When it comes to non-surgical aesthetics trends, two procedures that seem to be on everyone’s radar these days are microneedling and radiofrequency (RF). Alone, they each encourage the production of new collagen and elastin to improve skin tone, texture, and tautness. But what happens when you combine them? Well, you boost their already potent powers. Microneedling with radiofrequency (a.k.a. RF microneedling) combines both treatments in a single device and session. The amalgamation of controlled micro-injuries and heat creates a lit-from-within glow and firmer skin. But, with so many different RF microneedling treatments out there, how is one to choose?
With that in mind, we thought it was only appropriate to dive into the ever-popular treatment and break down the most talked about microneedling radiofrequency devices — they are now a mainstay in doctors' offices from coast to coast — to decipher which one is best for your skin and its needs.
Microneedling & Radiofrequency: How Does It Work?
The beauty world has known of microneedling's skin-boosting benefits for quite some time. Also known as collagen induction therapy, we are already familiar with how it works well with other treatments. In the infamous vampire facial, microneedling and platelet-rich plasma (PRP) join forces. And, more recently, we’ve seen microneedling and RF combos.
When the first generation of RF microneedling devices came to market, many patients and pros alike wondered if it was just another fleeting trend or an additional machine to buy. Yet, the modality has gained and maintained popularity primarily because it offers achievable results, says Talon Maningas, DO, a board certified plastic surgeon in Joplin, MO. New York City-based board certified dermatologist Brendan Camp, MD, agrees. “It is well-tolerated, efficacious, offers reliable results, and is usable on all skin types, making it a popular treatment option,” he notes. It can be employed on both the face and body with little downtime.
To understand how RF microneedling came to be, let's first revisit some of the OG skin-tightening treatments. The idea started with Thermage®, which developed wave frequencies that would tighten skin without burning it, says Leif Rogers, MD, a board certified plastic and reconstructive surgeon in Los Angeles. “Since then, the technology has advanced greatly in terms of the best ways to deliver radiofrequency energy and the limits of human tissue's ability to respond to the energy to achieve maximum results with minimal recovery periods,” he explains.
All RF microneedling devices (they're only available in-office and must be administered by a professional) work the same: they employ sterile needles to pierce the skin and simultaneously deliver radiofrequency energy. “The energy heats the surrounding tissues to cause a controlled injury,” Dr. Rogers says. As a result, the body’s natural healing responses are initiated. In addition to creating thicker, firmer skin, microneedling plus radiofrequency can also improve the appearance of:
- Fine lines & wrinkles
- Acne scars
- Stretch marks
- Enlarged pores
- Skin laxity (though the results are not comparable to surgery)
- Excessive sweating
Compared to standalone microneedling, the addition of radiofrequency provides far superior results, says Michael Somenek, MD, a double board certified facial plastic and reconstructive surgeon in Washington, DC. On its own, microneedling creates controlled injuries within the skin to produce new collagen and improve texture and tone. Traditionally administered radiofrequency treatments, meanwhile, are done transdermally and max out at around 42 degrees Celsius, which is suboptimal for collagen stimulation, says Kenneth Mark, MD, a board certified dermatologist with offices in NYC, the Hamptons, and Aspen. “But the combination of microneedling and radiofrequency allows us to bypass the epidermis and deliver energy to the dermis to the optimal temperature for collagen stimulation, which is around 65 degrees Celsius,” he explains.
Is Microneedling Radiofrequency Like a Laser?
RF microneedling is different from a laser, and so are its results. Lasers emit a single wavelength of light that the skin then absorbs via specific targets, and the heat (from the laser energy) destroys that target. Radiofrequency microneedling relies on mechanical injuries courtesy of a narrow needle plus an electric current to heat the skin and trigger a wound-healing response.
The limitation with lasers is that they are not appropriate to use on every skin tone because of the risk of discoloration and scarring. “Radiofrequency microneedling is an equal opportunity treatment that works on all skin types,” Dr. Camp says. While the procedure is safer for darker skin, Dr. Maningas shares that microneedling may not be as efficient as lasers for certain concerns.
Both have their place in a dermatologist or plastic surgeon’s toolbox, it's best to first decide on your skin goals (with the help of a professional) before selecting a laser or RF microneedling treatment. Like anything, microneedling with radiofrequency has its limitations, so a combination approach often works well. Resurfacing lasers, PRP, subcision, chemical peels, and even plastic surgery can be part of the plan for maximizing the results.
