ONDA and EMFACE: Two Different Approaches to Lifting (The Evolution of EBD VII)

This is the full text of my column in the December 2024 issue of D&PS.

What is Soprano Titanium lifting?

Alma Korea's Soprano Titanium and DEKA Korea's ONDA are apt examples of a device's “reboot” or “rebirth.” Originally a hair-removal system, Soprano Titanium was developed into a new treatment by Alma Korea and Korean physicians and is now spreading internationally. Combining 755, 810, and 1064 nm, it does not directly target the intended chromophore. Instead, under the extended theory of selective photothermolysis, heat diffuses toward hair stem cells.

Some who question its lifting effect see little difference from commonly used 1064 nm, 300 ms Laser Genesis or dual toning. Others suggest that Titanium lifting may act on the tissue around hair follicles in ways that have not yet been clearly established.

Earlier split-face studies compared long-pulsed Nd:YAG lasers with RF. Mark B. Taylor et al.'s “Split-face Comparison of Radiofrequency Versus Long-pulsed Nd:YAG Treatment of Facial Laxity” and Douglas J. Key et al.'s “Single-treatment Skin Tightening by Radiofrequency and Long-pulsed, 1064 nm Nd:YAG Laser Compared” found laser effects comparable to RF. Yet monopolar RF remained widely used after HIFU arrived, while long-pulsed Nd:YAG lifting did not. The latter was very painful and could cause third-degree burns with even a brief lapse in attention. Soprano Titanium combines three wavelengths with strong contact cooling, originally designed to improve hair-removal efficacy and safety. This likely explains its strong results with little discomfort.

Figure 1. A study of 1064 nm Laser Genesis or dual toning, performed with a 300 ms pulse.

Figure 2. Comparing Nd:YAG laser and RF. Earlier 1064 nm Nd:YAG treatment required particular care to manage pain and avoid third-degree burns. Source: “Single-Treatment Skin Tightening By Radiofrequency and Long-Pulsed, 1064-nm Nd:YAG Laser Compared,” Douglas J. Key, Lasers in Surgery and Medicine 39.2 (2007):169–175.

How does ONDA work?

DEKA Korea's ONDA began as a body-contouring device and expanded internationally into facial treatment. Whereas conventional RF systems use frequencies such as 1, 2, 4, 6.78, or 40.68 MHz, ONDA operates at 2.45 GHz. Because heat is generated as polar water molecules rotate and create friction, ONDA heats tissue efficiently. At higher frequencies, the electromagnetic field generated through dielectric behavior, together with differences in tissue conductivity and permittivity, becomes more important than conductive heating from current flow. As a result, more energy reaches fat than skin. Monopolar RF reaches deeper than bipolar RF, but still deposits less energy in fat than skin, and at fat depth tends to follow fibrous septa. ONDA, by contrast, delivers more energy across the fat layer as a whole than to the skin.

Figure 3. ONDA's microwave frequency lies above RF and below light. Source: “Ab-initio Study of X-ray Spectroscopy of Molecular Ions,” Alessandra Puglisi.

ONDA focuses microwave energy at the desired depth using internationally patented return-electrode technology. Initially introduced for body laxity, cellulite, and fat reduction, it became widely used in the US and Europe. After a 3 mm handpiece using this technology was developed, its Korean launch was delayed by more than a year while MFDS approval was obtained. Facial use produced effects similar to those observed in abdominal and thigh cellulite treatment, and ONDA became immediately popular after its Korean introduction.

Figure 4. ONDA effects on abdominal cellulite (top). Source: “Use of a Microwave Device for the Treatment of Cellulite and Localized Fat Adiposity: a 1-year Follow-up Study,” Benedetta Salsi et al., Skin Res Technol. 2023 Jul;29(7):e13408. doi:10.1111/srt.13408. Effects on thigh cellulite (bottom). Source: “Microwave Therapy for Cellulite: An Effective Non-Invasive Treatment,” Luigi Bennardo et al., J Clin Med. 2022 Jan 20;11(3):515. doi:10.3390/jcm11030515.

How does RedTouch stimulate collagen?

DEKA Korea's RedTouch is a 675 nm laser whose principal feature is collagen selectivity. Earlier photorejuvenation devices heated collagen indirectly, through absorption by water. Unlike that extended selective-photothermolysis approach, RedTouch is designed around collagen-selective photothermolysis. Melanin also absorbs relatively strongly at this wavelength, so early work addressed melasma, including “A New 675 nm Laser Device in the Treatment of Melasma: Results of a Prospective Observational Study.” Interest soon shifted toward collagen effects, with applications described for facial aging, acne scars, and striae distensae. Collagen-selective treatment produces less discomfort and downtime than approaches using water as the chromophore. Energy concentrated in the papillary dermis may also encourage more youthful collagen. Clinically, effects appear quickly for the level of discomfort and recovery involved, with improvements in melasma, redness, pores, brightness, and texture alongside overall contour and wrinkle changes. Redness improvement is thought to reflect better ECM around the vascular plexus near the basement membrane.

Figure 5. Collagen molecular structure. Source: https://scienceon.kisti.re.kr/commons/util/originalView.do?cn=TRKO202000002637&dbt=TRKO&rn=&page=3&keyword=undefined.

How does EMFACE address facial muscles?

BTL Korea's EMFACE combines HIFES (High-Intensity Facial Electrical Stimulation) and RF for facial rejuvenation. HIFES is intended to produce supramaximal contractions of the frontalis in the forehead and the zygomaticus major, zygomaticus minor, and risorius in the midface, promoting repositioning and restructuring of facial tissues. The mechanism is not yet fully understood, although clinical experience has shown some repositioning and restructuring of tissues connected to these muscles.

Figure 6. EMFACE treatment areas. Source: “Holistic Approach for Noninvasive Facial Rejuvenation by Simultaneous Use of High Intensity Focused Electrical Stimulation and Synchronized Radiofrequency: A Review of Treatment Effects Underlined by Understanding of Facial Anatomy,” Suneel Chilukuri et al., Facial Plast Surg Clin North Am. 2023 Nov;31(4):547–555. doi:10.1016/j.fsc.2023.06.006. Epub 2023 Aug 23.

(To be continued in the next issue)

References

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