Radiofrequency Microneedling: Overview of Technology, Advantages, Differences in Devices, Studies, and Indications

Effective treatment of corticosteroid-induced facial erythema using fractional radiofrequency microneedling

OBJECTIVES

To investigate the efficacy of Fractional Radiofrequency Microneedling (FRM) in treating corticosteroid-induced facial erythema.

METHODS

A retrospective study was conducted involving eight patients diagnosed as corticosteroid-induced facial erythema. Each patient underwent a single session of FRM. Evaluative measures included Clinician's Erythema Assessment (CEA), Patient's Self-Assessment (PSA), assessment of telangiectasia severity, procedure-associated pain (10-point scale), patient satisfaction (3-point scale) and secondary outcomes.

RESULTS

The study found a 75% success rate and 100% effectiveness rate in alleviating erythema symptoms. CEA and PSA scores decreased by 67.7% and 78.1%, respectively. No cases of erythema rebound were recorded during the 3-month follow-up period.

CONCLUSIONS

FRM demonstrated effectiveness and safety in treating facial erythema, offering promising advancement in dermatologic therapeutics.

Paired Treatment Using Radiofrequency Microneedling and 755-nm Picosecond Laser With Fractionated Lens Array for Facial Rejuvenation

BACKGROUND

Patients frequently complain about fine lines, wrinkles, dyschromia, and photoaging, for which lasers and energy-based devices can treat each of these. Pairing various devices in a single treatment session can be safe and effective, but different technologies, mechanisms, histologies, parameters, and techniques must be considered.

OBJECTIVE

To examine the utility of a paired treatment regimen using radiofrequency microneedling and 755-nm picosecond laser with fractionated lens array to improve the clinical appearance of facial wrinkles and photoaging.

MATERIALS AND METHODS

A prospective clinical study investigated this paired treatment regimen using 4 monthly sessions.

RESULTS

Twenty-five subjects were enrolled, while 18 subjects completed 3-month follow-up. The mean age was 54 years, and 92% were women. Fitzpatrick Skin Types I to IV were represented. Assessments compared baseline with the 3-month follow-up. Two of 3 blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 94.4% of cases. For physician Global Aesthetic Improvement Scale, 100% of subjects had clinical improvement. Overall, 88.9% of subjects were considered to be satisfied with their treatment. No serious or unanticipated adverse events occurred.

CONCLUSION

Paired treatment using radiofrequency microneedling and 755-nm picosecond laser with fractionated lens array can safely and effectively improve facial wrinkles and photoaging.

Efficacy and safety of fractional micro-needling radiofrequency for the treatment of enlarged pores on the cheeks of a chinese cohort: a retrospective study

To explore the efficacy and safety of fractional micro-needling radiofrequency (FMRF) in the treatment of enlarged pores on the cheek in a Chinese cohort. Patients with enlarged facial pores who underwent FMRF between January 2020 and December 2022 were included in this study. Blinded clinical assessments were performed by two independent dermatologists using a six-grade photographic enlarged pore scale and a quartile grading scale. Patients were asked to rate the degree of pain related to treatment on a visual analog scale (VAS), with scores ranging from 0 (no pain) to 10 (worst pain ever). A paired t-test was used to analyze the six-grade photographic enlarged pore scores. A total of 22 patients received three consecutive sessions of FMRF treatment, with intervals of 1-3 months, and underwent follow-up as scheduled. The mean six-grade photographic enlarged score was 3.55 ± 0.96 at baseline, while the score decreased significantly to 2.59 ± 0.59 after three treatment sessions (P < 0.05). The improvement score of the patients, assessed by two independent dermatologists, was 2.31 ± 0.71, according to the quartile grading scale. The mean VAS score was 6.42 ± 1.44. FMRF is effective and safe for the treatment of enlarged facial pores after three sessions.

Efficacy and safety of fractional microneedle radiofrequency for atrophic acne scars: A real-world clinical study of 126 patients

OBJECTIVE

To analyze the clinical efficacy and safety of fractional microneedle radiofrequency (FMR) for facial atrophic acne scars in a real-world setting.

METHODS

The clinical data of patients with atrophic acne scars who had received FMR therapy from February 2018 to August 2022 were retrospectively analyzed. The improvement of atrophic acne scars was assessed using the ECCA Grading Scale (échelle d'évaluation clinique des cicatrices d'acné), Global Aesthetic Improvement Scale (GAIS), and modified Manchester Scar Scale (mMSS). Adverse reactions during FMR treatment were also recorded. Univariate and multivariate logistic regression analyses were performed to evaluate the efficacy and safety of FMR for atrophic acne scars.

