No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Radiofrequency Microneedling: A Comprehensive and Critical Review
Abstract
Background:
Many studies have evaluated radiofrequency microneedling (RFMN) in various dermatologic conditions. However, the efficacy and safety of RFMN, and how it compares with other energy-based devices in a clinician's armamentarium, remains unclear.
Objective:
To review higher-quality evidence supporting RFMN and the dermatologic conditions which it can be used in.
Materials and methods:
A search was conducted in MEDLINE and EMBASE from inception to May 13, 2020, using the terms: "radiofrequency microneedling" OR "fractional radiofrequency" OR "radiofrequency needling" OR "radiofrequency percutaneous collagen induction." Only randomized, split body or blinded studies with original data on humans were included. Non-English or non-dermatology-related studies were excluded.
Results:
Forty-two higher-quality studies were included after applying the inclusion and exclusion criteria. There were 14 studies for skin rejuvenation, 7 for acne scars, 6 for acne vulgaris, 5 each for striae and axillary hyperhidrosis, 2 for melasma, and 1 each for rosacea, cellulite, and androgenetic alopecia.
Conclusion:
Radiofrequency microneedling is an effective intervention that can be used repeatedly and safely in combination with other treatment modalities and in individuals with darker skin phototypes. Radiofrequency microneedling-induced dermal remodeling and neocollagenesis are slow and progressive but continue to improve even 6 months after treatment.
... Combining RFM with cysteamine provides a synergistic effect in treating refractory melasma. The micro-injuries created by RFM enhance the penetration of cysteamine into the dermis, allowing it to act more effectively by inhibiting tyrosinase, a key enzyme involved in melanin synthesis [9,12,17]. This combined approach not only addresses the overproduction of melanin but also promotes dermal remodeling and neocollagenesis, which improves skin texture and reduces pigmentation more effectively than either treatment alone. ...
... The results of our study support the hypothesis that combining RFM with cysteamine enhances therapeutic outcomes by leveraging the complementary mechanisms of each modality. RFM increases the dermal absorption of cysteamine, thereby amplifying its ability to reduce melanin synthesis via tyrosinase inhibition [12,17]. Additionally, RFM-induced neocollagenesis helps repair the dermal damage associated with melasma, providing a more holistic approach to treatment. ...
... The observed incremental efficacy of Group D, treated exclusively with RFM, augments the existing literature endorsing RF's utility in managing melasma [17]. The VISIA score analysis for Group D, mirroring the UV spot reduction achievements of Group C, delineates RF's autonomous effectiveness in mitigating UV-induced skin alterations. ...
Background
Refractory melasma remains a challenge in dermatology, necessitating the exploration of innovative treatments.
Aims
This study aims to evaluate the efficacy and safety of combining radiofrequency microneedling (RFM) with Cysteamine cream, applied both in‐office and as a part of a home‐care regimen, to treat refractory melasma.
Patients/Methods
A vehicle‐controlled, split‐face trial was conducted on 30 Fitzpatrick skin types III and IV participants. Subjects received RFM and Cysteamine serum on one side of the face and RFM with saline on the contralateral side. Additionally, a random half‐added Cysteamine cream was applied at home. The modified Melasma Area and Severity Index and VISIA skin analysis were used for assessment.
Results
Significant improvement in melasma severity and skin texture was noted on the sides treated with RFM and Cysteamine, including observable benefits from both in‐office and home‐based Cysteamine use with minimal adverse effects.
Conclusions
The combined approach of RFM with Cysteamine provides a promising and safe modality for managing refractory melasma, showing notable improvements.
... RFM is a minimally invasive treatment that aids in skin rejuvenation through dermal remodeling and neocollagenesis [7]. It consists of RF combined with microneedling to penetrate into the skin via mechanical and thermal energies [7]. ...
... RFM is a minimally invasive treatment that aids in skin rejuvenation through dermal remodeling and neocollagenesis [7]. It consists of RF combined with microneedling to penetrate into the skin via mechanical and thermal energies [7]. The procedure relies on the mechanical effects of microneedles that penetrate into the skin to deliver heat in the form of radiofrequencies that stimulate growth factors to migrate and trigger proliferation of keratinocytes and fibroblasts necessary for skin remodeling [7]. ...
... It consists of RF combined with microneedling to penetrate into the skin via mechanical and thermal energies [7]. The procedure relies on the mechanical effects of microneedles that penetrate into the skin to deliver heat in the form of radiofrequencies that stimulate growth factors to migrate and trigger proliferation of keratinocytes and fibroblasts necessary for skin remodeling [7]. RFM can primarily be used in the context of skin rejuvenation to improve skin tightness, reduces skin roughness, and target dyspigmentation in photoaged skin [7]. ...
