is designed to cover both cheeks like headphones, and the EVOKE chin is designed to cover the cheeks from below , in order to deliver high-frequency energy more effectively and cause a heat effect depending on the area to be treated. It has a structure that fits to support .

Both have the same principle of generating high frequency waves with electrodes on the applicator to heat the skin. and so on, depending on your purpose.

If you feel something wrong during treatment, you can stop the machine yourself

If you feel something wrong during treatment, you can stop the machine yourself EVOKE is equipped with an emergency stop button for the patient to press during treatment. By pressing the emergency stop button during the treatment, it is possible to immediately stop the machine from generating high-frequency energy .

During the EVOKE treatment, the cheeks and under the chin feel warm, and no anesthesia is required. However, it can be said that it is a machine designed with safety in mind, as it has a function to automatically stop the machine by itself in the event that it feels hotter than expected, or if an abnormality is detected.

Number of treatments, pain, downtime and risk of EVOKE


EVOKE can be expected to tighten and lift the area around the cheeks and chin immediately after the treatment due to the tightening action that causes collagen contraction with high-frequency heat. The effect tends to be felt even with one treatment, but it is recommended to receive multiple treatments at regular intervals to further enhance the effect.

Although there are individual differences depending on the degree of skin sagging, the recommended EVOKE treatment frequency is once a week to obtain a sufficient effect, and the total number of treatments is 6 times . In addition, the treatment takes about 30 minutes, and there is almost no downtime, and makeup can be applied after the treatment.

EVOKE treatment pain and downtime

EVOKE treatment is said to cause almost no pain, and basically no anesthesia is used . When performing the treatment, an applicator is attached with a gel applied to protect the skin around the cheeks and chin, and high frequency waves are applied to apply heat. During that time, you can spend time reading or looking at your smartphone.

In the unlikely event that you feel strong pain during the treatment, please press the emergency stop button or consult with the practitioner without patience. In addition, EVOKE is a treatment with a high-frequency machine that does not involve procedures that place a burden on the body, such as incisions in the skin, so scabs do not form after the treatment and there is almost no downtime, so makeup can be applied immediately after the treatment. It is possible .

Risks and side effects of EVOKE treatment

EVOKE is a treatment that applies high-frequency heat for 30 minutes, so after the treatment, there tends to be a slight redness in the area where the high frequency is applied, such as the cheeks and around the chin. inconspicuous .

In addition, there may be a slight tingling sensation immediately after the treatment, but it usually tends to subside within a few hours. No serious risks or side effects from EVOKE treatment have been reported, but if you feel any other abnormalities, please consult a medical institution.

Advantages and disadvantages of EVOKE and who is suitable for the treatment

Advantages and disadvantages of EVOKE treatment

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・You can aim for tightening around your cheeks and chin ・You can expect a lift-up of your face ・You hardly feel any pain during the procedure can apply makeup・Multiple treatments may be required to obtain a higher effect ・This is a free medical examination not covered by insurance ・Different treatments may be indicated depending on the cause of sagging skin

Those who are suitable for EVOKE treatment

  • Those who want to improve sagging caused mainly by the decrease in collagen and elastin due to aging
  • Those who are resistant to surgery involving skin incisions
  • Those who want face lift surgery with short downtime
  • Those who want a natural finish that shows results with each treatment
  • Those who are not good at procedures such as anesthesia injections that are painful when undergoing surgery

Treatments other than EVOKE that can be expected to improve facial sagging

In addition to high-frequency machines such as EVOKE, there are other cosmetic medical treatments that are said to be able to improve the sagging of the face, such as a surgical treatment called “face lift surgery” and a special thread that can be caught. There is a "thread lift" that obtains a lift-up effect by inserting it under the skin.

Each treatment has a different lifting mechanism and different skin tissues, so it is necessary to consult a doctor at a medical institution to determine which treatment is suitable for you.

treatment Presence or absence of incision Overview of treatment
face lift Yes The skin and fascia that cause sagging are removed, partially excised, sutured, etc., and the skin is pulled up.
thread lift (thread lift) Nothing A special thread with a hook is inserted under the skin to pull up the subcutaneous tissue.
HIFU machine Nothing The heat generated by concentrating ultrasonic waves causes the SMAS of the fascia, which is the base of the skin, to contract and cause a lift-up effect.

face lift surgery

A facelift is an operation in which an incision is made in the skin in an inconspicuous area from the ear to the temple and the skin is pulled up to improve sagging . By surgically returning the tissue that causes facial sagging, such as subcutaneous fat that has drooped due to aging, loose skin and subcutaneous fascia (SMAS), and ligaments, to its original position, sagging can be achieved. can be expected to improve.

There are various surgical methods, and depending on the degree and cause of the slack that differ from person to person , the ligaments and SMAS at the site that pulls the slack are peeled off and excised, or excess subcutaneous fat is removed. I will . The applicable range varies slightly depending on the medical institution, but generally the entire face, excluding the forehead, eyelids, nose and mouth, to the upper part of the neck including the face line.

