The Difference Between RF Microneedling and Traditional Microneedling

In 1995, plastic surgeon Dr. Des Fernandes (he's also the founder of skincare brand Environ) used hypodermic needles to help minimize wrinkles and scars. Soon after, he developed a stamp-like tool with surgical-grade needles on it that could temporarily puncture the skin to promote wound healing, and ultimately, collagen synthesis. Today, everyone from celebrities to soccer moms are opting for microneedling as demand continues to soar.

Prospect, KY dermatologist Tami Buss Cassis, MD says, "The easiest way to explain microneedling is that ‘micro’-size needles create tiny holes, or wounds, in the top layers of the skin, which then promotes wound healing and stimulates the production of collagen and elastin fibers. As the skin heals, fine lines, pore size and overall texture improve to rejuvenate the appearance of the skin." The treatment is also used to smooth a variety of scars, including those from acne and stretch marks.

Another major benefit of the treatment is that the open wounds serve as delivery pathways for any products applied afterward. "Because microneedling creates microchannels in the skin, we can take advantage of this by applying substances like platelet-rich plasma (PRP) or exosomes to deliver growth factors and peptides deep into the skin for more radiant results," explains Beverly Hills, CA facial plastic surgeon Kimberly J. Lee, MD. "Even after the microneedling treatment is done, the PRP and exosomes continue to work to stimulate collagen production to enhancelonger- lasting results."

There are three main types of microneedling treatments: "Electric, handheld devices that move across the skin with needles going in and out like a ballpoint pen; manual devices that require pushing the needles in, like a stamp, or rolling them over the skin; and radio-frequency (RF) microneedling, where RF energy is released through the tips of microneedle electrodes," explains New York dermatologist Macrene Alexiades, MD.

Dr. Cassis favors a treatment called SkinPen, which falls under the first category (no RF energy), and is very popular for short-term skin-plumping and radiance. "We numb the skin topically, and then the procedure takes about 15 minutes," she says, noting that there may be some discomfort during, particularly on the forehead. "The skin looks raw and red immediately after, and then it will peel for a few days. It takes about a week to have complete healing, but then you will have an amazing glow. I try to get it done at least twice a year now that I’ve turned 50!" Dr. Lee is also a fan of SkinPen, which she says was "the first FDA-cleared microneedling device," and is clinically proven to improve the appearance of acne scars with a few treatments.

Chapel Hill, NC dermatologist Beth Goldstein, MD uses a device called Rejuvapen NXT, which is another no-RF option. "It's FDAcleared to treat facial wrinkles with little to no downtime, and I’ve seen great results, not only with smoothing fine lines and creases, but also acne scarring, enlarged pores and stretch marks."

For the past 15 years, Dr. Alexiades has worked to help create and launch the prototype design for radio-frequency microneedling as we know it today. "As my research has shown, you must combine microneedles with radio frequency to get long-term wrinkle and scar reduction, and improvement in skin quality," she says. RF microneedling is also a go-to treatment for skintightening. "The use of radio frequency adds the element of heat to also enhance the tightening of the skin," Dr. Goldstein adds. "However, because of this, a higher pain level and more downtime may be necessary."

Dr. Alexiades's recent paper in the Dermatologic Surgery journal reveals that RF microneedling may also have a role to play in fat reduction. "We proved that when RF microneedling is delivered deep into the subcutis, it also remodels the fat while tightening the overlying skin. This can be offered as a single treatment and is effective for lax skin above the knee and localized fat deposits."

A topical numbing cream is applied, which may take up to 45 minutes to kick in, but then the treatment itself is relatively quick. Dr. Goldstein says a full face can be done in around 30 minutes. Although there is numbing beforehand, there may still be some pain and discomfort. You may have seen Kim K.'s viral Instagram post about her Morpheus8 treatment "to tighten her stomach," which she described as "painful but worth it." Post-treatment, hydrating serums and other products are applied, and the skin will look like it's been sunburned.

"Due to inconsistencies of penetration, it's best to avoid the use of exfoliating products such as retinoids and topical acids for one week prior to treatment," says Dr. Goldstein, noting that patients should also avoid aspirin, ibuprofen and naproxen during this time, as they thin the blood and increase risk for bruising or bleeding. "If those medications are required, any discontinuation should be discussed with the prescribing provider."

This depends on which device was used, but it's generally minimal with a day or two of redness and superficial swelling. "Within a week, you should notice improvement in skin tone and texture," says Dr. Alexiades. Patients need to keep their skin dry and clean for 12 hours post-treatment to allow the microchannels or micro-wounds to properly close and heal, adds Dr. Goldstein.

It varies per device, but for many, it's recommended to have one to three treatments spaced four weeks apart.

Vivace, VirtueRF, Matrix Pro, Profound, Genius, Morpheus8, Intensif, SmoothGlo, INTRAcel, Secret, and VoluDerm. Profound debuted in 2018 and is still considered the strongest of the bunch with the ability to induce more collagen and elastin, but with that comes more discomfort and a higher price tag (though only one treatment is needed).

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