Background
Medical aesthetic procedures for facial rejuvenation with laser and energy‐based devices (EBDs) are rapidly increasing. The following cases highlight real‐life experience using a multi‐modality system with various handpieces that combine intense pulsed light (IPL), laser hair removal (808 diode), high‐intensity focused ultrasound (HIFU), radiofrequency microneedling (RFM), and thermal radiofrequency (RF) for antiaging and rejuvenation treatment. Laser and RFM treatments may improve skin conditions by inducing cutaneous changes that remodel the skin matrix.
Methods
Six physicians who treat patients for skin rejuvenation reported on clinical cases from their practice using a multi‐modality system with various handpieces.
Results
During the meeting, the advisors discussed 15 cases and agreed to select seven patients with different ages and skin phototypes receiving various treatments for photodamage of the face, neck, and décolleté. The advisors discussed why they selected the case, previous treatment, type of treatment, results, and clinical pearls.
Conclusion
Sharing best practices in medical aesthetics using combination treatments on a single multi‐modality energy‐based device such as laser and MRF for facial, neck, and chest skin may support healthcare providers treating patients for skin rejuvenation to improve clinical outcomes.
... Microneedling has emerged as a straightforward, safe, and highly effective minimally invasive treatment with a broad spectrum of applications [71][72][73][74]. ...
... Initially developed for skin rejuvenation, it has evolved to address an extensive range of skin conditions, including scars, acne, alopecia, drug delivery, and even hyperhidrosis [72]. Various microneedling devices are available, such as rollers or hand-held fully automated pens. ...
... The key to effectiveness of microneedling lies in its tiny micronsized needles, which delicately penetrate the skin's surface. These needles serve a dual purpose: they break down and revascularize old and hardened scar tissues, while also stimulating the formation of healthier collagen [72]. To yield the best results, it is crucial to reach a specific depth during the treatment to facilitate the breakdown and neo-formation of tissue. ...
Burn injuries are a significant public health concern, marked by substantial mortality and morbidity. The repercussions of burns extend beyond immediate trauma, often resulting in persistent challenges such as abnormal scar formation. Addressing the complexities of preventing and treating hypertrophic scarring requires innovative approaches that transcend mere survival, emphasizing the importance of enhancing the quality of survival of burn patients. Efficient prevention and treatment of hypertrophic scarring present considerable challenges, constituting a multifaceted endeavor to improve existing approaches and formulate novel strategies for optimal outcomes.
The research demonstrates the positive impact of combining laser Doppler imaging and NexoBrid® on the eventual scar quality of burn victims resulting from improved burn depth evaluation and reduced reliance on burn surgery. The effectiveness of Glyaderm®, a human-derived collagen-elastin dermal substitute, in enhancing scar quality in a cost-effective single-stage procedure is highlighted. Dissolving microneedles emerge as a promising, minimally painful alternative for hypertrophic scar treatment, with potential for personalized treatment techniques. A comprehensive systematic review affirms the efficacy of pressure therapy in scar prevention and treatment, emphasizing specific requirements for effectiveness. Scar hydration studies reveal that while costly silicone gels offer benefits compared to no therapy, more economical and patient-friendly moisturizers may be as effective. Moisturizers can replace silicone gels, with an impact on blood flow and the importance of reevaluating compositions for scar treatment. The exploration of anti-AGE enzymatic compounds for deglycation and decrosslinking in damaged skin shows promise for improving skin elasticity. In conclusion, this doctoral work signifies the progress made in scar management, emphasizing the anticipation of a more scarless future despite the long road traveled.
... [32][33][34][35][36][37][38][39][40][41][42] Radiofrequency microneedling is currently efficacious in the treatment of aging facial rhytids, acne scars, cellulite, striae, rosacea, alopecia, and axillary hyperhidrosis. 9,[43][44][45] There are myriad available products (Table 5). [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] ...
... 9,[43][44][45] There are myriad available products (Table 5). [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] ...
... The authors therefore advocate for surgeons and physicians to take ownership of this valuable treatment modality. 44 Multigenerator radiofrequency device that implements an array of radiofrequency sources and controls the phase of the current flowing through the electrodes using an algorithm Infini (Infini Sonic Therapy, Van Nuys, CA) 45 Fractional radiofrequency microneedling device that includes insulated, preset needle depths and independently variable power levels and uses a combination of radiofrequency energy and microneedling ...
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 and Embase 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.