Unlike EVOKE, the skin is incised, so the downtime such as swelling and swelling after surgery is long-term, and it tends to take more than 3 months before the scar becomes inconspicuous. In addition, although it may be necessary to stay in the hospital for several days after surgery, it has a strong lifting effect because it physically pulls up the tissue that causes sagging, and the effect can be expected to last for several years .

thread lift

A thread lift (thread lift) is a lift-up technique that lifts up the slack on the face and neck by inserting a special thread with a catch called "thread" under the skin . A needle is used to insert multiple threads into areas where sagging is a concern, such as the cheeks and neck.

In addition, it can be expected to plump cheeks that have lost volume due to the decrease in collagen and elastin due to aging, and to improve wrinkles such as nasolabial folds caused by sagging. Thread lift is a procedure that does not involve skin incision, but the material and structure of the thread differ depending on the product, and there are various types such as those that melt after being inserted under the skin and those that do not melt.

Main absorbent (melting type) threads Thread characteristics
silhouette soft The three-dimensional cones called bio-cones attached to the thread hook the subcutaneous tissue 360 degrees around the thread.
shopping thread Nearly 50 to 100 short threads called short threads are inserted like cosmetic acupuncture, and the tension of the threads supports the skin from the inside.
happy lift Hook the subcutaneous tissue with fine hair-like thorns attached symmetrically toward the center of the thread
mint lift It has a structure in which thorns are attached to the thread, and is said to be stronger than conventional cut-type thorns.

In the case of the dissolvable type threads used in many medical institutions these days, the duration of the effect varies depending on the product, but it is roughly 8 to 18 months . After the procedure, mild swelling and discomfort when opening the mouth may occur for a few days to a month, and downtime tends to be shorter with EVOKE .

HIFU machine

HIFU is an abbreviation of the English "High lntensity Focused Ultrasound", and 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 focus ultrasonic waves on a certain part of the body to collect heat and raise it to a high temperature, just like black paper burns when sunlight is focused on one point with a magnifying glass. Proteins have the property of shrinking due to heat, so applying heat with HIFU can be expected to have a tightening effect.

Mechanism of thermal action by HIFU

As a major difference from high frequency, HIFU can bring about a heat effect to a thin membrane-like fascia called SMAS, which is a type of protein deeper in the skin, which has a three-layer structure of epidermis, dermis, and subcutaneous tissue . SMAS plays the role of a foundation that supports the skin, and when loosening occurs due to aging, the ability to support the skin weakens and may cause sagging.

By tightening the slackness of the SMAS, which is the base of the skin, with heat stimulation, it is expected to have a lift-up effect from underneath the skin . Therefore, if the cause of sagging is due to loosening of SMAS, sagging treatment with HIFU may be an option instead of treatment with a machine that uses high frequency waves such as EVOKE.

In addition, by replacing the tip of the handpiece that is irradiated with HIFU when performing treatment, heat energy can be delivered to skin layers with different depths, such as SMAS, dermis and subcutaneous tissue (mainly fat). is possible . For example, by bringing heat to the subcutaneous tissue, you can expect the effect of partial thinning 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 high-frequency machines such as EVOKE, and swelling and redness at the treatment site may occur for about a week . There are mainly the following types of machines that can perform sagging treatment with HIFU.

  • Ulthera
  • sono queen
  • Doublo
  • Ultracell Q Plus
  • Lipocell
  • Liposonic
  • Ultraformer Ⅲ

What you need to know before undergoing EVOKE treatment

Those who cannot receive treatment

  • Those who are pregnant or breastfeeding
  • Those who have metal plates, threads, or implanted medical devices in the treatment area
  • Those with keloids at the treatment site, those with keloid constitution
  • Others who have been diagnosed as unable to undergo treatment at a medical institution

Also, please note that minors need to obtain the consent of their parental authority to receive the treatment, and if consent is not obtained, the treatment cannot be performed.

Precautions after receiving treatment

After receiving the EVOKE treatment, the skin is prone to dryness due to the heat stimulation of the high frequency waves, so it is recommended to use lotion or milky lotion to moisturize on a daily basis. In addition, since you are easily irritated by ultraviolet rays, please take measures against ultraviolet rays by wearing a hat and using sunscreen when you go out for 2 to 3 days.

You can apply makeup and wash your face from the day you receive the treatment, but please refrain from rubbing or scratching the treatment area for a few days. In order to prevent swelling and redness after the procedure due to the promotion of blood circulation, it is necessary to refrain from bathing and drinking alcohol on the day of the procedure, but showering is possible from the day.

EVOKE is an unapproved medical device in Japan

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, when considering treatment, please understand the following points and receive a full explanation about risks and side effects from a medical institution.