RESULTS

A total of 126 patients with facial atrophic acne scars were included. A total of 590 FMR treatment sessions were accomplished, with each of 82 patients receiving 4 or more treatment sessions, and 1 receiving a maximum of 14 sessions. All patients showed improvement in symptoms after FMR treatment, with moderate to significant improvement (ECCA score reduction of 26%-100%) in 92 (73.0%) patients. As the number of treatment sessions increased, the ECCA score gradually decreased from an average of 85.6 before to 35.0 after FMR. The average scores for distortion, color, and visual analogue scale (VAS) of mMSS all showed certain reductions. The change in GAIS score indicated improvement after treatment, with minimal improvement in 16 patients (12.7%), good improvement in 57 patients (45.2%), significant improvement in 45 patients (35.7%), and optimal improvement in 8 patients (6.4%). The univariate and multivariate logistic regression analyses revealed that the long pulse width and the number of FMR treatment sessions were positively associated with clinical efficacy. Compared to the short pulse-width group (200 ms), the longer pulse-width group (300 ms) (odds ratio [OR] = 8.3, p = 0.003) and the even longer pulse-width group (400-500 ms) (OR = 52.6, p < 0.001) demonstrated stronger efficacies. Patients who received more than three treatment sessions had better outcomes compared to those who received three or fewer treatment sessions (OR = 4.0, p = 0.036). All patients experienced posttreatment transient erythema, but no crusting, infection, or blister. Six cases developed grid-like erythema around 1 month posttreatment and one case experienced hyperpigmentation, both of which resolved within 1-3 months after appropriate management.

CONCLUSION

FMR is a safe and effective treatment modality for improving facial atrophic acne scars, and the number of FMR treatment sessions and pulse width are associated with clinical efficacy.

Treatment of periorbital aging with negative pressure fractional microneedle radiofrequency: A self-controlled clinical trial

BACKGROUND

Several treatment modalities are used for the treatment of periorbital rejuvenation with variable results. Recent studies showed that fractional radiofrequency may be an effective treatment modality for periorbital aging. This study aims to determine the efficacy and safety of negative pressure fractional microneedle radiofrequency (NPFMR) as a treatment for periorbital aging.

METHODS

Twenty-five patients with periorbital aging were involved in this study. They were treated two times with an interval of 1 month. The patients were evaluated before treatment and 1, 3, and 6 months after the final treatment.

RESULTS

The research findings suggest that periorbital wrinkles of the patients were significantly improved by VISIA system (p < 0.05). Physiological indicators detected by MPA10 system showed that compared with before treatment, the hydration increased (p < 0.05) and trans epidermal water loss (TEWL) decreased (p < 0.05) at 3 and 6 months after treatment. The glossiness increased at 1 month after treatment compared to pre-treatment (p < 0.05) and returned to the baseline level at 3 and 6 months after treatment. There was no significant change in melanin content (p > 0.05). Periorbital dermal thickness of the patients significantly increased at 1, 3, and 6 months after treatment according to skin ultrasound (p < 0.05). A periorbital skin biopsy revealed that the collagen fibers in the dermis were significantly thicker and more orderly after treatment, and the expression of type I collagen fibers and elastic fibers was increased compared with that before treatment. One patient developed post-inflammatory hyperpigmentation (PIH) at 1 month after the first treatment, which improved after active treatment. No other adverse reactions were observed.

CONCLUSIONS

NPMFR could be an effective and safe treatment modality for the treatment of periorbital aging.

Review of radiofrequency microneedling: history, devices and uses

Radiofrequency microneedling (RFM) has recently become a popular choice for the treatment of various dermatologic conditions and rejuvenation. Many studies have sought to evaluate the efficacy of RFM. However, its role in the management of these conditions remains unclear. A comprehensive literature search including randomized controlled trials, cohort studies, and case series evaluating the efficacy of RFM in various skin conditions was performed. In this review, we discuss the history and mechanism of RFM, describe various device features, and discuss the use of RFM in various skin conditions and rejuvenation.

Successful treatment of rare adverse event after radiofrequency microneedle on Fitzpatrick skin type IV : a case report

Radiofrequency microneedle (RFM) is relatively safe to use for all skin types but there is still possibility of adverse events. Tram-track scarring or uniform papular eruptions is a rarely reported adverse event, but it is challenging to manage. We report a case of successful treatment of tram track scarring post RFM using a combination of light emitting diodes 640 nm and a salicylic acid peel and home treatment with a combination of azelaic acid and retinoic acid. There is still no standard therapy to treat this case. The results of clinical observations showed the lesions completely recovered in 6 months.

Radiofrequency Microneedling: Technology, Devices, and Indications in the Modern Plastic Surgery Practice

Background

Since the initial invention of microneedling, advancements have been made to improve the desired effects. The addition of radiofrequency to microneedling devices was developed within the past decade as a way to induce thermal injury and increase dermal heating to enhance the dermal wound healing cascade.

