Aesthetic treatment trends are always shifting, and recently we’ve seen a surge in interest in in-office facial muscle training treatments such as EMFACE and Sofwave. While some experts are fully on board, others are not so convinced of these treatments’ merits. We asked top dermatologists to share how these emerging treatments compare with injectable tweakments.
Featured Experts
- Nina Hartman, MD is a board-certified dermatologist in Washington, D.C.
- Kathleen Behr, MD is a board-certified dermatologist in Fresno, CA
- Julie Russak, MD is a board-certified dermatologist in New York
- Dr. Joel Schlessinger and Dr. Daniel Schlessinger are board-certified dermatologists in Omaha, NE
What are in-office facial muscle training treatments?
“There are several energy-based facial muscle stimulation devices available,” says Washington, D.C. dermatologist Nina Hartman, MD. “These treatments use electrical stimulation to trigger repeated muscle contractions, essentially ‘training’ the facial muscles to improve tone and support.”
They aim to improve facial structure, tighten skin and reduce wrinkles by strengthening the “levator,” or lifting muscles of the face, while also stimulating the production of collagen and elastin in the skin, adds Fresno, CA dermatologist Kathleen Behr, MD.
The pros and cons of muscle training treatments
“As we age, facial muscles gradually lose firmness and strength—similar to muscles elsewhere in the body,” says Dr. Hartman. “By inducing strong, repeated contractions, these devices can help strengthen those muscles, leading to a subtly more lifted appearance and improved facial contour and support.” Dr. Behr notes that these treatments are an especially nice option for patients who are needle-phobic or want to avoid fillers.
“The stimulation targets the elevator muscles, the ones responsible for upward support and lift, ” adds New York dermatologist Julie Russak, MD. “That’s the premise, and in the right patient, it’s the right choice.”
“But this is where the conversation gets more interesting than most people realize,” she continues. “Not all facial muscles respond the same way to stimulation, and we don’t want to stimulate all of them. The face works as a network of opposing forces. Some muscles lift; others pull downward. Strengthen the wrong group, and you can actually accelerate the problem.”
Dr. Russak points to the platysma as an example, noting that overworking it can create more heaviness. “Clinically, I’m often focused on relaxing that muscle, not strengthening it. The same is true for other areas where excess pull is already contributing to jowling or tissue descent.”
“Even when targeting the right muscles, we have to be realistic about what muscle tone can and cannot do,” Dr. Russak says. “A lot of what we call facial aging isn’t a muscle issue at all. It’s about ligaments losing support, fat pads sliding downward and changes to, and thinning of, the bone structure over time. These are deeper, structural changes that stimulation alone can’t reverse.”
Omaha, NE dermatologist Joel Schlessinger, MD notes that exaggerated muscle activity in the face can result in bulging areas, such as the jaw. “The same thing goes for people who work out to excess and create a body that, while ripped, doesn't look natural,” he says.
Injectables vs. muscle training treatments
“Although there is growing interest in these treatments, they are not a replacement for injectables,” says Dr. Hartman. “Neuromodulators, such as Botox injections, work in a completely different way—they relax targeted muscles to soften dynamic wrinkles and can also create a subtle lifting effect through selective muscle modulation. Similarly, dermal fillers address volume loss, which is primarily due to age-related changes in fat and bone. They restore structure and contour in a way that muscle stimulation devices cannot.”
Dr. Hartman adds that injectables and facial muscle stimulation treatments can work synergistically, but they are not interchangeable. “Each targets a different layer and mechanism of facial aging, and the best outcomes typically come from a thoughtful combination approach.” Dr. Behr, for example, likes to combine hyaluronic acid and biostimulatory filler treatments with muscle stimulation treatments.
“Patients aren’t rejecting injectables. They’re rejecting outcomes,” points out Dr. Russak. “They’re rejecting the frozen forehead, the pulled look, the filler that adds volume without restoring structure. They’ve seen enough of that to know it’s not what they want, and they’re looking for alternatives that feel more aligned with how they actually want to look.”
Ultimately, it’s not simply about the tool. “It’s about understanding anatomy and science and applying it the right way,” Dr. Russak continues. She notes that the most sophisticated patients aren’t asking her to choose between muscle stimulation and injectables. “They’re asking me to understand their face well enough to know when each tool is appropriate or when neither is,” she says.
