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The Science of Myotonology®                                                                                                                        Myotonology® is a facial rejuvenation system that relies on a patented treatment method and specific proprietary frequencies, wavelengths and serums, coupled with microcurrent electricity, to stimulate and tone the muscles of the face and neck in order to reduce the signs of aging. This treatment also improves the overall health color and texture of the skin, resulting in a more youthful, “lifted” look.     Myotonology® uses a very small amount of electricity measured in microamps, or 1,000,000th of an amp, abbreviated µA. It is sub-sensory in most cases, and mimics the body’s own electrical current. The microcurrent amperage range utilized by Myotonology® is from 1µA to 1,000µA – a range that is generally considered a cosmetic current level. Therefore, the MyoTone and MyoMed professional units are considered Food and Drug Administration (FDA) Class II devices. Unlike higher risk Class III devices, they do not need extensive FDA clinical trials for pre-market approval (PMA), but rather rigorous FDA electrical safety testing and a 510(k) pre-market notification. The predicate device for any microcurrent device is the Transcutaneal Electronic Nerve Stimulator unit (TENS) used for pain management. TENS devices supply current above 1,000 µA, or 1 milliamp, and can cause the visible contraction of muscles. This is considered a medical-current level.     Myotone devices deliver a cosmetic current below 1,000uA, so they are considered  Microcurrent Electronic Neuromuscular Stimulators (MENS) devices. A current above 1,000 µA has also been proven clinically to be counter-productive to facial toning, because it fatigues the muscles by tetanizing them, thus depleting them of energy instead of energizing and toning them. The result is increased sagging of skin. Another important factor to consider with facial toning treatments is the frequency of the current being applied, known as Hertz (Hz). Hz is the unit of measure of the frequency of electrical impulses or the number of impulses per second, i.e. 1 Hz = 1 impulse per second. The effective frequency range for facial toning is 1-100 Hz. Within this range, there is an excitation of the motor nerves which leads to muscular re- education with proper technique. The placement of probes and movement determines whether the muscle will be relaxed (lengthened) or tightened (shortened).     A muscle operates on an all-or-nothing principle. It will not contract until electrical stimulation reaches a threshold potential, and then it will depolarize and contract. This concept was first established in 1871 by Henry Pickering Bowditch, who showed that it is not possible to “sneak” up on a muscle with an obscure shaped wavelength and make it contract more quickly, or more often. Therefore, any device that is touted as using multiple wavelengths that “cycle” is marketing hype -- muscles are either on or off.  Furthermore, stimulating muscle nerves with too much current causes them visibly contract and tetanize, which is counterproductive, and not the goal of Myotonology®.   The Myotone unit has a maximum current output of 580uA of monophasic, 10Hz positive current. The Myotone pulses very quickly, (100ms/cycle) so the gentle current both stimulates and tones the muscles while helping penetrate hydrating serums via iontophoresis. This makes the device extremely versatile as it address multiple problem areas. Galvanic positive or negative DC current allows the user to infuse the epidermis with special ionized serums by a method called “iontophoresis.” This well-documented procedure allows for hydration of the skin, as well as increased circulation, lymphatic drainage, and stimulation of collagen and elastin production. i ii     How does Myotonology ® work?   Myotonology® systematically reduces the signs of aging by maintaining or increasing muscle tone in three ways: muscle re-education via a cerebral effect, circulation, and increased cellular function. During a session, the user isolates approximately 30 muscles of the face and stimulates the muscle fibers with microcurrent impulses to restore proper tone to the facial muscles. The skin of the face and neck are the only area of the body where skin is directly attached to muscles. As the muscles lengthen or contract with age, signs of aging will appear here first. With microcurrent impulses, the muscles can be either relaxed or tightened depending on the desired outcome. As the muscles are re- educated and move to the proper location, the skin moves with them, diminishing fine lines and wrinkles.    The cerebral effect occurs in part because microcurrent mimics the body’s own electrical impulses. As people age, the brain’s ability to “sense” a muscle’s condition is dulled, while its ability to initiate neural impulses is slowed and diminished because of changes in the peripheral nervous system.iii The brain uses specialized proprioceptors called the Golgi Tendon Organ (GTO) to gather information about the facial muscles and help decide whether or not to initiate neural impulses to contract muscles, relax muscles, or just maintain tonus in them.     In the 1970s, George Goodheart Jr., D.C., proved that muscles can be re-educated via the GTO and returned to a more natural state. iv Thomas Wing and George Goodheart combined the GTO and microcurrent therapy to achieve a method for stimulating muscles to re-educate them. Microcurrent effectively “reminds” the brain to initiate more impulses. By the specific placement of the probes and subsequent gentle movement of the muscles to the correct place, the brain “senses” the new desired location. As the brain sends and receives more signals, the  effect of microcurrent therapy is re-educated, freshly toned muscle memory.     