Objectives

With an overabundance of literature and mainstream media focused on microneedling and radiofrequency microneedling, this review aims to focus on the available high-quality evidence.

Methods

A comprehensive review of the literature was performed across PubMed (National Institutes of Health, Bethesda, MD) and Embase (Elsevier, Amsterdam, the Netherlands) databases. Attention was focused on manuscripts that provided objective data with respect to clinical application, innovation, anatomy, and physiology.

Results

Optimal outcomes are achieved when needle depth is targeted to the reticular dermis. Needle depth should reflect the relative differences in epidermal and dermal thickness throughout the face. A depth of at least 1.5 mm should be used for the forehead and temporal skin, 1.0 mm for the malar region, 2.0 mm (maximum depth for radiofrequency microneedling) for the nasal side walls, 0.5 mm for the perioral skin, and 1.5 mm for the neck. Deeper settings can be used with care to provide some fat reduction in the submentum.

Conclusions

The authors find herein that radiofrequency microneedling is a safe adjunctive tool to surgical aesthetic procedures. The addition of radiofrequency poses an advance over traditional microneedling devices for skin tightening, with improvements in both safety and efficacy over time.

Level of Evidence 5

Nonsurgical Rejuvenation of the Neck

Nonsurgical skin tightening in the neck is an area of significant growth with seemingly countless devices. Optimal treatment choice depends on the patient's concerns, anatomy, and lifestyle. Patients with minimal skin laxity, but dynamic platysmal bands may benefit from botulinum toxin injections. Mild to moderately lax skin can be addressed with microfocused ultrasound or radiofrequency with microneedling. Significant sun damage and laxity can both be addressed with fractional ablative lasers. Options for submental preplatysmal fat include percutaneous radiofrequency, radiofrequency-helium plasma, deoxycholic acid injections, and cryolipolysis. Of these, percutaneous radiofrequency has the highest patient satisfaction and lowest complication rate.

Clinical outcomes and patient satisfaction after S.I.H technology®: follow-up of 258 patients

BACKGROUND

Aging is a natural process. The association between the gradual loss of tissue integrity and the force of gravity determines a condition from which it is complex to go back. The approval by the American FDA of the monopolar radiofrequency (Thermage^®) dates back to 2002. Since then, innovation has made great strides up to the development of endodermal technology in recent years which allows subcutaneous probes to act with precision and under careful control on the treated areas.

METHODS

We retrospectively reported our experience in rejuvenation treatments of the face and of different areas of the body using the Subdermal Induced Heat (S.I.H.) technology^®, featuring a population of 258 patients who received 502 treatments between 2018 and 2022. Clinical outcomes and patient satisfaction were assessed, respectively by analyzing adverse events and complications at 7 days from treatment, and patient-reported outcome at 3, 6 and 12 months using a 5-point Likert Scale.

RESULTS

Only 25 complications were reported, of which 68% consisted in bruising, 24% in hematomas and 8% in edema. Most patient were reportedly satisfied with overall treatment, with 55% of them being "very satisfied" with the results at 6 months from initial procedure.

CONCLUSIONS

We highlight the manageability of the S.I.H. technology which has been proven to be safe and effective in achieving satisfying results for skin rejuvenation, with a reduced number of sessions required and good maintenance of the results obtained.

Energy-based devices in the treatment of acne scars in skin of color

BACKGROUND

Acne scarring is disfiguring and psychologically taxing on patients. Many energy-based modalities have emerged and been studied for the treatment of acne scarring; however, there is a paucity of these studies in skin phototypes IV-VI.

OBJECTIVE

To review the medical literature and discuss the most significant studies regarding safety and efficacy of energy-based devices (ablative lasers, non-ablative lasers, and radiofrequency microneedling) in the treatment of ethnic skin (skin phototypes IV-VI).

METHODS

A literature search was conducted using the PubMed database and bibliographies of relevant articles.

RESULTS

Ablative and non-ablative lasers have proven to be effective for treatment of acne scars in ethnic skin. The risk of developing adverse effects such as post-inflammatory hyperpigmentation is contingent upon several factors including skin phototype, laser device, fluence, and moreso density settings. Non-ablative fractional lasers have been considered first line for the treatment of acne scars in skin of color due to their better safety profile; however, they are less efficacious and require more treatments compared to ablative lasers. Studies regarding efficacy and safety of radiofrequency microneedling for treatment of acne scarring in skin of color are limited, but are promising.

CONCLUSION

Ablative lasers, non-ablative lasers, and radiofrequency microneedling are all useful treatments for acne scarring in ethnic skin when appropriate settings are used. Further head-to-head studies are needed to evaluate their efficacy and safety in darker skin phototypes V-VI.