... Several studies investigated the ideal settings for skin rejuvenation. Overly aggressive treatments, i.e. high temperatures, long delivery durations, and closely spaced treatments, resulted in less clinical improvement [13][14][15][16]. According to these studies, temperatures at 67 °C, 3 to 4 mm spacing between needle penetration, and needle lengths equivalent to the reticular dermis result in an optimal clinical outcome [15]. ...
... Overly aggressive treatments, i.e. high temperatures, long delivery durations, and closely spaced treatments, resulted in less clinical improvement [13][14][15][16]. According to these studies, temperatures at 67 °C, 3 to 4 mm spacing between needle penetration, and needle lengths equivalent to the reticular dermis result in an optimal clinical outcome [15]. ...
Radiofrequency microneedling (RFMN) is a commonly used fractional device to treat skin laxity and rhytids. Several studies investigated its histological and clinical effects. However, the role of the applied energy per needle (EPN) and total energy in the outcome remains unclear. The aim of the present study is to analyze the correlation between applied energy and resulting histological and clinical volume effects of RFMN treatment for skin rejuvenation. Ex vivo porcine skin was treated with a RFMN system equipped with insulated needles. Histological measurements of coagulation volumes were correlated with the delivered EPN, ranging from 20 mJ to 100 mJ. For the clinical investigation, a cohort of patients received treatment on the lower face and submental area. Absolute volume changes were calculated using computer-aided three-dimensional analysis. Pearson’s and Spearman’s correlation coefficients r were determined. Histologic analysis revealed a strong positive correlation between EPN and coagulation volume (r = 0.976; p < 0.005). A total of 30 patients, with a mean age of 55.9 ± 8.7 years, were recruited and received 1.7 ± 0.8 sessions (1–3) with a total energy of 1518.2 ± 784.1 J. Three-dimensional imaging revealed a strong logistic correlation with the total energy applied across all sessions (r = 0.676; p < 0.001). Analysis showed a positive association between the number of sessions and volume change. Study findings indicate a very strong and strong correlation between the applied energy and the resulting histological and clinical outcome in RFMN treatment, respectively. The introduction of coagulation volume as a matrix in RFMN treatments enables medical doctors to tailor and adjust treatment plan to the individual patient.
... While bipolar devices offer less penetration, they provide more controlled energy distribution and reduced discomfort ( Figure 2). Additionally, bipolar RF devices are frequently combined with light-based technology known as photodynamic synergy [126,[134][135][136][137][138][139][140][141]. ...
... Typically, RF treatments excel at addressing skin laxity, fine lines, scar and acne. Conversely, deeper RF treatments target subcutaneous fat tissues, aiming for localized fat reduction and body contouring through the heating of fat cells and stimulation of collagen regeneration [137,[142][143][144]. The latest RF devices use fractional technology to deliver RF energy through an array of electrodes, or microneedles. ...
Background
Energy‐based photoelectric and ultrasonic devices are essential for skin rejuvenation and resurfacing in the field of plastic surgery and dermatology. Both functionality and appearance are impacted by factors that cause skin to age, and various energy types have variable skin penetration depths and modes of transmission.
Aim
The objective is to advise safe and efficient antiaging treatment while precisely and sensitively controlling and assessing the extent of thermal damage to tissues caused by different kinds of energy‐based devices.
Methods
A literature search was conducted on PubMed to review the mechanisms of action and thermal effects of photoelectric and ultrasonic devices in skin remodeling applications.
Results
This paper reviews the thermal effects of energy‐based devices in skin resurfacing applications, including the tissue level and molecular biochemical level. It seeks to summarize the distribution form, depth of action, and influencing factors of thermal effects in combination with the mechanisms of action of various types of devices.
Conclusion
Accurate control of thermal damage is crucial for safe and effective skin remodeling treatments. Thorough investigation of molecular biochemical indicators and signaling pathways is needed for real‐time monitoring and prevention of severe thermal injury. Ongoing research and technological advancements will improve the accuracy and control of thermal damage during treatments.
... [8] Some Articles indicate that the safety of RFM in comparison to other energy-based devices remains unclear. [9] In other articles it is noted that by delivering energy bypassing the epidermis, damage to the epidermis and subsequent dyspigmentation can be avoided. [10,2] In addition RFM is safe in all skin types. ...
... Among others, RFM is indicated in skin rejuvenation, acne scars, melasma, thinning hair, and dermatological conditions such as acne vulgaris and rosacea. The method is also highly regarded in treatments for parts of the body other than the head and neck area, being used in the treatment of cellulite, striae, and hyperhidrosis [9,18]. Distinctive from other available methods in aesthetic medicine are following the ability to control the penetration depth and target tissue that undergoes micro-injuries, no limitations in terms of the device's application in different skin types (according to Fitzpatrick's division), and low risk of severe adverse effects. ...
