Radiofrequency Microneedling: A Comprehensive and Critical Review

Standard operating protocol for utilizing energy-based devices in aesthetic practice

BACKGROUND

Lasers and other energy-based devices are increasingly becoming popular in aesthetic practice. Many centers employ doctors or technicians to perform these procedures where treating doctor and operating doctor may be different. Hence the need for standard operative protocols, to be followed while performing these procedures to avoid mistakes, complications and to get optimum results. In the current review article, group of doctors who have worked with these energy-based devices over many years worked together and suggested the protocols to be followed for the most commonly used energy-based procedures.

AIM

To provide Standard operating protocols for the operator and staff to ensure, efficacy, safety, for the patient and for the devices.

METHODS

The following protocols have been drafted based on the best practices followed by the authors in their clinics and reflect their consensus opinion. The objective is to provide operating protocols in a standard format, which can be of use by practicing dermatologists and their staff. The protocols include both general guidelines for the laser room and specific protocols for different machines. The draft follows the following schema: General instructions for all the energy-based devices. Specific protocols for different devices: Laser hair removal, fractional lasers, Q-switched lasers, fractional microneedling radiofrequency and cryolipolysis.

CONCLUSIONS

The protocols proposed help to maintain the uniformity and avoid complications. However, these instructions are generalized and not machine or lesion specific. There may be variations in the protocols depending on the treatment lesion and treating doctor as well as machine.

Effectiveness of microneedle fractional radiofrequency combined with transcutaneous delivery of botulinum toxin in the management of post-acne scars

BACKGROUND

Post-acne scars are a common sequela of acne, especially prevalent among young people. Delayed treatment not only affects self-perception of beauty but also affects the mental health of patients.

OBJECTIVE

This study aims to investigate the clinical efficacy of microneedle fractional radiofrequency (MFR) combined with botulinum toxin A (BoNT/A) in managing post-acne scars.

METHODS

This retrospective study involved 63 adult patients with post-acne scars, divided into two groups: group 1 (n = 30) and group 2 (n = 33). Group 1 received treatment with MFR combined with transcutaneous delivery of BoNT/A, whereas group 2 received treatment with MFR alone. The study observed the clinical outcomes in both groups.

RESULTS

Based on experimental analysis, the combination of MFR with transcutaneous delivery of BoNT/A demonstrated superior clinical efficacy compared with group 2. There were no significant differences in baseline data or treatment-related pain and adverse reactions between the two groups. However, group 1 exhibited a higher effectiveness rate, lower ECCA score after treatment, higher satisfaction levels, and statistically significant differences compared to group 2.

CONCLUSION

MFR combined with transcutaneous delivery of BoNT/A represents an effective and safe alternative for treating acne scars with minimal side effects and complications.

SUMMARY STATEMENT

Post-acne scars are a common sequela of acne and combination therapy proves beneficial. Microneedle fractional radiofrequency (MFR) combined with transcutaneous delivery of BoNT/A can be considered an effective and safe alternative for the treatment of acne scars with minimal side effects and complications. It works together through microneedles, radiofrequency, and botulinum toxin. MFR combined with transcutaneous delivery of BoNT/A is based on the direct action of MFR on acne scars and the use of microneedle to create a transient skin microchannel, facilitating BoNT/A penetration into the skin.

Microneedling Therapy for Striae Distensae: Systematic Review and Meta-Analysis

INTRODUCTION

Striae distensae (SD), linear scars of derma, caused by disproportionate skin stretching, which indicates a cosmetic problem and even endangers individuals' psychosocial health. Microneedling, representing a relatively new procedural therapy, has shown brightening but diverse results in the remedy of SD. Our study systematically investigates and further evaluates the efficacy of microneedling for SD.

METHOD

This study was conducted following the PRISMA guidelines. According to the preplanned search strategy, four electronic databases were comprehensively searched for eligible clinical controlled studies. Standardized mean difference (SMD) and odd ratio (OR) with 95% confidence intervals were calculated for continuous data and dichotomous data, respectively.