Radiofrequency and Radiofrequency Microneedling in Skin of Color: A Review of Usage, Safety, and Efficacy

BACKGROUND

Radiofrequency (RF) and radiofrequency microneedling (RFM) for rhytides, scarring, and skin rejuvenation are believed to have a lower risk of postprocedural dyspigmentation in darker skin types.

OBJECTIVE

To explore the safety and efficacy of RF and RFM in Fitzpatrick skin Types III to VI.

METHODS AND MATERIALS

A systematic review of PubMed/MEDLINE databases from 2000 to 2021 using combinations of the terms radiofrequency, microneedling, skin of color, and Fitzpatrick was performed. Exclusion criteria included non-Fitzpatrick skin Types III-VI patient population, nonprimary articles, nonskin radiofrequency, and nonhuman studies.

RESULTS

Thirty-five articles addressing the use of RF or RFM in skin of color were identified-22 for skin rejuvenation, 7 for acne scars, 4 for nonacne scars, 1 for hyperpigmentation, and 1 for acne treatment. Seven studies noted transient postinflammatory hyperpigmentation, 1 observed mild prolonged hyperpigmentation, and only 1 study reported permanent scarring.

CONCLUSION

Radiofrequency and RFM seem to have a low risk of scarring or hyperpigmentation in skin of color. This review demonstrates that these procedures have been successfully used primarily for rhytides, acne scarring, and skin rejuvenation. However, a large proportion of the studies lack strong quality evidence.

Clinical and histological evaluation of microneedle fractional radiofrequency treatment on facial fine lines and skin laxity in Koreans

BACKGROUND

Facial wrinkles and sagging are the most visible signs of aging and can cause profound distress. Microneedle fractional radiofrequency (MFR) is a minimally invasive procedure, which utilizes both microneedling and radiofrequency energy to rejuvenate the skin.

OBJECTIVE

To describe the safety and efficacy of a temperature-controlled MFR device on facial fine lines and laxity.

PATIENTS AND METHODS

A retrospective chart & histology review was performed on individuals who received bipolar MFR for facial rejuvenation. A total of 15 Koreans with a median age of 46 years were included. All participants underwent a single treatment session. The results were assessed objectively using serial photography and subjectively based on the participants' satisfaction scores. Histologic changes before, immediately after MFR and at 4 months follow-up was examined. Complications were also recorded.

RESULTS

Partially denatured collagen fibers and dermal shrinkage was observed immediately after MFR whereas an increase in elastin and collagen was noted at 4 months follow-up. 86.7% of recipients considered the results satisfactory. Consensus ratings by two independent dermatologists on the objective outcomes at 4-month follow-up were very much improved (53.3%), much improved (26.7%) and improved (20%). Treatment was well tolerated and did not cause any significant long-lasting discomfort.

CONCLUSION

Temperature-controlled bipolar MFR is a minimally invasive treatment option to consider for facial fine lines and laxity via neo-collagenesis and neo-elastogenesis. The procedure was safe and clinically effective.

Fractional microneedle radiofrequency treatment for enlarged facial pores: A real-world retrospective observational study on 75 patients

OBJECTIVE

This study aimed to analyze the clinical results and influencing factors of the fractional microneedle radiofrequency (FMR) treatment for enlarged facial pores on different facial sites.

METHODS

The clinical data of patients with enlarged facial pores who underwent FMR treatment from January 2019 to December 2020 were collected. The efficacy and complications of FMR for enlarged pores in different facial areas were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to explore the clinical factors related to the efficacy of FMR after the first treatment session.

RESULTS

Totally, 75 patients with enlarged facial pores were included (full-face FMR for 45, nasal FMR for 58, frontal FMR for 45, and cheek FMR for 72 patients). All patients received more than one treatment session, two patients received five treatment sessions, and the mean number of FMR session was 1.7. The moderate to excellent improvement rates in patients with nasal, frontal and cheek enlarged pores after the first session were 13.8%, 8.9%, and 11.1%, respectively. The improvement rate rose with the increasing number of treatment sessions. Multivariate logistic regression analysis revealed that long pulse-width (300 ms) was positively associated with clinical efficacy after the first session (OR = 22.4, 95% CI [2.0-250.4], p = 0.012), compared with the short pulse-width group (100-200 ms). The main adverse effects after FMR were transient pain, erythema, and edema. A minority of patients developed acneiform eruption.

CONCLUSION

This study confirms that FMR is safe and effective in improving enlarged facial pores. The pulse width is associated with the improvement of nasal enlarged pores.

Efficacy of microneedle radiofrequency therapy in the treatment of senile purpura: A prospective study

BACKGROUND

Radiofrequency (RF) devices have been used for skin rejuvenation and treating skin laxity. It may also be effective for senile purpura (SP) based on its action of promoting neocollagenesis with minimal epidermal damage. This study aimed to evaluate the efficacy and safety of microneedle RF for treating SP of the forearms in elderly.