Introduction and purpose: For all skin types, micro-needle radiofrequency (FMR) can be a safe and effective aesthetic medicine procedure for the treatment of various dermatological and aesthetic conditions. The aim of the study is to present the mechanism of action and assess safety, treatment efficacy, and possible side effects on the basis of a review of the scientific literature. Description of the state of knowledge: FMR uses micro-needles to penetrate the skin to a depth of up to 4.5 mm and deliver radiofrequency current in a fractional manner, producing the controlled fractions of micro-injuries in the dermis, inducing neocollagenesis, neoelastinogenesis, and angiogenesis. FMR has a wide range of positive effects such as skin rejuvenation, skin tightening, facial and body scar remodeling, and hair growth through transdermal collagen induction. Summary: Increasingly, patients are looking for minimally invasive methods of skin tightening and fat remodeling. In response, Aesthetic Medicine has proposed a combination of two techniques, micro-needling and radiofrequency. As more and more studies are showing the effectiveness and efficiency of this procedure, also emphasizing its safety, minimal risk of serious side effects, and ease of use, micro-needle radiofrequency is being proposed as an attractive answer to people's desires for a less invasive method of skin rejuvenation. However, further research in this area is needed to optimize the parameters of the treatment to achieve the best results.
... At the same time, the mechanical effects of microneedles on the skin also improve transcutaneous absorption of topical products, and promote secretion of growth factors to stimulate migration and proliferation of adjacent keratinocytes and fibroblast for skin remodeling. 5,6 At present, MFR has also presented good efficacy in the treatment of skin rejuvenation, acne vulgaris, acne scars, surgical scars, axillary hyperhidrosis, striae, and more. 5 In this study, we aim to determine whether the energy of MFR affects the efficacy of BoNT/A, and to provide an optimal strategy for energy device combined with BoNT/A therapy in the clinic. ...
... 5,6 At present, MFR has also presented good efficacy in the treatment of skin rejuvenation, acne vulgaris, acne scars, surgical scars, axillary hyperhidrosis, striae, and more. 5 In this study, we aim to determine whether the energy of MFR affects the efficacy of BoNT/A, and to provide an optimal strategy for energy device combined with BoNT/A therapy in the clinic. Xinruan Information Technology, China) conducted running training for 1 week, and the terminal event was that the mice ran the whole course stably at the preset maximum speed. ...
Background:
The combination of botulinum toxin type A (BoNT/A) and energy equipment have been widely used in the clinic.
Aims:
To determine whether the energy of microneedle fractional radiofrequency (MFR) affects the efficacy of BoNT/A and to provide an optimal strategy for the energy device in combination with BoNT/A in the clinic.
Methods:
First, a total of 45 females with moderate-to-severe periorbital crow's feet wrinkles were enrolled and divided into three groups according to different treatment methods and intervals, including BoNT/A injection alone, BoNT/A injected immediately after MFR treatment and BoNT/A injected 7 days after MFR treatment. The photographs were compared before treatment and 4 weeks after treatment. Then, the mouse models were established by combining MFR with BoNT/A at different intervals, to evaluate muscle strength, muscle mass, muscle nutritional markers, and important cytokines levels.
Results:
All patients in each group had high satisfaction. The MFR + BoNT/A (immediately) group could improve dynamic wrinkles, but the others had more significant efficacy (p < 0.05). The results of mouse models showed that all BoNT/A groups induced different degrees of muscle paralysis in vivo, but the paralytic effect induced by the BoNT/A group, MFR + BoNT/A (interval of 3-day) group, and MFR + BoNT/A (interval of 7-day) group were higher than others and the expression levels of muscle nutritional markers in NMJ tissues were significantly upregulated.
Conclusion:
MFR has a certain reduction effect on the activity of BoNT/A, and this reduction effect would last for 3 days after MFR treatment.
... South Korean RF devices are particularly noted for their compact designs, user-friendly interfaces, and sophisticated real-time monitoring systems integration, which improve the overall treatment experience. These attributes not only cater to the needs of healthcare professionals but also empower consumers to confidently engage with esthetic treatments [6]. ...
... Microneedling, also called percutaneous collagen induction therapy, creates controlled micro-injuries to stimulate collagen and elastin production, improving skin texture and elasticity [63]. Microneedling can be associated with RF energy to enhance collagen production in the deeper dermal layers [64]. These present solutions for wrinkled, scarred, and sagging skin of patients with sudden weight loss. ...
... Fatores como o tipo de pele do paciente, a condição a ser tratada e os produtos tópicos associados ao procedimento podem influenciar significativamente os resultados. Assim, uma análise crítica das evidências disponíveis é fundamental para compreender as reais vantagens e limitações do microagulhamento no preparo de pele, bem como para estabelecer diretrizes clínicas baseadas em evidências (Tan et al., 2021). ...
