ONDA与EMFACE分别是怎样的提升设备？（能量设备的演进Ⅶ）

曹昌焕院长2026.08.16

以下为我刊登于《D&PS》2024年12月刊的专栏全文。

钛提升（SOPRANO TITANUM）是什么设备？

Alma Korea的SOPRANO TITANUM与DEKA Korea的ONDA，是很适合用“reboot”（重启）和“rebirth”（新生）来形容的代表性医美设备。原本用于脱毛的SOPRANO TITANUM，经Alma Korea和韩国医生之手重生为一种新的治疗方式，并逐渐推广至全球。SOPRANO TITANUM混合输出755nm、810nm和1064nm三种波长，其作用并非直接针对发色团，而是依据扩展选择性光热作用理论（extended theory of selective photothermolysis），通过热扩散（heat diffusion）作用于毛囊干细胞（hair stem cell）。

对SOPRANO TITANUM提升效果持怀疑态度的人，曾认为它与常用的1064nm、300msec激光Genesis或双重调肤没有本质区别。也有医生认为，SOPRANO TITANUM提升对毛发周边组织的作用尚未明确，背后可能有其原因。

过去已有半脸对照研究，比较长脉冲Nd:YAG激光与射频的效果。Mark B. Taylor等的《Split-face Comparison of Radiofrequency Versus Long-pulsed Nd:YAG Treatment of Facial Laxity》，以及Douglas J. Key等的《Single-treatment Skin Tightening by Radiofrequency and Long-pulsed, 1064nm Nd:YAG Laser Compared》均显示，长脉冲Nd:YAG激光的效果并不逊于射频。然而，HIFU出现后，单极射频依然站稳了脚跟，长脉冲Nd:YAG激光却未能普及。原因在于，用它做提升时疼痛过于剧烈，稍有疏忽还可能造成三度烧伤。SOPRANO TITANIUM为提高脱毛效果与安全性，采用755nm、810nm、1064nm三波长同步输出，并配备强效接触冷却系统。可以认为，这正是它能够在无痛的同时取得良好效果的原因。

图1. 分析采用1064nm激光的Genesis或双重调肤（以300msec进行）的研究。

图2. Nd:YAG激光与射频的效果比较。传统1064nm Nd:YAG激光需要注意疼痛和三度烧伤风险。来源：Single-Treatment Skin Tightening By Radiofrequency and Long-Pulsed, 1064-nm Nd:YAG Laser Compared，Key Douglas J，Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery 39.2（2007）: 169-175。

ONDA提升通过什么原理发挥作用？

DEKA Korea的ONDA最初用于身体塑形，随后开始应用于面部，并逐步推广至全球。原有射频设备多使用1、2、4、6.78、40.68MHz等频率，而ONDA使用2.45GHz。考虑到射频通过极性水分子旋转、摩擦产热的组织加热原理，ONDA具有较高的产热效率。频率升高后，相比电流传导形成的加热（conductive heating），介电行为（dielectric behavior）产生的电磁场，以及组织间的电导率（conductivity）和介电常数（permittivity），变得更为重要。因此，更多能量会传递至脂肪层，而非皮肤层。单极射频比双极射频作用更深，但进入脂肪层的能量仍少于皮肤层；而且在脂肪层深度，能量往往主要沿纤维间隔传导。相比之下，ONDA倾向于将比皮肤层更多的能量传递至整个脂肪层。

图3. ONDA的微波频率高于射频、低于光。来源：Ab-initio study of x-ray spectroscopy of molecular ions，Alessandra Puglisi。

ONDA通过在多个国家获得专利的回路电极（return electrode）技术，将微波能量集中传递至所需深度。最初，它作为身体设备推出，用于改善松弛皮肤的弹性和橘皮组织，并减少脂肪，在美国和欧洲得到广泛应用。采用回路电极技术的3mm治疗头问世后，因等待韩国食品医药品安全处批准，在韩国的引进曾推迟一年多。将其用于面部后，发现可获得类似腹部、大腿橘皮组织治疗的改善，因此ONDA一进入韩国便迅速走红。