MATERIAL AND METHODS

In this prospective study, 23 patients who underwent a single session of microneedle RF device (GENIUS, Lutronic Co., Korea) therapy for SP were enrolled. Histopathological features were assessed 1 week before and 8 weeks after therapy. The total amount of collagen and elastic fibers were measured using the computer vision method, and epidermal thickness and the number of blood vessels were analyzed using ImageJ. The clinical improvements were evaluated by blinded evaluators and the patients using investigator global assessment (IGA) and patient global assessment (PGA), respectively. Data regarding the number of purpuric lesions and the size of the largest lesion were collected via a telephone survey.

RESULTS

The total amount of collagen and elastic fibers, and mean epidermal thickness tended to improve after RF treatments, although they did not reach statistical significance. The locally estimated scatterplot smoothing curve showed decreasing tendency in both size and number of purpuras as weeks progressed. PGA showed very satisfied in 65% of patients and IGA showed 39% near-total improvement and 43% marked improvement. There were no serious adverse events.

CONCLUSIONS

Microneedle RF therapy induces remodeling of dermal circumstances with minimal epidermal impairment. It may be a promising therapeutic option for SP.

Dermatologic facial applications of Morpheus8 fractional radiofrequency microneedling

Dermatologic patients are expressing increasing interest in minimally invasive procedures to address a wide range of common concerns from skin laxity to acne and scarring. Fractional radiofrequency (RF) microneedling offers an effective method for addressing a variety of dermatologic conditions with reduced downtime compared with historically more invasive procedural approaches. This article aims to describe the technology utilized in fractional RF microneedling (Morpheus8, InMode Aesthetics) and its studied applications in dermatology for treatment of the face.

Synergistic effect of microneedle-delivered extracellular matrix compound and radiofrequency on rejuvenation of periorbital wrinkles

Background

A combination of minimally invasive modalities can induce collagen regeneration more quickly and promote the penetration of topical agents, thus promoting skin rejuvenation. In this study, we aimed to investigate the synergistic efficacy of extracellular matrix compound (ECM-C) via microneedle (MN) and radiofrequency (RF) on periorbital wrinkles.

Method

A total of 25 participants with periorbital wrinkles were selected for this study. The left and right side of the periorbital area was randomly given ECM-C via MN or ECM-C via MN combined with RF. MN combined with ECM-C treatment was given 5 times at 2 weeks intervals, whereas RF treatment was given 3 times at 4-week intervals. The following items were assessed: wrinkles by VISIA^® system; biophysical parameters such as skin hydration, transepidermal water loss (TEWL), erythema index, and melanin index by CK multiple probe adapter; and skin elasticity and skin thickness by DermaLab Combo^® photographs were taken at the baseline and 2 weeks after the last treatment. Subjective assessments, such as Crow's Feet Grading Scale (CFGS) and Global Aesthetic International Scale (GAIS), were also recorded.

Result

A total of 25 participants with an average age of 43 years participated in this trial. Periorbital wrinkles on both sides decreased after the treatment, and the side treated with ECM via MN and RF showed better improvement than the other side with ECM-C via MN alone. Skin hydration increased after the treatment on both sides. TEWL, skin erythema, and skin melanin indexes were not changed. Skin elasticity and skin thickness increased more on the side of ECM-C via MN and RF than on the other side of ECM-C via MN alone. The evaluation scores for CFGS improved on either side; however, no difference was found for CFGS and GAIS between intergroup comparisons after the treatment.

Conclusion

The objective assessment of wrinkles, elasticity, and thickness of periorbital skin improved more on the side with ECM-C treatment via MN combined with RF than on the other side of ECM-C treatment via MN only. However, no statistically significant difference was found between the subjective CFGS and GAIS evaluation of the two sides.

Evaluation of clinical results of combined correction of age-related skin changes using fractional microneedle therapy and platelet-rich plasma activated by autologous thrombin

