1. INTRODUCTION:

Human skin has aging changed by two factors. The first is an internal aging. And the second is an outer aging, the internal aging caused by decreased hormone volumes with a controlled metabolism, falling down the function and activity of immunity and skin cells. Those problem will caused by reduce a bio syn-thesis and weakness of muscle tonus comes from an immunity proteins or a generative protein. SUKI alternative therapy promote the blood circulation on the skin and muscle regions. Normal blood circulation gives to make an all kind of metabolism activity and with that maintain to a skin flexibility and dermis function¹. The outer aging caused by increased wrinkles, decreased flexibility and an increased skin drying by the excessive sun aging with a various pollutants and an ultraviolet rays². And so it appears many women who used a lot money and time for the their face skin care³.

2. THEORETICAL BACKGROUND:

2.1 SUKI (Superficial Using Ki energy Instrument):

SUKI alternative therapy is a kind of oriental energy and multi-soft stimulating therapy that could be control the flow of chi energy on the human body and it helps the circulation the blood flow with the functional stability and a harmony and balance of autonomic nervous system. And more there is no side effects inflammation as like acupuncture therapy⁴. As a tool, that is designed for controlling the electrical energy flowing through the body surface. SUKI diameter is 2mm with a special metal material, 4mm Grip portion diameter, the entirely length is 65mm with cone type (ending region of SUKI).

SUKI alternative therapy is to activate the body's external region. SUKI technique is too simple and safety without pain and that could be comfortably and effectively promote the body conditions.

SUKI therapy has an advantage it could be accessed easily and securely, such as the public or professionals. In addition, when implemented in conjunction with other manual therapy show a strong synergistic effect. Nowadays so many countries (USA, Europe, South America, China, India etc.) using the alternative therapy for the people⁵. When normally chi energy flow it can be help make a body communication and can maintain a good health condition for human body.

1. Stimulation region: a special cheek muscle point.

2. SUKI measurement: before check muscle tonus and 5min after start the application therapy.

3. SUKI Experimental time: each participants performed 3minutes/4times in 4 weeks, according to the technique of the first method.

2.2 TENS (Transcutaneous Electrical Nerve Stimulation):

TENS is a kind of electrical instruments for treatments muscle problem in human body. Generally that has 4 types stimulation:

1) High frequency-low intensity stimulation

2) Low frequency-high intensity stimulation

3) High frequency-high intensity stimulation

4) Burst TENS

TENS measurement: before check muscle tonus and 5min after start the application therapy. TENS experimental time: each participants performed 5minutes/4times in 4 weeks, according to the technique of the first method

2.3 Structures of anatomy for CMT (Cheek Muscle Tonus):

Figure1. Buccinators⁶

As shown in <figure 1>. The buccinators muscle is a representative muscle in cheek region that has constructed as follows:

1) Structure: The buccinators arises from the outer surface of the alveolar processes of the maxilla bone and mandible, corresponding to the three pairs of molar teeth.

2) Origin: it is from the ptery-go-mandibular raphe and surrounding bony structures and insertion is in the fiber of the mouth.

3) Function: that purpose is pulls back the angle of the mouth and to flatten the cheek region. It is help in holding the cheek to the teeth during chewing. The buccinators assists the muscles of mastication.

4) Weakness: if this muscle will be weakness that escalating the aging on cheek area.

2.4 Skin structure⁷:

The skin is the single largest organ of the body. The word integument comes from a Latin word that means to covering it is reflecting the fact that the skin and its related structures form a covering over the entire body. And the skin is like as mirror reflective the internal organs in the human body⁸.

Skin and its related structures which the fatty tissue and muscles. Especially, the muscle is so much an important organs. Because this organs it gives effect to the skin tissues or aging. Some muscle weakness will cause the wrinkles and aging. In the face, eyes area, forehead, lower chin and cheeks region etc.