图4. ONDA改善腹部橘皮组织的效果（上）。来源：Use of a microwave device for the treatment of cellulite and localized fat adiposity: a 1-year follow-up study，Benedetta Salsi等，Skin Res Technol. 2023 Jul;29(7):e13408. doi: 10.1111/srt.13408。ONDA改善大腿橘皮组织的效果（下）。来源：Microwave Therapy for Cellulite: An Effective Non-Invasive Treatment，Luigi Bennardo等，J Clin Med. 2022 Jan 20;11(3):515. doi: 10.3390/jcm11030515。

RedTouch激光如何刺激胶原？

DEKA Korea的RedTouch采用675nm激光，将对胶原的选择性作为其主要优势。以光嫩肤（photo-rejuvenation）为目标的传统设备，通常根据水对光的吸收程度，以不同方式将热量传递给胶原。与这种扩展选择性光热作用理论不同，675nm RedTouch可视为更直接遵循胶原选择性光热作用（collagen selective photothermolysis）的设备。由于该波段的黑色素吸收率也相对较高，早期RedTouch论文研究的是黄褐斑治疗，如《A new 675nm Laser Dvice in the Treatment of Melasma: Results of a Prospective Observational study》。但很快，其对皮肤胶原的作用受到更多关注，并被确认可用于面部衰老、痤疮瘢痕、膨胀纹等多种适应证。与以水为发色团的传统扩展选择性光热作用相比，胶原选择性光热作用的恢复期和疼痛较少。同时，能量集中于真皮乳头层，可期待更多年轻胶原生成。临床上，相对于患者感受到的疼痛和恢复负担，其见效较快；除改善黄褐斑、泛红、毛孔、肤色和肤质外，还可见整体面部轮廓改善、皱纹减少等年轻化效果。面部泛红的改善，可能与靠近基底膜的血管丛周围细胞外基质（ECM）得到改善有关。

图5. 胶原分子结构（Collagen molecular structure）。来源： https://scienceon.kisti.re.kr/commons/util/originalView.do?cn=TRKO202000002637&dbt=TRKO&rn=&page=3&keyword=undefined.

EMFACE如何提升至肌肉层？

BTL Korea的EMFACE将高强度聚焦电磁刺激（High-intensity Focused Electromagnetic stimulation，HIFEM）与射频结合，用于面部年轻化。HIFEM使额部的额肌（frontalis muscle），以及中面部的颧大肌、颧小肌和笑肌（zygomaticus major、zygomaticus minor、risorius muscle）产生超最大收缩（supramaximal contraction），旨在推动面部组织的复位与重构。虽然设备的作用机制尚未完全阐明，但临床上已在一定程度上观察到，与肌肉相连的多种面部组织发生复位和重构。

图6. EMFACE的作用部位。来源：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等，Facial Plast Surg Clin North Am. 2023 Nov;31(4):547-555. doi: 10.1016/j.fsc.2023.06.006. Epub 2023 Aug 23。

