A Radiofrequency Microneedling Guide: The Process, Benefits, Risks, and Tips To Get the Best Results

Radiofrequency microneedling, or RF microneedling, is a dermatologic procedure that effectively corrects various skin problems. The technique combines the tissue-heating effect of radiowaves with the collagen-inducing ability of microneedling. This treatment is increasingly becoming a popular alternative to laser skin resurfacing, but patients often have many questions about it before booking an appointment.

If you’ve been curious about RF microneedling but aren’t sure if it’s right for you, read on. This article explains how RF microneedling eliminates skin lesions. I also discuss here the treatment’s benefits and risks and the things you can do to ensure the best results.

What Is Radiofrequency Microneedling, and How Does It Work?

Traditional microneedling entails passing rows of tiny needles on the skin. The small cuts introduce controlled micro-injuries that stimulate an inflammatory reaction. Inflammation clears up irritants and damaged cell debris before skin repair starts.

During the healing phase, superficial skin cells regenerate and close up the cut areas. Collagen production also increases as part of the repair process. At the end of the acute recovery phase, you will see new superficial skin cells replacing the old ones. Thinned-out spaces deep in the skin regain volume due to new collagen formation.

Overall, these changes smoothen wrinkles, even the skin tone, and reduce skin laxity, as if the skin just acquired a new surface. That is why microneedling is commonly used for skin resurfacing.

During RF microneedling, the needle tips emit radiofrequency waves that heat up deep skin tissue layers. Radiowaves are a type of energy wave related to light and lasers. However, instead of finding colored targets to vaporize, radiofrequency waves heat up the tissues by creating an electric current. 

The heat from the radiofrequency-charged needles destroys abnormally formed collagen strands—a mechanism that softens up scars. Radiowaves also induce inflammation and enhance collagen production. These actions combined reduce scar prominence and make the skin smoother and firmer.

RF microneedling treatment can also get rid of cellulite if longer needles are used. The heated needles create small damage zones in subcutaneous fat, causing this deep skin tissue layer to shrink and remodel.

The heat produced during RF microneedling affects only the deep tissue layers. The pigment-containing cells in the superficial skin layers called “melanocytes” are spared. RF microneedling does not cause post-inflammatory hyperpigmentation (PIH) because of its melanocyte-sparing action, an advantage over laser resurfacing.

What Conditions Does Radiofrequency Microneedling Treat?

The following are the indications of RF microneedling:

• Skin rejuvenation 
• Acne scarring
• Non-inflamed to moderately inflamed acne
• Melasma and other skin pigmentation problems
• Hair thinning
• Rosacea
• Body contouring
• Stretch marks
• Excessive armpit sweating

Candidates for skin rejuvenation using RF microneedling include younger patients with mild-to-moderate skin aging signs or fine lines recurring after facial plastic surgery. RF microneedling is sometimes combined with plastic surgery in patients with complex skin texture problems.

Who Should Not Do RF Microneedling?

Microneedling is generally safe in healthy individuals. However, the following conditions can make the procedure unsafe for some people:

• Collagen vascular disorders
• Active infection
• Immunosuppression
• Inborn and acquired clotting problems
• History of poor wound healing
• Pregnancy
• Bad scarring history
• Poor blood sugar control

Unlike in some types of laser treatment, having a dark skin tone is not an absolute contraindication for RF microneedling. Thus, it is a “colorblind” procedure.

What Are the Benefits of RF Microneedling?

When compared with other skin rejuvenation treatments, RF microneedling has the following advantages:

• Suitability for every skin type
• Ability to reach the subcutaneous skin layer
• Shorter downtime than CO2 laser treatment
• Longer duration of effects than botulinum toxin injection
• Better tolerated side effects

Studies show that RF microneedling’s cosmetic effects are comparable to laser resurfacing in treating acne scars and mild-to-moderate skin aging signs. The treatment also improves skin hydration, texture, volume, and collagen content.

What Should You Do to Prepare for Your RF Microneedling Session?

At BHSkin Dermatology, we give all our patients a thorough medical evaluation to ensure RF microneedling is suitable for them. If so, we give them enough time to prepare for the treatment and schedule their appointment soon after.