O microagulhamento é uma técnica ganhou destaque no preparo da pele devido à sua capacidade de estimular a produção de colágeno e melhorar a penetração de ativos tópicos. Este procedimento envolve o uso de dispositivos com agulhas finas que causam microlesões na pele, ativando o processo de cicatrização e promovendo a renovação celular. O objetivo do presente artigo é apresentar uma revisão narrativa a qual busca compilar evidências científicas sobre o microagulhamento no tratamento de diversas condições, como cicatrizes, hiperpigmentação e envelhecimento cutâneo. Além disso, a revisão explora a segurança, as indicações e as contraindicações do procedimento, oferecendo uma visão abrangente sobre suas aplicações no preparo da pele. Conclui-se que o microagulhamento, quando realizado corretamente, pode ser uma técnica eficaz e segura, com benefícios significativos para a saúde e a estética da pele.
... Radiofrequency radiation is a non-ionizing electromagnetic radiation with a frequency range of 3 kHz to 300 GHz [14]. Unlike most lasers that target specific chromophores, radiofrequency radiation interacts with the electrical properties of the target tissue and is independent of chromophores, making it safer for all skin types [15,16]. ...
... It delivers radiofrequency-generated heat energy to the dermis through microneedles, inducing thermal injury, stimulating new collagen production, and minimizing damage to the epidermis, with minimal side effects. The mechanical effects of microneedles on the skin can improve transdermal absorption of topical products, promote growth factor secretion, and stimulate migration and proliferation of adjacent keratinocytes and fibroblasts, achieving skin remodeling [40]. Fractional laser therapy promotes wound healing and stimulates collagen and dermal remodeling by acting on the microthermal treatment zone, making it one of the gold standards for acne scar treatment. ...
Background
Acne vulgaris is a chronic inflammatory skin condition, commonly resulting in acne scars. Treating acne scars remains a significant challenge in dermatology. With advancements in laser technology, its clinical use for treating acne scars has been increasing annually. However, bibliometric analysis on laser treatment for acne scars is lacking. This study aims to use bibliometrics to comprehensively understand the development trends and research hotspots in laser treatment for acne scars.
Methods
Using “acne scar” and “laser” as search terms, literature on laser treatment of acne scars from 2014 to 2024 was retrieved from the Web of Science Core Collection (WoSCC) database. The literature data were visualized using VOSviewers, CiteSpace, and R software, generating maps of countries, research institutions, authors, journals, references, and keywords.
Results
The analysis included 536 articles from 46 countries, with the United States and China leading in publications. Publications focusing on laser treatment of acne scars exhibit a consistent growth trend annually. Key research institutions include Mahidol University in Thailand, Cairo University in Egypt, and Hallym University in South Korea. The “Journal of Cosmetic Dermatology” had the highest number of articles in this field, while “Dermatologic Surgery” was the most cited publication. These publications involved contributions from 2135 authors, with Professor Manuskiatti Woraphong from Mahidol University in Thailand being the most prolific author in this field. Research on the efficacy of laser treatment for acne scars is a major focus in this field. Among the different types of lasers, CO2 lasers are the most commonly used. Emerging research focuses include therapies such as platelet‐rich plasma, picosecond laser, trichloroacetic acid, and burn scar.
Conclusions
Treatment efficacy is the primary focus of research in the field of laser treatment for acne scars. Platelet‐rich plasma, and novel picosecond lasers, have emerged as hot topics and trends in this research field. However, it is important to note that the impact factors of journals publishing in this field are currently low. Therefore, clinicians must consider and explore strategies for publishing high‐quality clinical research in the future.
... The Food and Drug Administration subsequently approved RF therapy for treating facial skin in 2006. The applications of RF therapy have since expanded to the cosmetic treatment of cervical, abdominal, and femoral skin [4]. Monopolar RF utilizes electromagnetic waves to generate controlled heat within the dermal layers, stimulating collagen synthesis and remodeling while also promoting tissue contraction [5]. ...