Background. Involutive processes in the human body are often accompanied by the only visible manifestation - a change in appearance. Against this background, the search for new treatment methods that will focus on timely and rational correction of age-related skin changes and combine the possibility of complex effects on the mechanisms of skin aging is relevant. Hardware physiotherapy technologies and innovative autologous cellular preparations have a powerful regenerative potential, trigger and support physiological tissue regeneration. Despite the substantial amount of data on combined aesthetic correction protocols, there were only isolated data in the domestic and foreign literature on the combined use of fractional needle radiofrequency therapy and platelet-rich plasma activated by autologous thrombin. This was the basis for this study. Aims. To evaluate the results of a combined method for correcting age-related skin changes based on a combination of hardware fractional needle radiofrequency exposure and injection therapy with platelet-rich plasma activated by autologous thrombin, comparing to monotherapy the same methods. Materials and methods. Fractional microneedle radiofrequency therapy was carried out three times with an interval between procedures of 3 weeks with the use of a high-frequency electrosurgical device Scarlet RF. Therapy with autologous plasma rich in platelets activated by autologous thrombin (PRP therapy) was performed three times with an interval between procedures of 3 weeks without the use of preliminary topical anesthesia. Combination therapy combined the use of the above methods. Regression of clinical signs of skin aging was evaluated according to digital dermatoscopy and regression of the total value of the dermatological index of the quality of life of patients, as well as improvement of qualitative and functional parameters of the skin. A statistical analysis was carried out. Results. A comparative analysis of the influence of various methods of correction of involutive changes in the skin of the face showed that the use of combination therapy provides the development of the most significant clinical effect in relation to all the assessed signs of skin aging. Combination therapy was accompanied by a significant increase in the integral index of microcirculation, regardless of age. The reconstructive effect on the morphological structures of the skin according to ultrasonography also turned out to be significantly higher for the combined method of treatment in comparison with radiofrequency therapy. Conclusions. The combined use of fractional microneedle radiofrequency therapy and PRP therapy provides a more effective and prolonged correction of age-related skin changes compared to the monotherapy.

Efficacy and Safety of Using Noninsulated Microneedle Radiofrequency Alone Versus in Combination with Polynucleotides for the Treatment of Melasma: A Pilot Study

Introduction

This split-face, double-blind, randomized controlled study investigated the efficacy and safety of using a microneedling radiofrequency (RF) device with polynucleotides (PN) versus RF alone for the treatment of melasma.

Methods

Thirty adult participants with melasma (Fitzpatrick skin types III–V) received three treatments with an invasive, bipolar, pulsed-type microneedling RF device on both sides of the face. The treatment sessions occurred once every 2 weeks. The hemifaces of each participant were designated for treatment and control with PN and normal saline solution (NSS), applied after treatment with RF. Measurements were made of melanin index (MI), erythema index (EI), skin roughness (by the Antera 3D system), modified melasma area severity index (mMASI) for each hemiface, and patients’ self-assessed improvement. These occurred at baseline and again following the final treatment (2 weeks and 1, 2, 3, and 6 months after). Mean values were obtained for MI, EI, skin roughness, and mMASI. A generalized estimating equation (GEE) was used to compare the obtained values for the outcome measures across all assessment points.

Results

All patients were women (mean age, 43.2 ± 7.0 years). Mixed melasma predominated (61.5%; n = 16), and the mean duration of melasma was 8.9 ± 6.5 years. Twenty-six participants were followed up to the 6-month assessment point. Significant improvements were observed from baseline in MI, skin roughness, and mMASI scores for both the PN and control sides at 6 months, with no statistically significant differences between sides. Patients’ self-assessed improvement scores also showed a positive trend. Melasma recurrence was observed in three patients at 2, 3, and 4 months after the last treatment session (10% recurrence rate).

Conclusions

The combination of an invasive, bipolar, pulsed-type microneedling RF with PN is not superior compared with microneedling RF alone in the treatment of melasma. Microneedling RF may be considered as safe and efficacious for the improvement of skin roughness, and as an adjunctive treatment option for melasma.

Clinical Trial Registration

This study was registered on ClinicalTrials.gov and assigned NCT number TCTR20210804002.

Efficacy and Safety of Using Noninsulated Microneedle Radiofrequency Alone versus in Combination with Polynucleotides for Treatment of Periorbital Wrinkles

Introduction

A few studies have evaluated the efficacy and safety of noninsulated radiofrequency microneedling (RFMN) to treat periorbital wrinkles in Asian patients. Recently, wound healing accelerators, polynucleotides (PNs), have received attention in wound management. However, their efficacy and safety have not been fully elucidated following RFNM. This study aimed to evaluate the efficacy and safety of noninsulated RFMN for periorbital wrinkles and the synergistic effect of PNs after RFMN.

Methods

Thirty subjects with Fitzpatrick skin types III to V and facial wrinkles (Fitzpatrick grades I and II) were enrolled. All volunteers were treated over the entire face with noninsulated RFMN for three sessions at 2-week intervals. The left and right sides of each patient’s face were randomly assigned to receive PNs (treatment group) or normal saline solution (control group). The indentation and maximum depth of wrinkles were objectively measured using Antera 3D. Subjective self-evaluations were obtained at baseline, 2 weeks after the third treatment, and at 1, 2, 3, and 6 months after the final treatment. In addition, pain scores, immediate reactions, and other adverse effects were evaluated.