RESULTS

According to the predetermined criteria, eleven eligible articles of six RCTs and five non-RCTs were included. Concerning clinical improvement, a significant difference was observed in the microneedle radiofrequency treatment subgroup (SMD: 0.57, 95% CI 0.20-0.94, P = 0.003). The pooled result of the second subgroup revealed that microneedling and lasers producing almost comparable effectiveness for treating SD with no significant difference (P = 0.35). The analysis result of the third subgroup of microneedling versus non-laser therapy indicated significant difference at the 5% significance level (SMD:1.01, 95% CI 0.51-1.51, P < 0.0001). With regard to patient satisfaction, the pooled estimate concluded that participants' satisfaction with therapeutic effect between MRF and laser group was comparable (P = 0.26), whereas microneedling exhibited significant superiority than both laser (P = 0.04) and non-laser treatments (SMD: 0.95, 95% CI 0.52-1.38, P < 0.0001). Occurrence of post-inflammatory hyperpigmentation (PIH) was not obvious in microneedling therapy compared to other treatments, and a statistically difference was observed (P = 0.0003). Microneedling treatment caused significant pain compared with laser therapy (P < 0.00001).

CONCLUSION

This systematic review and meta-analysis has provided initial evidence of the efficacy and safety of microneedling technology for SD.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Combined multilevel anti-aging strategies and practical applications of dermocosmetics in aesthetic procedures

Management of the signs of facial aging and other cosmetic skin problems have greatly evolved in the past years. People are also seeking to improve their well-being and global skin appearance, and when they consider using cosmetic procedures, they expect natural and long-lasting aesthetic results. Combined dermocosmetic approaches that address the signs of facial aging at all levels are increasingly being used by dermatologists to meet patient expectations while ensuring their safety. Minimally invasive and reversible procedures that can be performed in only one session are popular approaches for skin restructuring and volumizing as they are flexible, rapid and less burdensome for patients. These interventions can achieve even better outcomes when they are combined with cosmeceuticals as pre- or post-procedural adjuvants to prepare the skin, accelerate recovery and sustain results. The use of topical dermocosmetics is also recommended as part of the daily skin care routine to improve skin quality and help maintain skin barrier function. This review thus outlines the most commonly used combined multilevel anti-aging strategies, which start by addressing the deepest skin layers and then the more superficial signs of skin aging. Examples of multi-active cosmeceuticals and skin delivery enhancing systems are also presented, together with examples of the use of dermocosmetics as supportive care for aesthetic procedures, to provide insights into current applications of dermocosmetic products.

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.

A Clinical Guide to the Treatment of Cellulite and Comprehensive Review of the Etiology, Pathophysiology, and Utility of Intervention

INTRODUCTION

Cellulite is a common esthetic concern affecting most women. Despite its prevalence, there is no consensus on the optimal treatment approach for cellulite, partly due to the complex and multifactorial nature of its pathophysiology. Understanding the underlying biological processes along with available treatment options is important to be able to effectively counsel patients on effective management of this condition. This review aims to focus on high-quality evidence behind pathophysiology of cellulite, severity and grading, and its available treatment options.

METHODS

A comprehensive review of the literature was performed using PubMed and Embase databases. Manuscripts that provided objective data with respect to pathophysiology, grading scales, and applications of treatment options were utilized.

RESULTS

Using the existing CSS classification, an evidence-based algorithm is proposed for treatment of cellulite. Mild cellulite is best served with lifestyle modifications such as healthy diet, hydration, and exercise. Use of topicals in mild cellulite patients as adjuncts to lifestyle modifications have the highest efficacy, although there are inconsistent data on topical treatments. Moderate cellulite is best targeted with noninvasive treatment options including laser therapy, radiofrequency, and ultrasound. Radiofrequency demonstrates the strongest efficacy in the current peer-reviewed literature. Severe cellulite is recommended to be treated with minimally invasive approaches such as subcision and injectables.

