Face-lifts have come a long, long way since the early 20th century. Technically, a face-lift is known as a rhytidectomy (meaning “wrinkle excision,” if you speak ancient Greek) and aims to reverse gravity’s impact on the face — including heavy jowls and loosened, sagging skin. It’s a popular intervention and the third most common cosmetic surgical procedure in the U.S.

“As we get older, we lose muscle mass in the facial muscles that help pull the skin up,” says Dr. Kate Dee, M.D., founder of Glow Medispa in West Seattle and Kirkland. So, the sagging face isn’t just gravity, but an average loss of 3%-8% of facial muscle each decade after age 30.

Restoring youthful appearance historically required surgery that combined tissue tightening and excess skin removal. However, the surgery-phobic may be relieved to know experts can now perform facial improvements without scalpels and syringes.

But first, a little background.

History of the face-lift

World War I’s injuries led to plastic surgery and facial reconstruction improvements, which soon made their way into surgeons’ rooms. The first face-lifts essentially lifted, tautened and re-draped facial skin.

By the last half of the 20th century, the field discovered the superficial musculoaponeurotic system or SMAS. In essence, your head and neck contain five soft tissue layers. The SMAS works on the third layer, the superficial fascia.

“This is the plane lifting the face, with a membrane that extends down under the chin and blends into the neck,” Dee says. Tugging on the upper half lifts the lower half, too — like pulling sheets up over a bed.

At the time, surgeons pulled this layer up and back to undo gravity’s effects for a more natural look, along with tightening the skin, which sometimes provided an over-taut look.  

Newer advancements involved going deeper to undo sag and reposition soft tissue, and physicians started working on specific areas, such as brow lifts, facial implants and chin surgery. However, existing face-lift techniques presented similar issues for patients. Recovery often involves facial swelling, pain and downtime away from work or life — plus the potential problems that can occur in any surgery. In addition, face-lifts typically don’t provide skin improvements beyond tightening.

Nonsurgical face-lifts attempt to offer fast, less expensive and quicker-healing results. Dermal fillers plump up cheeks and lips with injectable gel to replicate muscles, while Botox decreases the muscle movements that lead to wrinkles. These anesthesia-free approaches work for a limited time and with minimal effect — unless overdramatic, as sometimes seen in aging Hollywood stars.   

But now, a new, noninvasive technique relying on the time-tested SMAS approach is evolving — no needles required.


Using no fillers, needles, or surgical techniques to tone facial muscles, lift the face, and reduce wrinkles, EMFACE devices — available as of October 2022 — are causing a stir in medical spas and dermatologists’ offices.

“This is the first device to do two things at a time,” Dee says.


EMFACE’s manufacturer, BTL Aesthetics, refined the devices for five years, including testing the techniques on 3,000 real people and conducting clinical studies. “In the world of aesthetics, it can be hard to know how much to believe,” Dee says. But the rigorous testing and research helped reassure Dee, a self-proclaimed “science geek.” 

Almost 93% of patients reported improvement in volume — which translates to fuller, more youthful faces. Significant numbers also noted more muscle tone and lift, fewer wrinkles and increased skin collagen and elastin.  

The research also helps Dee reassure patients about the cutting-edge tech. “Somebody else has already been the guinea pig,” she says. “It’s very safe technology.”

The device relies on approaches already in use, albeit in combination. Radiofrequency technology heats the skin’s outer layer, which increases facial elastin and collagen — factors that give skin a fresh appearance. Simultaneously, the EMFACE uses HIFES to selectively contract individual facial muscle nerves — which helps elevate, restore and increase the muscle density we enjoyed in our youth. It’s like a mini-workout for your face.

“By strengthening muscles, the resting tone of the lifting muscles is improved,” Dee says.

Treatment details

Each EMFACE treatment is only 20 minutes, and typically four treatments are recommended — but they can vary by the face being refined. Those who are older might need more treatments. Almost anyone can benefit, except those with scar tissue or electronic or metal implants.

Without downtime, stepping out for treatment on your lunch break is possible, with a same-day return to the job. Experts place three large pads across the cheeks and forehead. Patients lie back and relax; the procedure feels like a massage with warming sensations in heated areas.

“It doesn’t hurt, just feels a little weird when your muscles are contracting,” Dee says — she trialed the device recently on her own face. “You feel it in your forehead and cheeks because it’s stimulating the same muscles that help you smile.”

For example, the pad applied to the muscle’s forehead replicates Botox’s effect on the brow without needles. “It lifts the brows and fills out the volume in the forehead,” she says, and also noted that EMFACE lifts the eyelids without surgery and tones weakened facial muscles — which improves the jawline, an often-tricky area to get right.

“The coolest thing with this new device is that we can pull everything up in a way we never could before — without surgery.”

At Glow Medispa, we are driven by science, and everything we do is informed by the latest information and data available. We make a personalized assessment for each patient and strive to bring out your natural beauty.