Results

Twenty-nine subjects completed the treatment protocol. Most presented with grade II wrinkling (69%). At 2-month follow-up, Antera 3D image analysis revealed faster improvement for the treatment group. At 6-month follow-up, the majority of subjects reported an improvement of 25–75% in their periorbital wrinkles. The average pain score was 2.2 out of 10. No serious adverse events (infection, pigmentary alteration, persistent erythema, or scarring) were observed.

Conclusions

Noninsulated RFMN is safe and effective for treating periorbital wrinkles and can be used as a modality for transdermal drug delivery. Topical polynucleotides as an adjunctive treatment provide additional benefits for periorbital wrinkle treatment.

Trial Registration Number

TCTR20201105007.

Visualization of energy-based device-induced thermal tissue alterations using bimodal ex-vivo confocal microscopy with digital staining. A proof-of-concept study

BACKGROUND

Ex-vivo confocal microscopy (EVCM) enables examination of tissue alterations immediately after treatment with energy-based devices (EBDs). This proof-of-concept study aimed to describe EBD-induced tissue effects in ex-vivo porcine skin after treatment with microneedle radiofrequency (MNRF) and ablative fractional CO₂ -laser (AFL) using EVCM.

MATERIALS AND METHODS

Ex-vivo porcine skin was treated with MNRF and AFL. Three cryosections from each intervention were stained with acridine orange (AO) and scanned with EVCM. Reflectance confocal microscopy (RCM, 638 nm) and fluorescence confocal microscopy (FCM, 488 nm) images were captured and evaluated individually, after image fusion, and after digital hematoxylin and eosin (H&E) staining.

RESULTS

Bimodal EVCM was able to visualize EBD-induced thermal alterations in porcine skin. In RCM mode, the full width and depth of the vertically aligned microscopic treatment zones (MTZs) were displayed with clear demarcation to surrounding intact skin. In FCM mode, the ablation of the epidermis after AFL was prominent in contrast with the almost intact epidermis observed in MNRF treated skin. In fusion mode, fluorescence signal from AO marked the surrounding coagulation zone (CZ) from both interventions, with enhanced discrimination between ablation and coagulation. Digitally H&E-stained images closely resembled conventional histopathology but proved superior in terms of visualization of the CZ.

CONCLUSION

Bimodal EVCM with digital H&E-staining facilitates the identification and qualitative evaluation of thermal alterations induced by treatment with EBD. By providing high-resolution images comparable to standard histology, EVCM is a useful tool in the research and development of EBD to visualize and evaluate device-tissue interactions.

Optimizing skin tightening in aesthetics in men

The field of cosmetic dermatology has recently witnessed unbridled growth in the past several years. Part of this has been due to the increasing popularity of aesthetic treatments in men, who represent a growing patient population. Men tend to have higher levels of collagen density and greater skin thickness, but these begin to decrease earlier on. They can also more frequently have severe photodamage. Their clinical presentations can affect the selection of treatments. Physicians should be familiar with the subtle differences between treating men and women. Early studies and literature are beginning to shed more light on these important distinctions. We review the notable differences in facial aging, pathophysiology, and patient selection and discuss available treatment options with these factors in mind.

Transvaginal radiofrequency energy for the treatment of urinary stress incontinence: A comparison of monopolar and bipolar technologies in both pre- and post-menopausal patients

AIM

A study to compare the effect of two different radio frequency energy models (mono polar and bipolar) for the treatment of urinary stress incontinence.

METHODS

Retrospective chart review, which was conducted at 2 sites, 69 patients received treatment with a bipolar radiofrequency device. Out of those 69 patients, 13 patients received bipolar in conjugation with CO₂ laser treatment, while 32 patients received monopolar frequency. The study protocol normally consists of three sessions of treatment. Each session was four weeks apart with a whole 6-month duration follow-up. Results were evaluated by urogenital distress inventory (UDI)-6 questionnaire before and after treatment.

RESULTS

The bipolar group improved UDI-6 scores across time more so than did the monopolar group with some evidence suggesting that the bipolar radiofrequency treatment was more effective compared to the monopolar radiofrequency. Three months after treatment, the bipolar group UDI-6 values were lower than those of the monopolar group. Six months after treatment, the UDI-6 scores increased in both groups, suggesting decrease efficacy with time however, the bipolar group's UDI-6 scores were consistently lower than the monopolar group's scores.

CONCLUSION

This study shows benefit of both monopolar and bipolar radiofrequency device in patients with stress urinary incontinence and mixed UI, with bipolar RF more efficacious than monopolar RF. More randomized prospective studies are needed to confirm these findings.