CONCLUSION

Cellulite is a challenging cosmetic problem to treat, and thus multimodal treatment options should be considered in an attempt to achieve optimal outcomes and patient satisfaction. As the pathophysiology of cellulite is further elucidated, more targeted treatments may be developed in the future.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Microneedling versus microcoring: A review of percutaneous collagen induction for the face and neck

BACKGROUND

Microneedling (MN) and microcoring (MCT) are both methods used for percutaneous collagen induction. This minimally invasive technique involves creating controlled damage in cutaneous tissue to induce neocollagenesis and neoelastogenesis. MN utilizes solid microneedles and is commonly combined with radiofrequency (RF) to add thermal energy, while MCT involves hollow microneedles capable of removing excess tissue without inducing scar formation.

AIMS

The purpose of this review was to summarize recent literature for MN and MCT, with the goal of assisting clinical decision making regarding the use of these technologies.

METHODS

PubMed search was conducted for relevant articles published within the last 10 years. Scoping literature review was then performed with pertinent findings reported.

RESULTS

Existing literature investigating MCT is sparse. Limited data on in vivo, human effects of this technology exist. Two out of 14 studies in this review pertained to MCT.

CONCLUSION

Additional high-powered clinical studies are needed to guide future cosmetic treatments with MN and MCT.

Dissolving Hyaluronic Acid-Based Microneedles to Transdermally Deliver Eugenol Combined with Photothermal Therapy for Acne Vulgaris Treatment

A microneedle transdermal drug delivery system simultaneously avoids systemic toxicity of oral administration and low efficiency of traditional transdermal administration, which is of great significance for acne vulgaris therapy. Herein, eugenol-loaded hyaluronic acid-based dissolving microneedles (E@P-EO-HA MNs) with antibacterial and anti-inflammatory activities are developed for acne vulgaris therapy via eugenol transdermal delivery integrated with photothermal therapy. E@P-EO-HA MNs are pyramid-shaped with a sharp tip and a hollow cavity structure, which possess sufficient mechanical strength to penetrate the stratum corneum of the skin and achieve transdermal delivery, in addition to excellent in vivo biocompatibility. Significantly, E@P-EO-HA MNs show effective photothermal therapy to destroy sebaceous glands and achieve antibacterial activity against deep-seated Propionibacterium acnes (P. acnes) under near-infrared-light irradiation. Moreover, cavity-loaded eugenol is released from rapidly dissolved microneedle bodies to play a sustained antibacterial and anti-inflammatory therapy on the P. acnes infectious wound. E@P-EO-HA MNs based on a synergistic therapeutic strategy combining photothermal therapy and eugenol transdermal administration can significantly alleviate inflammatory response and ultimately facilitate the repair of acne vulgaris. Overall, E@P-EO-HA MNs are expected to be clinically applied as a functional minimally invasive transdermal delivery strategy for superficial skin diseases therapy in skin tissue engineering.

Efficacy and safety of a noninvasive, home-based radiofrequency device for facial rejuvenation: An open-label, intraindividual controlled trial

BACKGROUND

Wrinkle formation is the most visible characteristic of facial aging. Radiofrequency (RF) technology is currently utilized to reduce facial wrinkles and contribute to skin rejuvenation.

OBJECTIVE

To analyze the efficacy and safety of a noninvasive, home-based RF device applied for facial rejuvenation in Chinese people.

METHODS

A single-center, open-label, intraindividual controlled trial was performed on subjects who received an 8-week treatment of the RF device. A total of 22 female individuals aged 25-60 years with Fitzpatrick skin type III-IV were enrolled. Efficacy of treatment was subjectively evaluated using the Fitzpatrick Wrinkle Classification Scale (FWCS) assessed by physician or overall satisfaction of subject with a 10-point VAS, and objectively using the skin ultrasound examination as well as the 3D skin analysis system. Adverse event was recorded at each visit.