The following are the pretreatment measures we recommend for patients undergoing RF microneedling:

• Sun protection
• Discontinuation of skin-sensitizing treatments like retinoids, hydroxy acids, and tanning
• Antiviral intake if they are cold sore-prone
• Application of topical vitamins A and C to boost the skin’s healing ability
• Discontinuation of medications that disrupt clotting and skin repair mechanisms, such as non-steroidal anti-inflammatory drugs and steroids
• Avoiding alcohol and cigarettes, which can slow down the skin’s recovery

Clean up the treatment area and keep it free of cosmetics before coming in for your appointment.

What Happens During RF Microneedling Treatment?

I start a typical RF microneedling session by cleaning up the treatment area. Afterward, I apply topical anesthesia to numb the site. The medication can take up to 30 minutes to take effect. 

When the skin is sufficiently numb, that’s my cue to pass the device over the treatment area. Pinpoint bleeding occurs when I use the needling equipment, which is normal. I make sure to cover the entire treatment site. The session can take up to an hour, depending on the problem area size. 

At the end of the session, I clean up the skin and apply a vitamin-enriched moisturizer. I may also use topical antibiotics to prevent skin infections if needed. My staff and I will provide aftercare instructions before sending the patient home.

What Can You Expect After Your RF Microneedling Procedure?

The RF microneeding recovery process isn’t difficult at all if the procedure is done properly and the patient strictly adheres to the pre- and posttreatment care instructions. Below, I explain the things you can expect after your session.

What Is the Timeline of the Skin Changes After RF Microneedling?

The treated area will be sore the first few days after your session. Most patients observe mild-to-moderate pain, redness, and swelling, which disappear spontaneously. By the end of the week, the treatment site may flake and feel dry and itchy. Skin repair has started at this point. 

By the second week, the superficial skin layer completely regenerates, and you will notice a significant improvement in the skin’s hydration level and tone. Initially, collagen production is slow but will pick up speed, eventually peaking by the third or fourth month after your session. 

The skin’s texture and appearance will continue to enhance for several months up to a year due to continuous collagen strengthening and remodeling. Multiple treatments a few weeks apart help speed up the skin’s transformation. You may reduce the frequency of treatments after achieving your desired results.

How Do You Take Care of Your Face After Radiofrequency Microneedling?

Good aftercare helps speed up your recovery. We recommend the following measures to allow the treated site to heal nicely after RF microneedling:

• Wash the treated area using a mild cleanser and moisturize with hyaluronic acid. Do this routine twice daily.
• Avoid cosmetics for a few days or while the skin is inflamed. Healing skin is highly irritable.
• Protect the area from the sun.
• Continue antiviral treatment. If I prescribe an antibiotic, you must finish the treatment course.
• Minimize bruising by icing, taking bromelain or arnica supplements, elevating the area when at rest, and refraining from vigorous activities for a few days. 
• Don’t pick at the area while it’s healing. Avoid contact with irritants, such as pool water and harsh chemicals.  

If your regimen involves multiple cosmetic treatments, space them adequately to allow the skin to recover between procedures.

How Long Is the Downtime After RF Microneedling Treatment?

The downtime is minimal to none after RF microneedling. The inflammatory phase after the treatment is mild and tolerable for most people. However, restricting activities and protecting the area from trauma for a few days help avoid complications that can slow down your recovery.

What Are the Possible Side Effects of RF Microneedling?

The most frequent side effects of RF microneedling treatment are mild swelling, redness, and discomfort arising from normal inflammation. Bruising may occur in vulnerable individuals. These symptoms usually resolve even without treatment. However, acetaminophen, sleeping upright, and icing the site help reduce the symptoms. Some may need topical corticosteroids to minimize swelling.

The risk of complications after RF microneedling is small. However, the following may occur when an inexperienced provider performs the procedure:

• Skin infection
• Acne flare
• Cold sore reactivation
• Persistent needle marks
• Post-inflammatory hyperpigmentation, which resolves in 4 weeks
• Skin lumps
• Burns
• Blisters
• Scarring
• Excessive bleeding
• Worsening of the skin problem
• Unsatisfactory result
• Ineffectiveness

Choosing a highly experienced, board-certified dermatologist to perform your procedure helps ensure the best outcomes.