（下期继续）

参考文献

Altshuler, G. B., et al. "Extended theory of selective photothermolysis." Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery 29.5 (2001): 416-432.
Mendelson, Bryan, and Chin-Ho Wong. "Commentary on: modified composite-flap facelift combined with finger-assisted malar elevation(FAME): a cadaver study." Aesthetic Surgery Journal 38.12 (2018): 1284-1288.
Taylor, Mark B., and Inna Prokopenko. "Split-face comparison of radiofrequency versus long-pulse Nd-YAG treatment of facial laxity." Journal of Cosmetic and Laser Therapy 8.1 (2006): 17-22.
Key, Douglas J. "Single-treatment skin tightening by radiofrequency and long-pulsed, 1064nm Nd: YAG laser compared." Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery 39.2 (2007): 169-175.
Yu, Fangbo, et al. "New protocol for the R134a cryogen spray cooling assisted 1064-nm laser lipolysis." Lasers in Medical Science 37.6 (2022): 2605-2614.
Salsi, Benedetta, et al. "Use of a microwave device for the treatment of cellulite and localized fat adiposity: a 1-year follow-up study." Skin Research and Technology 29.7 (2023): e13408.
Bennardo, Luigi, et al. "Microwave therapy for cellulite: an effective non-invasive treatment." Journal of clinical medicine 11.3 (2022): 515.
Clementoni, Matteo Tretti, et al. "Three-dimensional analysis for measuring volumetric changes after a noninvasive treatment performed with a new system delivering microwave energy for unwanted abdominal fat reduction." Journal of Cosmetic Dermatology 22.12 (2023): 3291-3297.
Nisticò, Steven Paul, et al. "A new protocol to treat abdominal subcutaneous fat combining microwaves and flat magnetic stimulation." Bioengineering 9.5 (2022): 182.
Nistico, Steven Paul, et al. "A new 675 nm laser device in the treatment of melasma: results of a prospective observational study." Photobiomodulation, Photomedicine, and Laser Surgery 38.9 (2020): 560-564.
Piccolo, Domenico, et al. "Resurfacing with a new 675-nm laser device: A case series." Journal of Cosmetic Dermatology 20.4 (2021).
Cannarozzo, Giovanni, et al. "A new 675 nm laser device in the treatment of facial aging: A prospective observational study." Photobiomodulation, Photomedicine, and Laser Surgery 39.2 (2021): 118-122.
Cannarozzo, Giovanni, et al. "A new 675-nm laser device in the treatment of acne scars: An observational study." Lasers in Medical Science 36 (2021): 227-231.
Bonan, Paolo, et al. "Could 675-nm laser treatment be effective for facial melasma even in darker phototype?." Photobiomodulation, Photomedicine, and Laser Surgery 39.10 (2021): 634-636.
Bonan, Paolo, et al. "Facial rejuvenation: A safe and effective treatment with a fractional non-ablative 675 nm laser in Asian population." Journal of Cosmetic Dermatology 20.12 (2021).
Alter, Ido, et al. "Clinical application of 675 nm laser therapy for dorsal hand skin hyperpigmentation." Skin Research and Technology 29.10 (2023): e13484.
Magni, Giada, et al. "Laser emission at 675 nm: In vitro study evidence of a promising role in skin rejuvenation." Regenerative Therapy 22 (2023): 176-180.
Piccolo, Domenico, et al. "New 675 nm Laser Device: The Innovative and Effective Non-Ablative Resurfacing Technique." Medicina 59.7 (2023): 1245.
Verdelli, Alice, et al. "Striae distensae: clinical results and evidence-based evaluation of a novel 675 nm laser wavelength." Medicina 59.5 (2023): 841.
Alter, Ido, et al. "The 675 nm laser for the treatment of facial acne scars in dark skin type." Skin Research and Technology 29.11 (2023).
Coricciati, Luigi, et al. "The 675-nm wavelength for treating facial melasma." Skin Research and Technology 29.8 (2023): e13434.
Vitale, Massimo DF. "Management of mixed melasma on darker phototypes: a new and safe laser therapy treatment." IJCMCR. 2024: 37 (3) 5 (2024).
Chilukuri, Suneel. "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." Facial Plastic Surgery Clinics 31.4 (2023): 547-555.
Kinney, Brian M., Jan Bernardy, and Rea Jarošová. "Novel technology for facial muscle stimulation combined with synchronized radiofrequency induces structural changes in muscle tissue: porcine histology study." Aesthetic Surgery Journal 43.8 (2023): 920-927.
Kent, David E., et al. "First Evidence of Cutaneous Remodelling Induced by Synchronized Radiofrequency Aided by High-Intensity Facial Muscle Stimulation: Porcine Animal Model." Dermatologic Surgery 50.2 (2024): 178-181.
Goldberg, David J., and Karan Lal. "Treatment with synchronized radiofrequency and facial muscle stimulation: Histologic analysis of human skin for changes in collagen and elastin fibers." Journal of Cosmetic Dermatology 23.5 (2024): 1620-1628.
Gentile, Richard, and Yael Halaas. "Novel approach to facial rejuvenation by treating cutaneous and soft tissue for wrinkles reduction: first experience from multicenter clinical trial." Facial Plastic Surgery & Aesthetic Medicine 26.1 (2024): 1-6.
Kinney, Brian M., and Charles M. Boyd. "Remodeling of facial soft tissue induced by simultaneous application of HIFES and synchronized radiofrequency provides nonsurgical lift of facial soft tissues." Journal of Cosmetic Dermatology 23.3 (2024): 824-829.
Mendelson, Bryan, and Chin-Ho Wong. "Commentary on: modified composite-flap facelift combined with finger-assisted malar elevation (FAME): a cadaver study." Aesthetic Surgery Journal 38.12 (2018): 1284-1288.