aging is a gradual process , proportional to time , that causes structural and functional 
 changes due to internal degeneration .
aging can be divided into intrinsic aging , which is natural with the 
 progression of time , and environmental aging caused by the external environment .
uv - induced photoaging is usually observed on skin that is exposed to the sun .
its clinical 
 characteristics include earlier observation than intrinsic aging , deep and wide wrinkles , 
 inconsistent pigmentation and solar lentigo on the exposed skin surface2 .
along with recent socio - financial improvements , improvements in medical technology , hygiene 
 and nutrition have increased life expectancy . as the elderly population increases ,
many 
 treatment methods to reduce skin aging and improve wrinkles and pores are currently being 
 researched4 , 5 .
however , ablative laser treatment causes a financial burden and 
 side effects , such as erythema , edema , and hyperpigmentation .
in addition , the damage on the 
 epidermis caused by ablative laser treatment delays the time between returning to daily 
 activities6,7,8 .
recently , non - ablative skin 
 rejuvenation , which improves skin aging and photoaging without damaging the epidermis , has 
 been the preferred treatment9 .
previous studies suggest that radiofrequency ( rf ) effectively reduces abdominal obesity by 
 transferring heat to the dermis , increases blood volume in the capillaries and hence 
 increases blood flow , induces collagen formation , and increases the thickness of the 
 epidermis10,11,12 .
electroacupunture ( ea ) 
 has been reported to reduce inflammation , induce healing of damaged tissues , reduce pain , 
 and improve facial rejuvenation13,14,15 . 

low - level laser therapy ( lllt ) has been used in various research studies and has been 
 reported to have anti - inflammatory effects , reduce pain , reduce edema , induce healing of 
 damaged tissue or fracture , produce collagen , induce skin rejuvenation and to be effective 
 for acne and vitiligo16,17,18,19,20,21 . in this study , the effects of rf , ea , and lllt on wrinkles and moisture content were 
 investigated in 30 female subjects aged 3055 years .
the results will be used as a reference 
 for the further development of skin physical therapy .
the subjects of this study were 30 adult women aged between 30 and 55  years who presented 
 at m dermatology hospital in yongin , gyeonggi - do , south korea and who voluntarily agreed to 
 participate after listening to an explanation of the purpose of the study .
the subjects were 
 assigned to rf , ( n=10 ) , ea ( n=10 ) or lllt ( n=10 ) groups .
inter - group homogeneity testing for general characteristics prior 
 to treatment revealed no significant differences .
the ethics committee of namseoul university , south korea approved the study 
 ( irb approval number : 104147 - 201504-hr-003 ) .
the characteristics of the subjects are shown 
 in table 1table 1.general characteristicsvariableslllt(n=10)ea(n=10)rf(n=10)age ( years)42.9  3.743.4  7.142.8  4.9height ( cm)159.8  4.3158.0  4.3163.0  7.9weight ( kg)52.4  6.158.8  7.256.7
lllt : low - level laser therapy group ; 
 rf : radiofrequency group ; ea : electroacupuncture group .
lllt : low - level laser therapy group ; 
 rf : radiofrequency group ; ea : electroacupuncture group for the rf group , prix iii ( shenb co. , ltd .
, korea ) was used at 1  mhz ( rf energy , maximum 
 450w / cm ) in two 15-minute sessions per week for six weeks22 . for the ea group
, disposable stainless steel acupuncture 
 ( 0.20  15 mm ) was used . for ea stimulation , an ots h-306 ( hanil tm co. , ltd .
, korea ) was 
 used at a frequency of 3  hz , with 5 seconds of on time and 2 seconds of off time .
the 
 intensity of the ea was increased until the subject felt simulation and a small muscular 
 contraction and was then maintained . for the lllt group , redpulsar ( sometech inc .
, korea ) , 
 which is a diode laser , was used in two 15-minute sessions per week for six weeks at 635  nm , 
 with 10mw of the laser class iiib23 . a janus skin measurement device ( psi co. , ltd .
the faces of 
 the subjects were fixed in a specific spot and the facial skin conditions were meticulously 
 photographed using a 10 megapixel canon dslr camera lens .
wrinkles under both eyes were 
 measured through front - view photos , whereas wrinkles on the eye rims were measured through 
 profile - view photos . to minimize the measurement errors , the same rater performed 
 measurements from the beginning to the end in similar indoor environments ( room temperature 
 2021  c and humidity 5060% ) . a moisture checker ( psi co. , ltd .