By stimulating the facial muscles, microcurrent rebuilds the facial structure from the inside, truly giving the face a non-invasive “lift.”v Although results can be noticeable after several treatments, we recommend a tapered 6-8 week treatment plan to allow for the optimal cumulative cerebral and positive skin effects to take place.   As the brain “remembers” to send more signals, the effect of Myotonology® is tone muscle memory which is long lasting, while the increased collagen and elastin growth takes time to achieve desired results.   Myotonology ’s ® patented procedural method takes into account the functions of the different muscles and it relaxes, strengthens, or helps to tone the various muscle groups to achieve the best  results possible. To be more precise, the following examples may help explain the concept. The frontalis muscle in the forehead contracts and shortens with age, causing wrinkles to form. The patented procedure in Myotonology® calls for the use of a current and frequency that stimulates the GTO, and allows the muscle to return to its original lengthened state, smoothing fine lines and wrinkles caused by shortening or contracting with age.    Secondly, the orbicularis oculi tends to lengthen and cause hooding and drooping of the eyelids, sagging brows and wrinkles under the eyes. “Bags,” or “crêpe paper,” can also appear under the eyes as skin becomes more delicate and dehydrates with age. The Myotonology® procedure works with the GTO and the muscle to strengthen, shorten and tone, which “opens up” the eye by lifting the lids, raising the arch of the brow, and smoothing fines lines under the eyes. The Galvanic current helps hydrate the tissues around the eyes by infusion of ionized serums, helping diminish the “crêpe paper” look, while increased lymphatic drainage stimulated by the current reduces the puffiness or “bags.” The Zygomaticus major and minor muscles must also be tightened or “contracted,” because they lose tone, lengthen and cause the angle of the mouth to turn downward and form wrinkles. By placing the probes at the origin and insertion of the muscles this stimulates the GTO. The brain senses the stimulation, motor neurons get excited and the end effect of shortening the muscles reduces wrinkles by turning the angle of the mouth up slightly and “lifting” the cheek. The microcurrent provides a “re-education” of the muscles to return them all to the proper place and state of being.         In terms of circulation, the same microcurrent used in Myotonology® has been proven to increase circulation in the treated area by over 30 percent. By increasing circulation, the user is able to provide the muscles with the nutrients they need to maintain tonus. The tissue is flooded with blood, which provides nutrition and removes waste products. The proper chemical balance is achieved and the tissue becomes healthier. Increased circulation and the resulting effects  alter the function, color and overall health of the skin in a very positive way. vi vii     Myotonology increases cellular metabolism, as well, to enhance healing and hydration and increase the latent tissue repair that is cumulative. The mechanism at the core of this process is an increase of adenosine triphosphate (ATP) production in the mitochondria, caused by a  chemical reaction stimulated by the microcurrent at a cellular level. In the right current range, a threefold to fivefold increase was seen in clinical studies. ATP is referred to as the “energy of life,” and such a massive production and cumulative stockpiling over multiple treatments has profound effects on the skin and muscles of the skin. Increasing cellular metabolism in the area treated and directly stimulating the fibroblasts to produce collagen and elastin, leads to a plumping effect of the skin as well as improvement in skin elasticity and texture. Furthermore, muscles are provided with the energy and nutrients needed to maintain tonus in the desired “re- educated” location. vi vii   The landmark study by N Cheng in 1982 found that microcurrent stimulation increased the production of ATP in the mitochondria of the cells by 300 to 500 percent, as well as increasing protein synthesis by 50 percent and the uptake α-aminoisobutyric acid by 90 percent, which facilitates amino acid transport in and out of the cells. This also speeds up cellular metabolism exactly where the current is applied and gives the cells more energy to facilitate detoxification and production of collagen and proteins, including elastin. vi     In regards to the Cheng study, it is important to note that with applied electrical currents exceeding 1,000µA, the ATP concentration leveled, and at 5,000µA they plummeted below the baseline. Protein synthesis also dropped 50 percent at these levels. This is significant because some hand-held units, and cheap “professional” units, on the market operate at these higher current levels. They will often cause visible contractions and provide an “instant tone,” but the cumulative effect will leave the skin and muscles of the face depleted of ATP, therefore not able to hold the desired tonus. By comparison, using Myotonology® at the proper current level “energizes” the skin, giving it a surplus of ATP. So, the muscles are gently re-educated into proper position, then given extra energy and circulation for the brain to maintain tonus. The cumulative effects of Myotonology® are profound and long lasting. Vi    What else does the research show?     Emil Y Chi, Ph.D., director of the University of Washington‘s Department of Pathology, who performed clinical studies using microcurrent equipment, notes, ”The fact that the technology works in harmony with the body is evident.”    Examination of the skin tissue treated with microcurrent showed a 45 percent increase in the number of elastin fibers in the dermis, and the length if the fibers on average doubled. The collagen thickness in the connective tissues increased 10 percent, and the numbers of blood vessels increased by 35 percent. The application of microcurrent to skin and tissue produced a firmer and tighter feeling on the skin surface. Aside from muscle re-education and massive increases in ATP levels, microcurrent has other proven benefits for esthetic applications.    