The dermis contains two major types of glands: sweat glands and sebaceous or oil, glands. If body gets too hot, sweat glands produce perspiration, or sweat. Sweat contains water, salts, and other compounds. When sweat evaporates, it takes heat away from the body. Sweat also gets rid of wastes from the blood, along with water. In this way, the skin acts as an organ of excretion. Sebaceous glands produce an oily secretion called sebum. Sebum spreads out along the surface of the skin and in the skincare, the dermis helps to keep the keratin-rich epidermis flexible and waterproof⁹. The inner layer of the skin is the dermis. The dermis lies beneath the epidermis and contains collagen fibers, blood vessels, nerve endings, glands, sensory receptors, smooth muscles, and hair follicles.

1) Collagen:

This layer has 90% in the dermis. They have a 19 amino-acid and one-third proteins in the human body. It is protecting the skin and wrinkle from the sun⁹. One of the causes of skin wrinkling is the lack of collagens. Collagen is a major protein that forms the skin of the dermis and serves to maintain skin structure and elasticity for as aging grows older, collagen decreases as aging grows and it is known to induce skin wrinkling by inducing the collapse of skin cells. Thus, most of people who want to try to will be younger and have a beautiful skins and appearance¹⁰.

2) Elastin fibers:

It is so strong protein with spring functions and the protecting the broken of skin cells. That has also an important factor for the skin flexibility. This main function is gives to recovering flexibility from the changed cells and it presented the area with need to elastin activity. Elastin fibers will destructive getting older and that effectiveness will get bad and make an aging and wrinkles. The representative aging skin results it shows the wrinkles¹¹.

2.5 MTM Apparatus

As shown in <figure 2, 3 ,4>. MTM is a kind of apparatus it is designated from the calculation for the muscle tonus and flexibility in the human body.

Figure 4. Measurement

3. MATERIALS AND METHODS:

The purpose of this study is to know the enforcement the muscle tonus comparing the stimulated to the special muscle regions by the SUKI (Superficial Using Ki energy Instruments) alternative medicine techniques and TENS (Transcutaneous Electrical Nerve Stimulation). This study subject is a total 14 (female 14) without an acute and a chronic disease (Table 1).

3.1 Test method 1:

The aim of this study was to find the impact of face muscle tonus and improve the tonus by SUKI stimulation via MTM analysis.

As shown in<figure 5, 6, 7, 8>. SUKI stimulation region is a special point on the face (R.t cheek region). That point is a buccinators.

Table 1. General Characteristics (body condition)

Method	Age(years)	Weight(kg)	Height(cm)
SUKI T	21.25±1.134	50.88±8.262	160.53±6.228
TENS T	21.98±1.433	51.24±8.102	161.15±7.762

1) Experimental group position:

2) lying posture

3) Experimental time: 3 minute/each person

4) Interrupted stimulation by SUKI

5) All the data was analyzed with SPSS 22.0 for window program.

Figure 5. Calibration Figure 6. Measurement

Figure 7. Calibration. Figure 8. Measurement

Test method 1, experimental group’s age average is 21.25 years old and body weight is 50.88 kg , and the 160.53 cm. As we can see this experiment is very important the relaxation of participants. And so all participants posture keep to supine positions. At first, marking to the experiment area which muscle tonus calculate using MTM and then SUKI stimulation 3mins duration with interrupted application. And then after, using the MTM calculate the stimulated area(buccinators). SUKI therapy could give to elasticity and flexibility to the face muscle tonus.

3.2 Test method 2:

The aim of this study was to find the impact of face muscle tonus and improve the tonus by TENS stimulation via MTM analysis. As shown in <figure 9, 10, 11, 12>. TENS stimulation region is a special point on the face (R.t cheek region). That point is a buccinators.

1) Experimental group position:

2) lying posture

3) Experimental time: 5 minute/each person

4) High frequency-low intensity stimulation

5) All the data was analyzed with SPSS 22.0 for window program.