, korea ) was used to measure the skin moisture levels on 
 the forehead and right cheek . in order to reduce error ,
three measurements were taken and 
 the average was calculated ( table 2table 2.moisture ratevariablesforeheadcheekvery dry ( au)124124dry ( au)25342534moisturized ( au)35443544sufficiently moisturized ( au)45654565au : arbitrary unit ) .
all data were coded and analyzed using the spss statistical analysis program ( ver.18 ) .
to 
 determine the post - intervention changes in the number of wrinkles and moisture content in 
 each group , a test of normality was conducted .
if subjects passed the test , a paired samples 
 t - test was conducted ; otherwise , the wilcoxon rank - sum test was conducted . to determine
the 
 inter - group differences in wrinkles and moisture content , one - way analysis of variance was 
 used when they satisfied normality .
treatment of under eyes showed that wrinkles have significantly decreased on both sides 
 after rf , ea and lllt ( p<0.05 ) .
treatment of eye rims showed that wrinkles have 
 significantly decreased on the right side after rf , ea and lllt ( p<0.05 ) ( table 3table 3.changes in the number of wrinkles after rf , ea or lllt and a comparison of 
 wrinkle improvements between groupswrinklesinterventionprepostunder eyesrightrf*11.2  2.88.3  3.6ea*14.7  9.510.7  7.3lllt*14.4  6.211.3  4.4leftrf*12.9  4.58.0  3.3ea*16.5  8.913.0  7.3lllt*12.7  5.810.1  4.6eye rimsrightrf*8.1  4.16.0  3.1ea*12.3  8.19.8  5.9lllt*7.6  3.76.6  2.9leftrf7.9  5.26.8  4.3ea13.0  8.211.2  6.7lllt7.7  4.06.6  3.8values are shown as the mean  standard deviation , * significant difference between 
 the pre- and post - tests within each group , p<0.05 . paired samples 
 t - test ; wilcoxon rank - sum test ; rf : radiofrequency ; ea : 
 electroacupuncture ; lllt : low - level laser therapy ) .
values are shown as the mean  standard deviation , * significant difference between 
 the pre- and post - tests within each group , p<0.05 . paired samples 
 t - test ; wilcoxon rank - sum test ; rf : radiofrequency ; ea : 
 electroacupuncture ; lllt : low - level laser therapy treatment of forehead showed that skin moisture has significantly increased after rf , ea 
 and lllt ( p<0.05 ) .
treatment of cheek showed that skin moisture has significantly 
 increased after rf , ea and lllt ( p<0.05 ) .
significant differences have been observed on 
 skin moistures of the cheek between the two groups ( p<0.05 ) ( table 4table 4.changes in skin moisture after rf , ea or lllt and comparison of skin moisture 
 improvements between groupsmoisture contentinterventionprepostforeheadrf*35.3  2.537.1  3.0ea*33.7  3.838.7  3.2lllt32.9  4.836.9  4.9cheekrf*36.3  2.938.9  2.5ea*33.7  3.641.5  3.5lllt*34.5  2.939.9
 3.3values are shown as the mean  standard deviation , * significant difference between 
 the pre- and post - tests within each group , p<0.05 . paired samples 
 t - test ; wilcoxon rank - sum test ; lllt : low - level laser therapy ; ea : 
 electroacupuncture ; rf : radiofrequency ; 1 : rf ; 2 : ea ; 3 : lllt ) .
values are shown as the mean  standard deviation , * significant difference between 
 the pre- and post - tests within each group , p<0.05 .
paired samples 
 t - test ; wilcoxon rank - sum test ; lllt : low - level laser therapy ; ea : 
 electroacupuncture ; rf : radiofrequency ; 1 : rf ; 2 : ea ; 3 : lllt
desire for anti - aging and antioxidants has increased with economic growth and life 
 expectancy .
active participation of females in all aspects of society has increased the 
 attention paid to skin management3 , 21 .