RESULTS

In comparison with the baseline, evaluator-assessed FWCS scores showed significant improvement at 4 weeks (p < 0.005) and 8 weeks (p < 0.005) after treatment. All subjects reported different degrees of improvement in facial wrinkles after 8 weeks of treatment. The results of skin ultrasound examination revealed significant increase of the dermal thickness at week 8 (p < 0.05) as compared to the baseline. In addition, a significant decrease in the proportion and density of perioral wrinkles evaluated by the 3D skin analysis system was observed from baseline to week 4. The treatment was well-tolerated, and no serious adverse event was observed.

CONCLUSION

This noninvasive, home-based RF device was effective in improving skin texture and elasticity with a safe and well-tolerated treating procedure.

Combination of Fractional Microneedling Radiofrequency and Ablative Fractional Laser versus Ablative Fractional Laser Alone for Acne and Acne Scars

PURPOSE

Fractional microneedle radiofrequency (FMR) systems are used to treat inflammatory acne and scarring. Nonetheless, few controlled studies have combined this treatment with the traditional ablative fractional laser (AFL). We aimed to assess the safety and efficacy of the combination of FMR and AFL versus AFL alone in treating acne and acne scars.

MATERIALS AND METHODS

In this 20-week, randomized, split-face study, 23 Korean patients with facial acne and acne scars underwent FMR and AFL treatments. One half of each patient's face was randomly assigned to receive FMR+AFL, whereas the other half received AFL alone. Treatments were administered in three consecutive sessions at 4-week intervals. This study investigated the severity of inflammatory acne, acne scars, individual lesion counts, depressed scar volumes, as well as patient and physician satisfaction. In addition, five patients underwent skin biopsy, and sebum output was measured.

RESULTS

The FMR+AFL treatment demonstrated superior efficacy compared to AFL alone in terms of inflammatory acne and acne scar grading, lesion counts, and subjective satisfaction. The side effects were minimal and well-tolerated in both groups. Immunohistochemical findings from skin biopsy samples revealed that the application of FMR+AFL could induce an inhibitory effect on sebum secretion at the molecular level.

CONCLUSION

FMR combined with AFL is a well-tolerated and effective treatment modality for inflammatory acne and acne scarring.

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.

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

Evaluating the efficacy of microneedling technique in treating striae alba lesions

Striae alba, as an unsettling skin complication, has the potential to threaten the physical appearance and psychological health of individuals. So far, dermatologists' endeavors have been futile in finding an ideal treatment. This study evaluated microneedling as a novel treatment modality for striae alba scars. Microneedling was implemented in 1-3 sessions in 2-week intervals among patients with striae alba lesions. The lesions were photographed before and 3 months after the treatment, while all side effects were recorded. Two non-involved dermatologists and a patient self-report based on a visual analog score scale were utilized to evaluate the clinical improvement of striae scars. The complication rate among the 32 patients was 25%, which consisted of seven (21.9%) cases of post-inflammatory hyperpigmentation and one case (3.1%) of skin infection. The average improvement score among the patients in our study based on their self-report was 5.3 ± 1.3. (Range 4-8), while based on physician evaluation was 5.6 ± 1.2 (range 3.5-8). There was a significant association between lower age and higher self-report scores. Also, the improvement of lesions was more significant in skin type 3 compared to 2, based on physician assessment. In this study, MN was effective in ameliorating SA scars and was observed to induce better clinical satisfaction in younger patients and breast lesions. The studies concerning the use of MN in treating SA have yielded much attention lately, and they have denoted the relatively low cost of MN, its capability to be utilized over vast treatment areas, and its safety in that regard. Further research regarding the comparison of MN's efficacy in solo use versus implementing it as an adjuvant modality should be carried out.

Histological damage characteristics and quantitive analysis of porcine skin with non-insulated microneedle radiofrequency

OBJECTIVE

In recent years, the microneedle radiofrequency (MRF) has been widely used for skin rejuvenation, but histological studies on the immediate trauma caused by different parameters of non-insulated RF microneedles METHODS: The skin of three pigs was treated with different needle depths, pulse widths and energy levels of non-insulated microneedle RF. Samples were collected before, immediately, and 2 weeks after treatment. The immediate histological response of each group was assessed and quantified by hematoxylin and eosin staining, Masson staining and Victoria Blue staining.