For example, Dr. Mark combines Infini™ RF with LaseMD™ Glo to eliminate potential grid marks and downtime, while improving superficial lines, wrinkles, and pigmented lesions to give the skin an immediate glow. Dr. Somenek sometimes combines RF microneedling with a CO2 resurfacing laser treatment. “I like to think of the microneedling as going into the deeper dermis and stimulating the tissues underneath the skin,” he says. “Many lasers treat the superficial structure, like the epidermis and superficial dermal layers, so combining them can give optimal results.” Ari Hoschander, MD, a board certified plastic and reconstructive surgeon in NY, follows a similar approach and recommends lasers and RF needling for nearly all patients who are looking for skin rejuvenation. “Typically, I like to treat with RF microneedling first to build up a base layer of collagen, and then resurface the outer layers with a laser,” he shares.
Just like standalone microneedling, doctors can also do the radiofrequency-packed version alongside platelet-rich plasma (PRP) for amplified results. One combination to steer clear of? Neuromodulators like Botox® and Dysport®. “Simultaneously doing these can cause the toxin to diffuse to unintended treatment areas,” Dr. Camp cautions.
RF Microneedling Treatments: What’s Similar, What’s Different?
Some major upgrades have occurred since the first generation of RF microneedling devices. For starters, insulated and semi-insulated tips now allow doctors to dial up the heat without worrying about burns or pigment (the flipside is that more passes are necessary). “Insulated tips make the treatment appropriate for darker skin types, which may not ordinarily be able to do this type of procedure,” Dr. Somenek says. “Additionally, controlling the depths of the needles and going deeper into the tissues also stimulates other areas that we previously couldn't stimulate for improved results.”
So, what are some of the most notable similarities and differences between the RF microneedling treatments available today?
Regardless of a device’s name, radiofrequency microneedling devices rejuvenate the skin via superficial skin injuries that encourage new collagen. “Emitting radiofrequency energy deep in the skin generates a more robust response,” Dr. Camp says. This one-two punch is what leaves the skin post-treatment with pinpoint bleeding, minor redness, swelling, bruising, and temporary skin discoloration, all of which are normal.
One thing to note is that the energy and depth can be dialed up or down (as high or as low as the machine allows) to make the treatment more or less aggressive, and each treatment is individual in the depth of the tissue it reaches. The results are never instant. While you may notice an initial ‘glow’ from the microneedling, it can take anywhere from three to six months to see true improvement. The effect is dependent mainly on the depth of the procedure and the number of sessions done. Some devices require multiple treatment sessions, while others necessitate just one.
The saying, ‘no pain, no gain,’ most certainly applies to the more potent RF microneedling treatments, which can be uncomfortable. The deeper the heat and needles go, the more pain the patient feels. All treatments require an anesthetic – usually topical numbing cream – regardless of the penetration depth. As far as risks go, there are a few things to keep in mind. “I always warn about the potential for grid marks post-treatment, but, thankfully, it is rare and nearly always resolves without treatment,” Dr. Hoschander says.
Across the board, aftercare is of the utmost importance. “When using uninsulated needles, there's the potential for stress spotting, which are little dots on the skin,” says Jason Emer, MD, a board certified dermatologist in West Hollywood. “We want to prevent them, so hydration and exfoliation are essential.” As part of a post-care plan, Dr. Emer has his patients use his Emerage Cosmetics Aerify Complexion Kit, which consists of hyaluronic acid, retinol, vitamin C, and a lightening agent.
Every device differs in some way, but the main points of difference are usually the size and number of needles on the handpiece, how far into the skin the needles go, and how much RF energy the tool releases. Dr. Somenek says that the most considerable distinction between some devices is controlling the amount of radiofrequency energy they emit. And, as Dr. Hoschander shares, the more control the practitioner has over the exact depth, the more tailored they can make the treatment.
If you are looking for a tightening effect, the number of needles doesn't matter as much, Dr. Emer says. But the volume does come into play when you are looking to address fine lines and more superficial skin concerns, he adds. In-office RF microneedling can reach anywhere from three to eight millimeters deep into the skin, with the latter end being more suitable for the body. “The three to four-plus millimeter mark targets fat reduction, which shouldn't be done on the face,”he notes. For comparison sake, the depth of at-home dermarollers max out around 0.5 millimeters and do not offer the radiofrequency component.
But it's not just the needle size and depth, technology also plays a role. As Dr. Rogers explains, some devices are monopolar while others are bipolar. “Monopolar devices need a grounding pad where the energy flows from the handpiece through the body to the grounding pad and back to the machine,” he explains. “With a bipolar device, the energy flows from one needle tip to another or to a grounding bar built into the tip of the handpiece, which effectively keeps the energy localized.”
The Best of the RF Microneedling Bunch
With so many different options available these days, it can be tough to determine which RF microneedling device is best for you. It's similarly tough to place each device into a specific category and level of intensity since most can be adjusted for strength and depth depending on the patient. “Plus, there are other factors to take into consideration, like the number of needles, depth of needle penetration, whether the needles are insulated or not, bulk heating versus fractionated, motorized and manual deliveries, and each brand's proprietary reason as to why their device is better,” Dr. Emer adds.