Background: Monopolar radiofrequency (RF) has emerged as a promising modality for tightening the skin of aged faces. Although many studies have assessed the efficacy of monopolar RF via the clinical evaluation of photographs, few have examined the long-term effectiveness and safety of this therapy using various skin testing devices. Methods: Twenty women with aged faces participated in this study. After a single monopolar RF treatment, three blinded dermatologists who were not involved in the treatment evaluated its clinical efficacy and safety after 4, 12, and 24 weeks. Skin firmness, fine wrinkles, skin pores, and skin tone were also measured using an indentometer (Courage+Khazaka Electronic GmbH, Köln, Germany) and a facial aging measurement device (Mark-Vu; PSI Plus, Suwon-si, Republic of Korea). Results: Skin laxity in the jowls and nasolabial folds showed significant improvement 12 weeks after the single monopolar RF treatment when evaluated by dermatologists, and this improvement lasted 24 weeks (p < 0.05). Moreover, the participants reported improvement at 4 weeks compared to baseline which lasted 24 weeks (p < 0.05). Skin firmness measured in the cheek increased 4 weeks after treatment and continued to improve during 24 weeks of follow-up (p < 0.01). Although there was a gradual increase in improvement in skin pores, fine wrinkles, and skin tones, there were no statistical differences compared to the baseline. No patients experienced pain during the treatment, and no burns, skin breakdown, or scarring occurred after treatment. Conclusions: A single monopolar RF treatment is effective for females with aged face. A significant improvement in the jowls and nasolabial folds and facial skin firmness was observed between the 4- and 24-week follow-ups without adverse effects.
... Also, the combination of fractional microneedling (RF) and PRP shows significant improvement in average skin thickness and has been shown to be a powerful, safe, and effective treatment method for mild to moderate laxity in the neck area. PRP shows promising uses in skin rejuvenation; however, more studies are needed to test its validity alone or in combination to improve results [59][60]. ...
Blue light, with wavelengths from 400 nm to 500 nm, is an important part of the sun's electromagnetic radiation spec- trum, which is present in human daily life, especially in the modern era due to the increased use of electronic devices through their screens. Low-energy and low time of expo-sure to blue light can enhance the prevention of certain skin conditions such as psoriasis, eczema, and atopic dermatitis, while studies have demonstrated that prolonged expo- sure to high-energy blue light can increase the amount of skin damage. DNA, cell death, skin barrier and fibroblast damage, hyperpigmentation, and photoaging. Therefore, in the fields of aesthetics and cosmetology, it is important to study the problems caused by exposure to the blue radiation spectrum. Improved protection filters, extracts of plant products, a variety of antioxidants, and natural ingredients from plants and algae are added to cosmetic products and compose innovative formulations as part of a comprehensive photoprotection strategy. In recent decades, antiaging strategies have been developed that include minimally invasive treatments with remarkable safety and efficacy and reduced recovery time. A combined approach of these treatments can provide optimal results in repairing the skin damage caused by ultraviolet (UV) and visible radiation and, consequently, in the overall improvement of the appear- ance of photoaged skin.
... comunicações, medicina, indústria, pesquisa científica e muitos outros campos (DAYAN et al., 2020;TAN et al., 2021;ROHRICH et al., 2022). A radiofrequência é amplamente utilizada na área da estética para tratar uma variedade de preocupações com a pele, emagrecimento, aumento de performance e melhorar a aparência. ...
A radiofrequência é amplamente utilizada na área da estética para tratar uma variedade de preocupações com a pele, emagrecimento, aumento de performance e melhorar a aparência. Diante dos expostos, o presente trabalho tem como objetivo realizar uma revisão da literatura científica no intuito de compreender o efeito da radiofrequência na redução de medidas em praticantes de atividades físicas, através da busca de artigos em bancos de dados, tais como PubMed, Scientific Electronic Library Online (Scielo), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) e Biblioteca virtual de Saúde (BVS). Estudos demonstraram que a Radiofrequência possui efeitos biológicos que abrangem a vasodilatação, a melhoria na oxigenação, o aumento da permeabilidade da membrana celular, a facilitação na drenagem de resíduos celulares e, consequentemente, a redução dos níveis de radicais livres e de líquidos intracelulares. Além disso, a radiofrequência estimula o sistema imunológico e promove a produção de fibras de colágeno de maior qualidade.
BACKGROUND
From the initial development of radiofrequency devices to new technologies such as micro-coring, there has been tremendous growth of nonlaser energy-based devices in dermatology over the past few decades.
OBJECTIVE
To review the origins and development of energy-based devices in dermatology and dermatologic surgery.
MATERIALS AND METHODS
A literature search was conducted on PubMed from inception to February 1, 2025 to identify critical publications on energy-based devices within dermatology.
RESULTS
Since the initial research surrounding radiofrequency-based surgical tools in the 1990s, numerous dermatologists have pioneered the development of energy-based devices to target skin laxity and texture, enhance body contouring, and improve muscle tone. The rise of these energy-based devices has allowed for minimally invasive treatments to address patients' aesthetic concerns with less pain and downtime.