Chi’s study also proved that the redness, irritation, and inflammation of surgically traumatized tissue could be decreased significantly when treated with microcurrent. vii   Furthermore, a study conducted in 1996 by A.G. Canseven, showed that applying microcurrent to wounds in rabbit skin in the range of 2ooµA to 400µA had an effect on collagen growth.     “The hydroxyproline content was found to be increased in the wound tissue at the end of 72 hours of applying current which indicates collagen synthesis is promoted by electric current.” viii The pre- and post- surgical applications of microcurrent are promising with regards to the healing of tissue and remodeling of scars by stimulating collagen production. Furthermore, reduction in bruising post-cosmetic injection is possible because of increased circulation and lymphatic drainage. Case studies are currently being done for Myotonology® by a noted plastic surgeon in New York to determine the best protocols for remodeling scars, bruising and healing in relation  to surgery.     Another important study relating to surgical wound healing using microcurrent was performed in  2009 by Fernanda A. S. Mendonça. This study showed evidence that wounds treated with microcurrent alone, or microcurrent coupled with application of aloe vera gel, showed an earlier onset of the proliferative phase of healing in the rats. Mendonça notes, “Simultaneous application of aloe vera gel and microcurrent is an excellent choice for the treatment of open    wounds thus indicating a synergistic action of these two applications.” ix       Myotonology® substantiates this study, because its proprietary conductance gel used during sessions to help deliver the current into the skin contains aloe vera. Aloe vera is a naturally occurring humectant, as well, so it helps with deep hydration of the skin. Of course, the Myotonology® conductance gel contains many other beneficial ingredients for the skin, so if a study showed increased healing in surgical wounds, the benefits for normal skin are no less than paramount.    In a Chinese hospital clinical case study (Tuen Mun, 1988) lymphatic drainage in post radiation cancer patients with lymphedema was shown to be increased by 28 percent. The post-surgical healing and positive benefits for the skin and muscles of the face are evident and easily recognized in this study, as well. Vii     Finally, in 1991 Drs. Bert Sakmann and Erwin Neher, won the Nobel Prize for their work on the response of microcurrent on the physiology of human cellular membranes. Microcurrent’s electrical impulses, depending upon the frequencies used, would cause an opening in the “voltage sensitive cellular ion channels.” Their research showed that each cell contains between 20 and 44 different ion channels, each being specific for a particular nutrient: calcium, magnesium, sodium, etc. Later it was shown that this pulsation of the cell’s membrane allowed for a process known as “electroporation,” whereby toxic material (including heavy metals) trapped inside the cell could be “electrically pulsated” out. Thus, microcurrent helps the body remove waste products in the cell by “pulsing” it out, and increasing circulation and lymphatic drainage in the surrounding tissue. X    It follows that muscle re-education, increased circulation and cellular metabolism, coupled with a massive increase in cellular energy production, protein synthesis, waste removal and lymphatic drainage, will lead to latent tissue repair and, therefore, a firmer, tighter feeling of the skin on the face. Compared to the other anti-aging modalities available, Myotonology® is the safest, most non-evasive way to get a more youthful appearance.  Lasers, radio frequency and many other resurfacing techniques, actually wound the dermis to stimulate collagen production and are often very painful. Myotonology® achieves the desired effect “naturally” with no pain and no downtime. The broad scope of possible future use, coupled with time-tested, patented methods, verified results, and clinically researched technology, make Myotonology® the most obvious choice in the cosmetic market today.                                           i        Robertson, VAL 2006 Electrotherapy Explained: Principles And Practice  4th  edition, 2006: pp. 79-80                               ii       W atson, Tim; Iontophoresis; 2012;   http://www.el ectrotherapy.org/downl oads/Modaliti es/Iontophoresis%20jan%202012.pdf;     iii      Adams and Victor's Principles of Neurology, Ropper A., Brown, R. 2005 pp (580-587)     iv     “Applied kinesiology & Golgi tendon organ spindle cell” 18(3);Goodheart, George, Digest of  Chiropractic Economics Nov/Dec 1975:18-19.     v      W ing, Thomas W .  How a Chiropractic Modality Became a Medical Modality- The 20th Anniversary of           M.E.N.S.   Microcurrent. The Digest of Chiropractic Economics 1993; 35 (Jan/Feb):28-29     vi     Cheng N, Van Hoof H, Bockx E, et al. (1982). "The effects of electric currents on ATP generation, protein synthesis, and membrane transport of rat skin". Clin. Orthop. Relat. Res. (171): 264–72. PMID 7140077.     viiMicrocurrent.net; W hat is Cosm etic Microcurrent?;  http://www.mi crocurrent.net/;        viii(Canseven AG, 1996) “Is it possible to trigger collagen synthesis by electric current in skin wounds?” Biochemical Biophysical Research Communication Journal,  1996 Jun;33(3):223-7.)     ix  Mendonça, FA, et al 2009 Effects of the application of Aloe vera (L.) and microcurrent on the healing of wounds surgically induced in W istar rats. Acta Cir Bras.2009 Mar-Apr;24(2):150-5.)     x   W eaver JC. 1995 Electroporation Theory,Concepts and M echanisms. Methods Mol Biol. 1995;55:3-28. Review

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