Synergistic Effect of 300 μm Needle-Depth Fractional Microneedling Radiofrequency on the Treatment of Senescence-Induced Aging Hyperpigmentation of the Skin

Aging-associated dermatological pigmentary diseases are associated with accumulation of senescence cells and the disruption of basement membrane due to chronic ultraviolet radiation (UVR) exposure. Our study is on the synergistic effect of the novel 300 μm needle-depth fractional microneedling radiofrequency (FMR) treatment and conventional Q-switched ND:YAG laser on aging-associated hyperpigmentation of the skin. The prospective controlled clinical trial of 25 Asian women revealed significantly higher improvements not only on wrinkles, but also on hyperpigmentation. Additional ex vivo study revealed significant reduction of pro-melanogenic markers as well as senescent keratinocytes, while increased expression of collagen type IV on the epidermal basement membrane, after additional FMR treatment on UV-irradiated human tissues. These results demonstrate that 300 μm needle-depth FMR might effectively remove senescent keratinocytes that secrete pro-melanogenic markers, and repair disrupted basement membrane, therefore preventing constant hyperpigmentation of the aged skin.

Efficacy and safety of non-insulated fractional microneedle radiofrequency for treating difficult-to-treat rosacea: a 48-week, prospective, observational study

Rosacea is a common chronic facial inflammatory skin disease. However, treatment for "difficult-to-treat rosacea" cases has not been established. This 48-week, prospective, observational study analyzed patients who underwent three non-insulated fractional microneedle radiofrequency (NFMRF) sessions at 2-month intervals. Therapy efficacy, epidermal barrier function, and side effects were evaluated. 34 subjects completed the trial. NFMRF resulted in CEA score reduction from 2.65 ± 0.59 to 1.56 ± 0.50 (P < 0.001) and mean DLQI reduction from 16.70 ± 3.55 to 10.48 ± 2.92 (P < 0.001). The successes of CEA (44.12 vs. 2.94%), IGA (91.67 vs. 25.00%), and flushing (58.82 vs. 26.47%) were observed. Among 34 patients, 22 reported "excellent" or "good" improvement and 30 were "very" or "relatively" satisfied. Skin barrier results revealed that hemoglobin content significantly decreased from 376.47 ± 71.29 at visit 0 to 161.32 ± 52.86 at visit 3. 2 of 30 patients followed-up at 6 months had a relapse at 18 and 20 weeks, respectively. No serious side effects were observed. NFMRF alone results in visible improvement and has great efficacy for difficult-to-treat rosacea without compromising patient safety or damaging the skin barrier.

Radiofrequency Rejuvenation of the "Tweener" Patient: Under, Over, or Through the Skin

The demand for noninvasive facial rejuvenation continues to increase as younger, well-informed patients enter the aesthetic market. We refer to a subset of these patients as "tweeners," those who present with early signs of neck and facial aging, but who have not yet developed changes significant enough to warrant a traditional excisional surgery approach. Many of these patients are in search of a minimally invasive intervention, a bridge in between observation and surgery. The authors describe their experience with radiofrequency (RF) technology as an in-office tool to address the aging face in a select patient population. This review also attempts to comprehensively search the existing body of literature to describe the RF technologies and devices available for facial rejuvenation. The efficacy and safety profiles of the devices are discussed, and the devices are categorized by their method of RF delivery-over (contact), through (microneedle), and under (percutaneous) the skin.

Microneedling for the Treatment of Scars: An Update for Clinicians

Background

Microneedling (MN) is used for the treatment of scars, amongst other indications. Although used in Asia and the Middle East for decades, related to the supposed lack of post-procedure pigmentary alterations even in darker skin types, MN only recently gained attention in the United States as an effective, well-tolerated aesthetic treatment.

Materials and Methods

A systematic review of the Medline database was completed using search terms “microneedle” or “microneedling” or “micro needle” or “micro needling” and “scar”. Included articles were written in English and discussed the use of MN for the treatment of scars in human subjects.

Results

Fifty-eight studies were included for review, with a total of 1845 patients treated for acne scarring, hypertrophic or keloid scars, and those resulting from surgery, trauma, varicella or smallpox. MN and its counterpart fractional radiofrequency MN (FRF-MN) were used as monotherapy or in combination with topical, surgical or systemic modalities. MN and FRF-MN treatment resulted in clinical improvement of scar appearance from baseline. No serious adverse events occurred.

Conclusion

MN is a well-tolerated, minimally invasive procedure that can be used for the treatment of scars with a high level of patient satisfaction. Further clinical studies are needed to develop standardized treatment protocols.

Laser Rejuvenation of Nonfacial Skin: A Review and a Personal Approach

BACKGROUND

Laser skin rejuvenation historically has emphasized facial photodamage. In this review, we examine energy-based rejuvenation for nonfacial skin.

OBJECTIVE

The purpose of this review is to summarize past and current energy-based rejuvenation off the face.

RESULTS

Many energy-based interventions can address pigment, tone, and texture irregularities of nonfacial skin.

CONCLUSION

With conservative settings, current devices can be applied safely for nonfacial skin rejuvenation.