CONCLUSION
Dermatologists have played a critical role in the advancement behind the rise of energy-based devices for a variety of aesthetic indications. Dermatologic Surgery has published many of the landmark studies behind these devices and continues to be at the forefront of innovation for further research and clinical trials.
Radiofrequency microneedle (RFMN) could mechanically penetrates the epidermis and emits radiofrequency energy to the target skin layer. This innovative system offers the capability to deliver precisely controlled radiofrequency energy at varying depths within the skin in a single insertion. We hypothesized that the new RFMN could improve both pore size and skin laxity simultaneously by single insertion and multiple discharges, thus reducing the number of treatment passes and improving the treatment efficiency. Therefore, we carried out this pilot study to confirm the clinical effects and corresponding histological changes. In clinical part, 3 subjects received a single RFMN treatment. Subjects’ faces were randomly divided into superficial base-energy and deep high-energy side or superficial high-energy and deep base-energy side. Facial characteristics were documented using standardized photographic techniques at various points in the study. In animal experiment, the abdomen of Bama miniature pig was divided into 4 treatment zones: the blank control group; superficial base-energy and deep high-energy group; superficial high-energy and deep base-energy group; no energy control group. Skin samples were collected immediately and 1 month post-treatment for histological analysis to observe the corresponding histological changes. Immediately after treatment, we found that the severity of erythema and petechiae may be related to the parameter settings. 1 month after treatment, improvement in skin laxity and facial pore size on both sides of the face was observed. The treatment resulted in a more significant improvement in relaxation on the superficial base-energy and deep high-energy side, but the pore improvement appeared to be more pronounced on the superficial high-energy and deep base-energy side. A trend of decreasing intensity in vascular dilatation was observed across the treatment groups, with the superficial high-energy and deep base-energy group exhibiting the most pronounced dilation. Histological observations immediately after treatment revealed that 2 seperated injury zones, which was caused by the same needle discharged electric twice, and one charge in the deep and one in the shallow. Immediate post-treatment dilation of blood vessels in all treatment groups was observed. A trend of decreasing intensity in vascular dilatation was observed across the treatment groups, with the superficial high-energy and deep base-energy group exhibiting the most pronounced dilation. 1 month post-treatment, histological analysis revealed an increase in dermal thickness, elastin, collagen fiber thickness and density, perivascular inflammatory cell infiltration across all treatment groups. Overall, our study demonstrated that variations in energy delivered at different depths by a new RFMN could induce distinct histological changes and corresponding clinical efficacy. This finding holds promise for optimizing the clinical application of RFMN. By tailoring the depth and energy settings in one insertion, specific concerns such as enlarged pores or facial laxity can be addressed more efficiently.
Objective
To evaluate the efficacy and safety of a thermo‐mechanical fractional device for the treatment of photodamaged skin.
Methods and Materials
Twenty‐five subjects received three thermo‐mechanical fractional device treatments at monthly intervals. Low treatment settings of a 5 ms pulse duration and 100 μm tip protrusion were administered in 1–2 passes. Digital images were evaluated for improvement on the Fitzpatrick Wrinkle Classification Score 3 months after the final treatment. Secondary efficacy endpoints included ratings on a Global Aesthetic Improvement Score and Subject SatIsfaction Questionnaire.
Results
Forty‐eight percent of subjects demonstrated a ≥ 1 score improvement in the Fitzpatrick Wrinkle Classification Score, and 96% of subjects demonstrated a good to excellent Global Aesthetic Improvement Score. Sixty‐eight percent of subjects were “satisfied” to “very satisfied” with treatment results.
Conclusions
The thermo‐mechanical fractional device at low settings is safe and effective for improving signs of photodamage with minimal patient discomfort.
Dear students, future cosmetologists,
The teaching material we present uses data from research and websites on current topics in the field of aesthetics and cosmetology such as anti-aging treatments, skin rejuvenation, body shaping and fat reduction, tattoo removal as well as treatments for slimming and body shaping. These are primarily new insights based on the application of hardware devices used in cosmetology practice around the world. In each separate topic, the indications, the necessary qualifications and permits for the use of the device, the method of dosing, the side effects and all that are based on medical documentation from published professional papers are processed.
Medical science is clearly moving forward, we must follow new knowledge, both in terms of effects and side effects when applying certain cosmetic treatments. As uncommercial as it may seem, medical ethics should be observed when applying these treatments. Guided by the principle of doing no harm, we are moving forward towards the application of ethics on a scientific basis.
Every research offers new dimensions in our practical work, this textbook offers just that, education for medical persons, education for practitioners and facts for education for clients, because not everything presented is always harmless.
BACKGROUND
Radiofrequency microneedling (RFM) is a potential treatment for primary hyperhidrosis. However, its efficacy is unclear, and treatment parameters and outcomes vary across studies.