therefore , this study aimed to 
 investigate the effects of rf , ea and lllt on wrinkles and skin moisture content .
a previous study by el - domyati et al.10 , 
 which conducted a quantitative evaluation of dermal collagen after rf treatment , reported an 
 increase in type i and type ii collagens and a decrease in the number of wrinkles under the 
 eyes and on the eye rims ( p<0.01 ) .
a study by abraham et al.24 also reported improvements in wrinkles , pore size , and the 
 laxity of facial skin .
the present study reported similar findings in that wrinkles under 
 the eyes and on the eye rims were significantly decreased ( p<0.05 ) .
based on previous 
 studies that reported that rf induces the formation of new collagen by transferring heat to 
 the dermis25 , 26 , we hypothesize that the formation of new collagen contributed to 
 the improvement of wrinkles under the eyes and on the eye rims in this study .
barrett14 reported that the number of 
 wrinkles on eye rims decreased by 50% and wrinkles under the eyes decreased by 20% after 10 
 sessions of ea .
kwon et al.27 reported 
 that miso facial rejuvenation acupuncture significantly decreased the width of wrinkles on 
 eye rims from 4.87  3.63 to 2.43  2.04 . using jae - seng acupuncture ,
cho et al.28 reported significant improvements in the 
 number of eye wrinkles , consistent with the present study ( p<0.001 ) .
a previous study by barolet et al.29 , in 
 which 12 led treatments at 660  nm , 50  mw / cm and 4  j / cm were conducted on a 3d 
 model of tissue - engineered human reconstructed skin , reported improvements in wrinkle depth , 
 surface roughness and fitzpatrick wrinkling severity scores .
russell et al.30 incorporated combination led light therapy 
 ( 633  nm and 830  nm ) and also reported improvements in periorbital wrinkles . in the present 
 study , wrinkles under the eyes on both sides and wrinkles on the left eye rims were 
 significantly decreased after lllt treatment ( p<0.05 ) .
based on previous studies , which 
 reported that lllt treatment induced collagen up regulation and down - regulation of matrix 
 metalloproteinase , it can be inferred that the increase in collagen on the epidermis 
 contributed to the improvement of wrinkles .
kwon et al.31 reported that the moisture 
 content of the right side of the face increased from 49.10  10.95au to 63.20  12.42au 
 after miso facial rejuvenation acupuncture ( p<0.001 ) . in the present study ,
the moisture 
 content improved significantly on the forehead and the cheek in the ea group ( p<0.05 ) . a 
 previous study by oh et al.32 reported 
 that the relaxation of the skin and the wrinkles increased as aging progresses since the 
 moisture content decreases .
therefore , it can be inferred that the increase in the moisture 
 content observed in the present study was caused by the decrease in wrinkles .
firstly , since the study was not conducted on 
 a large number of participants and it was only conducted on female adults between the ages 
 of 3055 years , generalization of the results is limited . secondly
, since the study only 
 confirmed the effects in a span of 6 weeks , evaluation of long - term effects was not 
 possible .
therefore , further studies should be conducted on a larger sample pool composed of 
 female participants from a larger age range , and long - term effects should be confirmed 
 during a span of at least 6 months .
 [ purpose ] the purpose of this study was to investigate the effects of radiofrequency 
 ( rf ) , electroacupuncture ( ea ) , and low - level laser therapy ( lllt ) , which are used in 
 physical therapies , on facial wrinkles and moisture . 
 [ subjects and methods ] a total of 30 
 female participants aged 3055 years participated in this study and the results will be 
 used as a reference for further development of skin physical therapy . 
 thirty adult females 
 were assigned to an lllt ( n=10 ) , ea ( n=10 ) , or rf group ( n=10 ) . 
 the intervention was 
 performed in two 15-minute sessions per week for six weeks . 
 subjects skin tone and 
 pigmentation were observed before and after the intervention . 
 [ results ] treatment of the 
 under eye area showed that wrinkles were significantly decreased on both sides after rf , 
 ea , and lllt . 
 treatment of the eye rims indicated that wrinkles significantly decreased on 
 the right side after rf , ea , and lllt . 
 [ conclusion ] the application of lllt , ea , and rf 
 had positive effects on wrinkle and moisture content of adult women s faces . 