RESULTS

In the treatment of non-insulated microneedle RF, different energy levels affected mainly the range of thermal damage (p = 0.044), and different needle depths affected mainly the depth of the cavity (p = 0.022). But the width of the coagulation zone width was determined by different factors. There was no significant difference in the histology of immediate damage caused by different pulse widths. Reepithelialization of the epidermis and basic wound repair can be completed within 2 weeks.

CONCLUSION

Non-insulated RF microneedle therapy is an effective and safe treatment that can stimulate dermal wound healing with less thermal coagulation and a wide range of reversible thermal damage. However, it should be noted that the set needle depth may not correspond to the actual penetration depth, nor to the actual depth of histologic trauma.

Efficacy and Safety of the Micro-insulated Needle Radiofrequency Device for Reduction of Submental Fat

BACKGROUND

Recently, it has been reported that a micro-insulated needle radiofrequency (RF) system is effective at achieving subcutaneous fat reduction; however, no study has yet applied this technique to reduce submental fat.

OBJECTIVE

To evaluate the efficacy and safety of a fractional RF device with a micro-insulated needle to reduce submental fat.

MATERIALS AND METHODS

In this prospective, single-blinded, pre-post comparative study, 24 adults with excess submental fat were treated once using a micro-insulated needle RF device. Outcomes included efficacy (submental fat rating by an independent investigator, fat volume quantified with a 3-dimensional camera, and patient satisfaction), assessed 1 and 2 months after the procedure, and safety (adverse events), assessed throughout the study.

RESULTS

The patients' Physician-Assisted Submental Fat Rating Scale score significantly decreased after 1 month and further decreased after 2 months. The average volume of submental fat was significantly decreased after 2 months (20.44 ± 5.53 cc to 16.41 ± 4.58 cc, p < .001). Patient satisfaction was high. Transient and mild local skin reactions without long-term sequelae were observed in 4 patients.

CONCLUSION

The micro-insulated needle RF device is beneficial for the reduction of submental fat and has tolerable safety profiles.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05517824.

Fractional CO2 -laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split-face trial

BACKGROUND

Ablative fractional CO₂ laser (AFL) is an established first-line energy-based treatment for acne scars. Microneedle radiofrequency (MNRF) is an emerging treatment, also targeting the skin in fractions. No studies have so far compared AFL with MNRF for acne scars in a direct controlled, side-by-side comparison. In this study, we compared AFL and MNRF treatments for acne scars in a randomized split-face trial with blinded response evaluation, objective measures, and patient-reported outcomes.

STUDY DESIGN/MATERIALS AND METHOD

Fifteen patients with moderate to severe acne scars were included. At baseline each patient had two similar test areas identified, these were randomized to receive a single treatment with either AFL or MNRF. Standardized multilayer techniques were applied with AFL and MNRF, first targeting the scar base, thereafter the entire scar area. Outcome measures included blinded evaluation of clinical improvement of scar texture (0-10 scale) at 1- and 3-months follow-up, local skin reactions (LSR), pain according to Visual Analogue Scale (VAS), skin integrity quantified by transepidermal water loss, and patient satisfaction.

RESULTS

Fifteen patients completed the study with a median test area size of 24.6 cm² (interquartile range [IQR] 14.9-40.6). A single treatment with AFL or MNRF equally resulted in a median 1-point texture improvement after 3 months follow-up (p < 0.001). Best responders achieved up to a 3-point improvement (n = 3 test areas, 10% of treatment areas). Erythema and loss of skin integrity was more intense after AFL compared with MNRF after 2-4 days (p < 0.001). Patients reported MNRF (VAS 7.0) to be significantly more painful than AFL (5.5) (p = 0.009). Patients were generally satisfied with the overall outcome on a 10-point scale at median 6 for both treatments (IQR 5-7).

CONCLUSION

AFL and MNRF treatments are equally effective at improving texture in skin with acne scars. AFL resulted in more pronounced LSRs whereas MNRF was more painful. Patients were generally satisfied with the overall outcome.