EVOKE is an unapproved medical device in Japan.
Acquisition route of medical equipment: Acquisition route is personal import from the manufacturer by the doctor of each medical institution.
About medicines to be careful about when importing for personal use (Ministry of Health, Labor and Welfare page)
Approval in Japan: There are no other medical devices that have the same performance and action as EVOKE and are approved in Japan.
Information on safety in other countries: There have been no reports of serious side effects or complications due to EVOKE treatment, but the main risks that may occur are transient redness, heat sensation, and extreme heat at the treatment site. Minor burns are rare.

EVOKE treatment flow and price

Flow of receiving EVOKE treatment

(1) Examination/Counseling

After filling out the medical questionnaire with medical equipment, you will receive medical examination and counseling by the doctor, tell the problem 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 questions about the procedure, please consult your doctor at this time.

(2) Washing face and applying gel

If you have applied makeup on the day of the treatment, cleanse and wash your face to keep the treatment area clean. After that, a protective gel is applied around the cheeks and chin to protect the skin of the treatment area from the heat generated by the high frequency.

(3) Attaching the applicator and irradiating high frequency

Attach either the EVOKE cheek or EVOKE chin applicator depending on the area you want to treat and irradiate the high frequency. It is said that the warmth will be felt around 3 minutes after the start of high-frequency irradiation, and the estimated time required for each treatment is about 30 minutes.

(4) Wipe off the gel and finish

After wiping off the remaining gel that was applied to protect the treatment area from heat, you will receive an explanation such as confirmation of the finish and precautions after treatment. When receiving multiple treatments to obtain a higher effect, most medical institutions offer counseling only for the first time, and if necessary, make a reservation for the next treatment date.

Price of EVOKE treatment

Sagging treatment with EVOKE using high frequency is a free medical treatment for beauty purposes, and insurance does not apply, so you will have to pay the full cost. In addition, since it is possible to set the price for the treatment menu of free medical treatment at each medical institution, the treatment fee of EVOKE differs depending on each medical institution, but the market price is as follows as a guideline.

Treatment site Estimated price (1 time)
EVOKE cheek 22,000 yen - 55,000 yen
Under the chin (EVOKE chin) 22,000 yen - 55,000 yen

How to choose a medical institution to receive EVOKE treatment

Effect, downtime and risk of high-frequency machine EVOKE in aesthetic medicine

Sagging that can be expected to be improved by high frequency using EVOKE is mainly sagging around the cheeks and chin caused by reduction of collagen. Depending on the degree and cause of the slack, other treatments may be suitable, so it is important to first receive counseling at a medical institution and listen to advice on the state of your slack and the corresponding treatment .

Therefore, when looking for a medical institution to receive EVOKE treatment, it is important to choose a medical institution that has a large number of sagging treatments and a doctor who is familiar with the characteristics of the high-frequency machine, or an EVOKE treatment that suits your improved concerns. It can be said that it is safe to receive treatment under the guidance of a doctor who will propose treatment methods that combine this with other treatments .

Yoshio Ikeda's EVOKE Q&A

Mr. Ikeda, who supervised the article, taught me about EVOKE.

What kind of problems is EVOKE suitable for?
Dr. Yoshio Ikeda
It is suitable for those who are concerned about sagging cheeks and double chin, those who want to lift up and make their face line look neater, and those who want a treatment without pain or downtime.
What age can I receive EVOKE treatment? Also, from what age should it be taken?
Dr. Yoshio Ikeda
You can take it at any age. If you start to worry about sagging, such as nasolabial folds or sluggish face lines, I think it's a good idea to have it done.
Are there any treatments that can be used together with EVOKE and are compatible?
Dr. Yoshio Ikeda
Recommended to use with hyphen. You can expect a synergistic effect of lifting.
Please tell me the treatment fee for EVOKE at Tokyo Dermatology / Plastic Surgery.
Dr. Yoshio Ikeda
22,000 yen per part for the cheeks and under the chin. Evoke will be handled by Ginza-in.
Please give a message to those who are wondering whether to receive EVOKE treatment from now on.
Dr. Yoshio Ikeda
If you want to tighten the face line to make your face look smaller, or if you want a treatment with less downtime and less pain, please try it.
Thank you, Professor Ikeda!

[For medical professionals] Effects of EVOKE and case photos

EVOKE reaches a maximum temperature of 43°C to 44°C in about 60 seconds, and is said to have a subcutaneous remodeling effect by promoting collagen production. In addition, since it is a hands-free device and the device automatically controls the temperature, it is possible to assign counseling and treatment to other patients during EVOKE treatment.

evoke_ temperature

Below is a sample photo provided by the manufacturer.

  • evokecase1
  • evokecase2
  • evokecase1
  • evokecase1

Introduction of supervising doctor

Dr. Yoshio Ikeda, general director of Tokyo Dermatology and Plastic Surgery. Studied plastic and cosmetic surgery under the late Professor Sadao Tajima at Osaka Medical College and Professor Ryuzaburo Tanino at Tokai University Hospital. We strive to spread safe and secure aesthetic medicine, such as providing treatments using advanced machines, making numerous media appearances, and reporting on non-cutting ptosis surgery and double eyelid surgery with little swelling.