Rather than racking your brain as to which one is best, think of it this way: there will always be something newer, buzzier, and more innovative. “It's like an iPhone — the newer models have more options and greater abilities than older models,” Dr. Emer shares. But, even so, the previous editions can still serve a purpose. Technology aside, you'll also want to discuss budget, downtime, and the pain factor with your doctor, which will influence their decision on which device to use.
With all that in mind, we’re breaking down what you need to know about some of the most talked about RF microneedling technology on the market today:
Dial It Up, Dial It Down
Devices like Vivace™, Genius®, Secret™ RF, EndyMed, and Fractora are all adaptable, meaning your provider can adjust the intensity of the energy and the depth of how far into the skin the needles go depending on how the skin ‘takes’ to the treatment and what you want to accomplish. These devices deliver visible results without the downtime or lingering swelling. “Just keep in mind that you'll see these specific devices more in medspas,” Dr. Emer says. “They're good, but they're just not as strong as some other machines.”
However, they still necessitate topical numbing cream to make the process more comfortable. It's also normal after these treatments for the skin to be pink and flaky for a few days, but nothing that makeup can't conceal.
Doctors, of course, all have their preferences when it comes to specific devices. For example, both Dr. Hoschander and Dr. Somenek like Secret™ RF because of the control it offers. “Adjusting the radiofrequency intensity is critical when we're looking to stimulate the tissue more aggressively,” Dr. Somenek notes. Secret™ RF reaches about 3.5 millimeters deep, which he says gives the ability to treat multiple areas of the tissue to render the best results. “Having used most of the RF devices on the market, I think Secret™ RF has one of the most comfortable handpieces, and it elegantly delivers the microneedles into the tissue,” he adds.
On the other hand, Dr. Mark prefers Lutronic's Infini™ RF device. “It is the gold standard for customization to each patient and each skin area,” he says. It has a longer pulse duration than others, which, as he explains, allows for the safer delivery of energy over about three times the length of time for more skin tightening. “In addition, the Infini™ needles are sharper and have a high torque motor to allow for more precise depth of penetration,” he notes.
The Newest Ones to Know About
While most RF microneedling systems use one megahertz, Pixel8-RF uses two to deliver a higher amount of energy more quickly for noticeable results without as much discomfort. “For patient comfort, Pixel8-RF sits on a Zimmer Chiller to make the treatment more tolerable,” Dr. Emer shares. It also has a motorized foot press, which he says is better for controlled depth and tightening. “If you're using a device with a stamper, you have to push it into the skin and it may not stamp the skin evenly and be less effective,” he explains. Following the treatment, Dr. Emer does a quick jelly mask and oxygen treatment so that patients already look better the next day.
Another newer technology is SylfirmX. It's different from other devices because it only reacts to atypical blood vessels and tissue to decrease pigmentation within the skin. This makes it ideal for hard-to-correct skin conditions like melasma and rosacea.
If You’re Down with More Downtime
Morpehus8 is the only device cleared by the United States Food and Drug Administration to deliver energy at its treatment depth. “It allows practitioners to treat deeper than any other treatment, especially Morpheus8 Body,” Dr. Maningas says. Many doctors use the device on the body because its depth can target fat cells as well. Some surgeons opt for Morpheus8 instead of liposuction because the treatment is less invasive. In addition, Morpheus8 has tips that allow the provider to deliver multi-level treatment depths in a single cycle, reducing treatment time, minimizing skin injury, and increasing uniformity. Dr. Rogers calls Morpheus8 his office's go-to because it predictably delivers energy with good results. “In many ways, it's the ideal device because you can treat the skin at multiple depths for the most substantial improvements,” he says.
Of all the microneedling radiofrequency options, Dr. Rogers says Profound® is perhaps the one with the most substantial results in a single session, “however, the treatments take much longer and the downtime is much longer.” In addition, it's pretty painful, so numbing cream alone usually won’t do. Post-procedure, the ensuing redness and bruising can linger for upwards of two weeks.
So, What's Next for RF Microneedling?
RF microneedling shows no signs of slowing down or becoming obsolete. The market is demanding continued advancement in non-invasive and minimally invasive technology, and time will no doubt bring them. “We are heading toward pushing the envelope of treatment powers and depths to maximize results,” Dr. Maningas says.
Will future devices go to even deeper levels of the tissue? Dr. Somenek believes that could be the case, if there are larger microneedling pins (greater than we've previously seen). “That, plus fine-tuning and adjusting the energy even more effectively, will take RF microneedling to the next level,” he notes. We'll have to wait and see what the future holds, but, for now, radiofrequency microneedling continues to be the treatment that both patients and doctors can't seem to get enough of.
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