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.

A Comprehensive Review of Microneedling as a Potential Treatment Option for Androgenetic Alopecia

BACKGROUND

Microneedling refers to a minimally invasive technique that uses multiple fine needles targeted skin epidermis for mechanical stimulation to obtain therapeutic or cosmetic effects. It is suitable for the treatment of a variety of dermatological conditions, including androgenetic alopecia (AGA).

OBJECTIVE

This article aims to make a comprehensive review of the relevant studies on microneedling for the management of AGA.

METHODS

Extensive literature search was performed using PubMed, Web of Science, and EBSCO databases. 4 in vivo studies and 25 clinical trials were included according to the inclusion and exclusion criteria.

RESULTS

The effects of microneedling on AGA was investigated in animal experiments. Several clinical trials, including randomized controlled trials, strengthen the validity of the findings. Microneedling therapy showed some encouraging results with minor complications when used alone or in combination with topical products.

CONCLUSIONS

Microneedling appears to be a safe and effective therapeutic option for AGA. Larger and more randomized controlled trials regarding the role of microneedling in AGA are strongly recommended to provide more definitive evidence.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Combination radiofrequency microneedling and carbon dioxide laser for acne scarring: A systematic review and retrospective case series across two centers

INTRODUCTION

Combination radiofrequency (RF) microneedling with fractional ablative carbon dioxide (CO₂ ) laser is a new approach for acne scar treatment.

AIMS

(1) to systematically review the literature on the safety and effectiveness of this treatment for acne scarring; (2) to assess safety and effectiveness in a 2-center case series.

METHODS

Systematic review: Articles that assessed the safety and effectiveness of combination RF microneedling and fractional CO₂ laser for acne scarring were included and quality assessed using the Downs and Black checklist.

CASE SERIES

Patient records were reviewed from 2 clinics, one in London, UK, and the other in Washington D.C., United States, to identify patients who underwent a single treatment with RF microneedling and fractional CO₂ laser for acne scarring. Outcome assessment was via the Scar Global Assessment (SGA) scale.

RESULTS

Systematic review: Three articles were included and reported improvements in acne scar severity. Adverse effects included erythema, edema, pain, vesicle formation, erosion, petechiae, desquamation, post-inflammatory hyperpigmentation (PIH), and acne flare. Quality scores ranged from 14 to 15 (maximum of 21).

CASE SERIES

Twenty-six patients were included. Mean SGA Score was 3.0 at baseline and 1.3 at follow-up. All patients had an improved SGA score. Adverse effects included erythema, pain, edema, skin crusting, PIH, and acne flare. All patients resumed normal activities within 7 days of treatment.

CONCLUSION

Combination RF microneedling and fractional CO₂ laser appears a safe and effective treatment for patients with acne scarring. A single treatment can result in noticeable improvements in acne scar severity with a short recovery time.

The Efficacy and Safety of Radiofrequency Microneedling Versus a Nonablative Fractional 1,550-nm Erbium:Glass Laser for the Rejuvenation of the Neck

BACKGROUND

Radiofrequency microneedling (RFMN) and nonablative fractional 1,550-nm erbium:glass lasers (NAFLs) have been reported to be used with success in neck rejuvenation. There are no head-to-head trials to compare these modalities.

OBJECTIVE

The purpose of the study was to compare the efficacy and safety of radiofrequency microneedling and nonablative fractional 1,550-nm erbium:glass lasers for the rejuvenation of the neck.

METHODS

This was a single-center, randomized, investigator-blinded clinical trial. A total of 21 subjects were randomized into 2 groups, NAFL and RFMN; subjects received 3 treatments 4 weeks apart and were followed up 12 weeks after last treatment.

RESULTS

Subjects in NAFL and RFMN groups showed 42.1% and 8.6% improvement in the Fitzpatrick-Goldman Wrinkling Score, respectively, 41.3% and 16.3% improvement in the elastosis score, respectively. Subjects in the NAFL 1,550-nm erbium:glass group showed significantly better blinded investigator Fitzpatrick-Goldman Wrinkling and Elastosis scores; subjects in the RFMN groups showed a more significant reduction in the Horizontal Neck Wrinkle Severity Score. There was a trend for higher patient satisfaction with the NAFL.