How Long Does It Take for Radiofrequency to Show Results?

You may see results as early as the second week when the active healing period ends and the skin’s surface completely renews. However, the volumizing effect of collagen will not reach its maximum until the third or fourth month. Improvement of acne scars and skin tightening will go on for up to a year with continued collagen remodeling.

How Many RF Microneedling Sessions Do You Need?

The number of RF microneedling sessions depends on the severity of the skin problem and the patient’s response. Some individuals see vast improvement after only 1-3 treatments, while others need more. Sessions are spaced every 2-4 weeks until the desired result is achieved. Afterward, maintenance treatments may be scheduled every 6-12 months. 

Why Should You Choose a Board-Certified Dermatologist to Perform Your RF Microneedling Treatment?

RF microneedling yields excellent results when performed properly. Board-certified dermatologists are the best providers of this treatment for the following reasons:

• Excellent cosmetic outcomes – Board-certified dermatologists have a profound knowledge of skin anatomy. This allows us to choose the right treatment spots to produce significant cosmetic enhancement.
• Minimal side-effect risk – Board-certified dermatologists have extensive training in performing this procedure. Our knowledge of RF microneedling’s nuances lets us anticipate and prevent complications easily.
• Keen ability to identify potentially fatal skin conditions – Patients sometimes come to us with suspicious lesions they think are amenable to RF microneedling but later turn out to be skin cancer. Board-certified dermatologists are physicians with vast experience in identifying skin diseases. Accurate diagnosis ensures you get timely treatment and prevent complications.

RF microneedling is similar to traditional microneedling. However, adding radiofrequency to the treatment poses unique risks that inexperienced providers may be unable to manage. Entrusting the procedure to a specialist ensures its safety and effectiveness.

Radiofrequency Microneedling—Key Points

RF microneedling is an up-and-coming cosmetic procedure that combines traditional microneedling with radiofrequency application. The treatment’s cosmetic results are similar to laser resurfacing, but it has the advantages of a shorter downtime and an easier aftercare regimen. While radiofrequency enhances microneedling’s effects on the skin, it also poses unique risks that need expert handling.

The procedure is generally safe for every skin type and produces great cosmetic results if done properly. Complications usually arise when untrained individuals perform RF microneedling. Entrusting your treatment to a board-certified dermatologist ensures you maximize its benefits and experience none of its downsides. 

LA’s Award-Winning Radiofrequency Microneedling Specialists

RF microneedling is an innovative cosmetic treatment that resurfaces the skin like laser therapy but has fewer downsides. This procedure is quickly becoming popular because of its many benefits. But where do you go if you don’t want to miss out on this skin treatment?

At BHSkin Dermatology, our skin specialists perform RF microneedling for various skin conditions every day. The treatment gets rid of fine lines, acne scars, pigmentation problems, and many other skin issues. Visit us at our Glendale or Encino office or use our telederm portal for your first consultation.

Book your appointment today!

Sources:

1. Alster, T. S. and Graham, P. M. (2018, March). Microneedling: A Review and Practical Guide. Dermatologic Surgery. 44(3). 397-404. https://doi.org/10.1097/dss.0000000000001248
2. Magro, I. et al. (2022, September 14). Transcutaneous Radiofrequency Microneedling in the Facial Plastic Surgeon’s Practice. Facial Plastic Surgery and Aesthetic Medicine. 24. https://doi.org/10.1089/fpsam.2022.0226
3. Nobari, N. N. et al. (2023, February 7). A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO2, erbium YAG) in the treatment of atrophic and hypertrophic scars. Lasers in Medical Science. 38(1). 67. https://doi.org/10.1007/s10103-022-03694-x
4. Rajput, C. D. (2021, April to June). A Prospective, Nonrandomized, Open-label Study, Comparing the Efficacy, Safety, and Tolerability of Fractional CO2 Laser versus Fractional Microneedling Radio Frequency in Acne Scars. Journal of Cutaneous and Aesthetic Surgery. 14(2). 177-183. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423204/
5. Shauly, O. et al. (2023, November 6). Radiofrequency Microneedling: Technology, Devices, and Indications in the Modern Plastic Surgery Practice. Aesthetic Surgery Journal. 5. https://doi.org/10.1093/asjof/ojad100

Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online