Test method 2, experimental group’s age average is 21.98 years old and body weight is 51.24kg, and the 161.15cm. All the participants need to relaxation of face muscle. And so all participants posture keep to supine positions.

At first, marking to the experiment area which muscle tonus calculate using MTM and then TENS stimulation 5mins duration with interrupted application.

And then after, using the MTM calculate the stimulated area(buccinators). TENS stimulation give to the face muscle(buccinators) and then TENS conditions as follows:

The intensity 1 used by 100Hz and the mode used No.2. It calculated recording and comparing the before and after results contained each data after test.

4. RESULTS AND DISCUSSION:

4.1 Test Result:

The data processing of the study the measurements of all items, using the SPSS 22.0 for window average (mean: M): was calculated as (standard deviation SD) and the standard deviation.

Table 2. AUC value by MTM analysis (Each Ex Sum/4 times)

Application	Before m-tone	After m-tone	Difference	B-A ratio (%)
SUKI G1	13.446	14.535	1.089	8,099
SUKI G2	14.257	17.789	3,532	24,773
SUKI G3	14.658	17.422	2,764	18,856
SUKI G4	9.665	10.883	1,218	12,602
SUKI G5	11.355	14.653	3,298	29,044
SUKI G6	9.987	13.268	3,218	32,852
SUKI G7	13.868	14.455	0,587	4,232
TENS G1	15.279	13.482	-1.797	-11.761
TENS G2	14.152	15.534	1.382	9,765
TENS G3	14.424	13.266	-1.158	-8.028
TENS G4	13.624	12.325	-1,299	-7,339
TENS G5	11.657	11.443	-0,214	-1,835
TENS G6	15.225	15.563	0.338	2,220
TENS G7	13.552	14,443	0,891	6,574

4.2 Test result:

The data processing of the study the measurements of all items, using the SPSS 22.0 for window average (mean: M): was calculated as (standard deviation SD) and the standard deviation.

The whole subject was the by paired T-test and one-way ANOVA. It was showed a validated general characteristics of the subjects which using descriptive statistics. It was carried out paired t- test to compare the difference before and after the point compress technique of SUKI of subjects, statistical significance was set at p <.05.

The increased level of the muscle tonus(before and after in research process) are as follows (Table 2).

The first test methods 1 has showed a significant differences in the SUKI experiments(.014). and correlation/c(.798). The second methods 2 has did not show a significant differences in TENS(.068) and correlation/c(.687) (Table 3) .

Therefore, The SUKI alternative medicine techniques applied to the skin points of the face region it can know that showed increased muscle tonus effect on the specific part of the face. SUKI alternative therapy requires continuous research.

Improvements/Applications: SUKI G2 showed a 17,789 compared to post a significant increase the tonus(3,532) from 14,257 in the prior compress technique of SUKI after that before applying for the MGM index in the area. G5 in groups that were compared before and after compress technique of SUKI significant increase from 14,685 to 17,422 in the prior post about the tonus level(2,764). G6 in comparison before and after compress technique of SUKI to tonus in the area which were significantly increased to 11,355 to 14,653(3,298). G7 showed before in the prior 9,987 to the 13,268 which increased 3,218 difference tonus level.

TENS G1 showed a 13,482 compared to post a decrease the tonus(- 1,797) from 15,279 in the prior compress technique of TENS after that before applying for the MGM index in the area. G3 in groups that were compared before and after compress technique of TENS significant decrease from 14,424 to 13,266 in the prior post about the tonus level(-1,158). G4 showed significantly decreased 13,624 to 12,325(-1,299). G5 showed before in the prior 11,657 to the 11,443 which decreased 0,214 difference tonus level. Analysis of variance before and after experiments (one-way ANOVA) has showed statistical significant=0,012. The SUKI t–test, showed statistical significant=0,006. But the TENS t–test, did not showed significant difference=0,620. The results was that the SUKI alternative therapy technique had an increased effect for the cheek muscle tonus(buccinators)¹².