CONCLUSION

This study showed that both treatments resulted in significant improvement in wrinkling and elastosis scores; the NAFL treatment was associated with significantly better blinded investigator Fitzpatrick-Goldman Wrinkling and Elastosis scores and better subject satisfaction.

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.

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.

Review of Lasers and Energy-Based Devices for Skin Rejuvenation and Scar Treatment With Histologic Correlations

BACKGROUND

Lasers and energy-based devices (EBD) are popular treatments for skin rejuvenation and resurfacing. Achieving desired outcomes and avoiding complications require understanding the effects of these devices at a histologic level. Currently, no comprehensive review summarizing the histologic effects of laser and energy-based treatments exists.

OBJECTIVE

To describe how lasers and EBD alter skin histology and improve the overall understanding of these devices.

MATERIALS AND METHODS

A PubMed search was conducted for studies with histologic analysis of fractional picosecond laser, fractional radiofrequency microneedling, nonablative lasers, and ablative lasers.

RESULTS

Fractional picosecond lasers induce intraepidermal and/or dermal vacuoles from laser-induced optical breakdown. Fractional radiofrequency microneedling delivers thermal energy to the dermis while sparing the epidermis, making it safer for patients with darker skin phototypes. Fractional nonablative lasers induce conical zones of coagulation of the epidermis and upper dermis. Ablative lasers vaporize the stratum corneum down to the dermis. Traditional ablative lasers cause diffuse vaporization while fractional ablative lasers generate columns of tissue ablation.

CONCLUSION

Lasers and EBD are effective for skin resurfacing and rejuvenation and have different mechanisms with disparate targets in the skin. Safe and effective use of devices requires understanding the histologic laser-tissue interaction.

Cosmetic dermatology in menopause

ABSTRACT

Skin changes that accompany aging lead many to seek treatments that restore a more youthful appearance. Common issues of concern include skin tone, wrinkles, skin thinning, sagging, laxity and decreased elasticity, and hollowing of the face. This work discusses these concerns and their anatomic bases and highlights evidence for a causal role played by menopause-associated hormonal changes where such evidence exists. In addition, treatment options are discussed, with an emphasis on minimally invasive approaches. A variety of modalities are discussed, including botulinum toxins, fillers, multiple types of lasers, radiofrequency devices, focused ultrasound, chemical peels, and thread lifts. These interventions, often in combination, can achieve goals of patients seeking aesthetic rejuvenation.

Microneedling for Hair Loss

BACKGROUND

Microneedling is a relatively novel therapeutic modality introduced in the 1990s where small, fine needles are used to create micro punctures in the skin. It is a minimally invasive procedure used for various dermatological conditions, including androgenetic alopecia (AGA).

OBJECTIVE AND METHODS

We comprehensively summarize the literature regarding microneedling in dermatology. We performed linear multivariable regressions to synthesize evidence from the clinical trials that investigated the efficacy of microneedling for AGA. Studies eligible for quantitative analyses were assessed for evidence quality.

RESULTS

The exact mechanism of microneedling action is yet to be determined, with theories that include the wound-healing cascade. Microneedling monotherapy significantly increased total hair count more than topical minoxidil 5% (β = 12.29; p < 0.001). The combination treatment of microneedling with topical 5% minoxidil increased total hair count significantly compared to monotherapy with microneedling (β = 7.63, p < 0.05). Increasing the overall treatment duration of microneedling and reducing the frequency of microneedling sessions may positively influence an increase in total hair count.

CONCLUSION

There are limited studies that investigate microneedling as a monotherapy for hair loss since majority of the trials combine it with other therapies such as topical minoxidil or platelet-rich plasma. While preliminary results look promising, further investigation of microneedling as a monotherapy in larger, randomized controlled trials will help determine its safety and efficacy, and place in treating AGA.