Botox Relaxes a Muscle, EMS Contracts One
Medically reviewed by
4 independent reviewers
Andrew Conrad Barile, PT, DPT
Doctor of Physical Therapy (DPT) | Licensed Physical Therapist (PT) | CEO and Founder, Xtreem Pulse LLC
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Dr. Andrew Conrad Barile is a Doctor of Physical Therapy and the CEO and Founder of Xtreem Pulse LLC, the engineering company behind PureLift. He earned his Doctorate in Physical Therapy from Daemen College and is a licensed physical therapist.
He brings over two decades of clinical and entrepreneurial experience across physical therapy, craniosacral therapy and medical device innovation, built on a working knowledge of human anatomy and muscle physiology.
For PureLift LAB he reviews how current is delivered across all ten levels, from sub-sensory nanocurrent and skin-level microcurrent to motor-level EMS, and how the Infuse pass fits into the same ten-minute routine.
Bertica M. Rubio, M.D.
Board-Certified Physician, Dartmouth Medical School | Medical Director, Antiaging Regenerative Medicine Clinic
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Dr. Bertica M. Rubio is a board-certified physician and Medical Director of the Antiaging Regenerative Medicine Clinic in Redlands, California. She earned her Doctor of Medicine from Dartmouth Medical School and completed her pediatrics residency at UC Irvine Medical Center.
With decades of clinical experience, she specialises in age management medicine, regenerative medicine, wound healing and growth factor therapies, and her practice integrates evidence-based medical science with advanced aesthetic treatment.
For PureLift LAB she reviews articles for medical accuracy across the whole dial, from the gentle nanocurrent and microcurrent settings through to muscle-level EMS and the Infuse pass.
Daniel Grinberg, MD, FACS
Board-Certified Otolaryngologist | Head and Neck Surgeon | Fellow, American College of Surgeons | Mount Sinai
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Daniel Grinberg, MD, FACS is a board-certified otolaryngologist and head and neck surgeon at ENT and Allergy Associates in West Nyack, New York. He earned his medical degree from Columbia University College of Physicians and Surgeons.
He completed his otolaryngology residency at New York University Medical Center, serves as Assistant Clinical Professor at Mount Sinai School of Medicine, and is a Fellow of both the American College of Surgeons and the American Academy of Otolaryngology.
For PureLift LAB he brings a wider clinical lens, connecting at-home facial stimulation from microcurrent to EMS to the anatomy underneath, with the same rigour we apply to every device specification.
Prof. Dr. med. Ivo Buschmann
Chair of Angiology, Medizinische Hochschule Brandenburg | Clinic Director, University Clinic for Angiology
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Prof. Dr. med. Ivo Buschmann is Chair of Angiology at the Medizinische Hochschule Brandenburg Theodor Fontane and Clinic Director of the University Clinic for Angiology at the Brandenburg University Hospital.
He trained at the University of Hamburg, was a Max Planck Society Fellow at the Max Planck Institute for Heart and Lung Research, and held senior consultant posts at the Charite Universitatsmedizin Berlin before his appointment as Chair in 2016.
One of Europe's leading authorities on arteriogenesis, with over 150 peer-reviewed publications and US and EU patents, he reviews for PureLift LAB how the evidence on electrical stimulation is read and where its limits lie.
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A neuromodulator blocks the signal that makes a muscle contract; EMS supplies a signal that makes a muscle contract.
This article sets out what to check before you start, such as:
- What a neuromodulator does
- What EMS does
- Why they are aimed at different regions
- What nobody knows
- What your injector decides
and many more!
They are also aimed at different problems in different parts of the face, which is the more useful way to think about it; the timing question has its own page.
Key Points:
Neuromodulators are used mostly on the upper face, where muscle movement creates lines.
EMS is used on the mid and lower face, where muscle tone supports contour.
Relaxing a muscle that creases skin and toning a muscle that supports tissue are different goals.
No published research covers the two used together.
Your injector decides the practical questions, and nothing here overrides that.
What a neuromodulator does
It interrupts the signal between nerve and muscle at a specific site, so the muscle injected cannot contract fully for a period.
The cosmetic purpose is usually about lines created by repeated movement: a frown line forms because the muscle underneath folds the skin thousands of times, and stopping the folding lets the line soften.
That is why it is used predominantly on the upper face, where expression creates creases, and used cautiously on the lower face where muscles are doing structural and functional work.
It wears off, typically over a few months, as nerve signalling recovers.
What EMS does
It supplies enough current to cross the motor threshold, so the nerve fires and the muscle contracts. Ward's work sets out that threshold alongside the two below it (PMID 19095805).
The cosmetic purpose is tone rather than stillness. Muscle responds to being loaded, and facial muscles are part of the structure holding the midface and jawline up.
Kavanagh and colleagues followed 108 women through 12 weeks of motor-level facial stimulation and measured an 18.6 percent increase in cheek muscle thickness (10.1111/jocd.12007). Chang and colleagues ran a double-blind sham-controlled trial (10.3390/ijerph17113783).
So one is about stopping movement that creases skin, and the other is about loading muscle that supports tissue.
Why they are aimed at different regions
The upper face is where expression lines form and where relaxing a muscle is usually the goal. Nobody is trying to build tone in the muscle between the eyebrows.
The mid and lower face is where tone affects contour, and where the goal is generally the opposite. A cheek muscle that does more is doing something useful.
That regional split is why the two are less directly opposed in practice than the mechanisms suggest, and it is also why the sensible conversation is about specific areas rather than about the face as a whole.
What nobody knows
No published research covers facial stimulation used alongside neuromodulators. The studies above tested stimulation on its own, in people who had not been injected.
So there is no evidence that EMS shortens the effect of an injection, and no evidence that it does not, and anybody stating either confidently is going beyond what exists.
We are not going to publish an interval or a claim about the combination for that reason.
What your injector decides
They know the product, the dose, the exact placement and the depth, and those four determine whether any of this matters in your case.
They also give aftercare instructions covering pressure and massage for a period after treatment, and those instructions govern whatever else you read.
Ask before your next appointment rather than after it, and bring specifics: the device, the output, which areas you work and how often.
What neither replaces
A neuromodulator does not build tone and a device does not relax a muscle, so neither is a substitute for the other.
Neither replaces lost volume, which is a filler question, and neither repositions tissue, which is what a facelift does.
Anyone presenting a home device as an alternative to injectables is describing a different mechanism and hoping you will not notice.
For the timing and spacing question, see facial devices and injectables, and for the layer map, the six layers of the face.
This is general information and not medical advice.
Two related questions come up often alongside this one, and we have answered both in full: the full safety picture, including who should not use one, and the timing around botox and fillers.