*p<0.05

Table 3. Correlation coefficient of Matching sample

Classification	N	Correlation/c	Significant
A/B SUKI	7	.798	.014
A/B TENS	7	.687	.068

Table4. Analysis of variance between B and A (one-way ANOVA)

T-delta
	Sum (square)	DF	Average (square)	False	P
G between G	17,215	1,000	9,216	2,938	0.012
Within G	28,570	11.000	0,837
Sum	45,785	12.000

This study was designed for the effectiveness of SUKI alternative medicine therapy to a face muscle tonus and an experimental group(female 14) was young women without no disease and medical diagnosis.

Some kind of long-duration uncomfortable position and unbalanced human position will make a disturbance of blood flow in the muscle¹³. Recently, with development of multi-medical technics and the economics circumstance emphasize the importance of appearance and the need of youth¹⁴. The correlation coefficient of matching sample data showed A/B correlation/c was 0.798. and the significant .014 by SUKI stimulation. But the A/B correlation/c was 0.687. the significant .068 by TENS stimulation(Table 3).

The analysis of variance between B and A(one-way ANOVA) data showed G between G was sum 17,215 and df 1,000 and average (square) 9,216 and false 2,938 and p value 0,012. But the within G was sum 28,570 and DF 11,000 and average(square) 0,837 and not showed p value(Table 4).

The matching sample verification data showed A/B SUKI deviation(Average 2,273/ SD/1.558/ SE 0.588) and p value 0,006. The A/B TENS deviation(Average 0,195/ SD 1,363/ SE 0,556). 95% CID maximum -0,214 and minimum 1,382 and p value 0,620. The CMT of face weakness will causing the wrinkle and aging to the buccinators area(Table 5). According to the results, nowadays known as widely kinds of various alternative therapy for the people health life¹⁵. Reported by thesis, muscle cells will activate with contraction and exercise by some kind of reasonably stimulations¹⁶. It was reported stress will give the physical problems on his master thesis¹⁷. And so some kind of stress will occur the weakness to the muscle tonus. And SUKI therapy increased the body energy flow and circulation¹⁸. Also said the SUKI alternative medicine gives to adjust the electrical energy¹⁹. In previous studies, it has been showed widely used such as the some kind of alternative therapy interventions for the increasing leverage of healing therapy program for the people. The human body has three types of muscle contraction like this: Concentric contraction and Eccentric contraction and Isometric contraction. This study is to know the effect for a certain face muscle tonus by stimulating with the SUKI alternative medicine therapy.

5. CONCLUSION:

The purpose of this study is to know the effects of changed face muscle tonus by SUKI alternative medicines therapy(pressure techniques) to stimulate the CMT(Cheek Muscle Tonus) as like a region(buccinators) and with comparing the TENS stimulation to the same area. The result is as follow:

Results of comparing the change before and after stimulation with SUKI therapy Analysis of variance before and after experiment(one-way ANOVA) has showed sig=0,012. The SUKI t–test, showed significant difference=0,006. But the TENS t–test, did not showed significant difference=0,620. The results was that the SUKI alternative therapy technique had an increased effect for the cheek muscle tonus(buccinators). *p<0.05

Over the results of the present study findings and research as a linear, a various techniques and tools can be seen that it is being used in a variety of ways for effective healthcare.

Therefore, the study suggests that require the use of tools such SUKI in order to improve function through the muscles tonus.

6. REFERENCES:

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Received on 12.12.2017 Modified on 24.12.2017

Research J. Pharm. and Tech. 2018; 11(3): 879-884.

DOI: 10.5958/0974-360X.2018.00163.4

	Match difference					t	DF	P
	Deviation			95% CID
	Average	SD	SE average	Mini	Maxi
A/B SUKI	2.273	1.558	.588	.587	3.532	3.240	6	.006
A/B TENS	.195	1.363	.556	-0.214	1.382	.343	5	.620

The Effects on Face Muscle Tonus by SUKI Alternative Therapy