OBJECTIVE
To understand the effect of RFM on treating primary hyperhidrosis, as measured by changes in the Hyperhidrosis Disease Severity Score (HDSS) before and after treatment, and to clearly define treatment settings most likely to optimize results.
MATERIALS AND METHODS
A systematic literature search utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted across PubMed, EMBASE, MEDLINE, Web of Science, and the Cochrane Library. Studies were evaluated for risk of bias via the ROBINS-I tool and Levels of Evidence/GRADE criteria. A random forest model identified RFM settings that predict HDSS score decrease.
RESULTS
Six publications met inclusion criteria. The level of evidence was classified as Grade B, indicating moderate quality. RFM intervention resulted in a mean HDSS score decrease of 1.63 (52% reduction, p < .05). The strongest predictors for HDSS score decrease were dwell time, energy, and depth, with feature importances of 0.43, 0.19, and 0.15 respectively.
CONCLUSION
Radiofrequency microneedling treatment significantly reduces HDSS scores in patients with primary hyperhidrosis. Moving forward, it would benefit physicians to standardize objective protocols in reporting RFM parameters and measuring outcomes.
When we think about facial rejuvenation, we have to think about the active interplay of muscles, fat compartments, bony structures, and vasculature to reveal the dynamic relationships just below the surface of the skin. This is useful in understanding an analytic approach to produce changes in a patient’s facial features. Surgical lifting procedures have typically been used to treat facial and neck skin sagging and laxity. However, a broad range of nonsurgical procedures have emerged as an alternative to surgery over the last decade. Through the administration of controlled dermal heating treatments, including radiofrequency (RF), intense pulse light (IPL), and ultrasound, offer varying tissue tightening levels. Compared to surgical procedures, noninvasive treatments have minimal downtime, relative safety for skin color, and a favorable side effect profile. Unfortunately, less intrusive procedures have a history of poor efficacy, uneven clinical outcome, and a shorter-lasting tightening effect.
Background:
Acne is a chronic inflammatory and immune-mediated disease of the pilosebaceous unit (the skin structure consisting of a hair follicle and its associated sebaceous gland). It is characterised by non-inflammatory lesions (open and closed comedones) and inflammatory lesions (papules, pustules, nodules, and cysts). Lesions may be present on the face, thorax, and back, with variable severity. Acne exhibits a global distribution and has a growing prevalence. Acne vulgaris is the most common form. Acne gives rise to complications such as scars and can seriously affect people's mental health, especially those with severe acne. Acne has a huge impact on the quality of life and self-esteem of those affected.
Objectives:
To synthesise the existing evidence on the efficacy and safety of non-systemic pharmacological interventions and non-pharmacological interventions (physical therapy and complementary therapies) in the treatment of acne vulgaris and related skin complications.
Methods:
We searched the Cochrane Database of Systematic Reviews, Epistemonikos, MEDLINE, and Embase to 2 December 2021, and checked the reference lists of included reviews. At least two authors were responsible for screening, data extraction, and critical appraisal. We excluded reviews with high risk of bias as assessed with the ROBIS tool. We evaluated the overall certainty of the evidence according to GRADE (as carried out by the authors of the included reviews or ourselves). We provide comprehensive evidence from the review data, including summary of findings tables, summary of results tables, and evidence maps.
Main results:
We retrieved and assessed a total of 733 records; however, only six reviews (five Cochrane reviews and one non-Cochrane review) with low risk of bias met the overview inclusion criteria. The six reviews involved 40,910 people with acne from 275 trials and 1316 people with acne scars from 37 trials. The age of the participants ranged from 10 to 59 years, with an average age range from 18 to 30 years. Four reviews included original trials involving only female participants and three reviews included original trials with only male participants. Main results for clinically important comparisons: Benzoyl peroxide versus placebo or no treatment: In two trials involving 1012 participants over 12 weeks, benzoyl peroxide may reduce the total (mean difference (MD) -16.14, 95% confidence interval (CI) -26.51 to -5.78), inflammatory (MD -6.12, 95% CI -11.02 to -1.22), and non-inflammatory lesion counts (MD -9.69, 95% CI -15.08 to -4.29) when compared to placebo (long-term treatment), but the evidence is very uncertain (very low-certainty evidence). Two trials including 1073 participants (time point: 10 and 12 weeks) suggested benzoyl peroxide may have little to no effect in improving participants' global self-assessment compared to placebo (long-term treatment), but the evidence is very uncertain (risk ratio (RR) 1.44, 95% CI 0.94 to 2.22; very low-certainty evidence). Very low-certainty evidence suggested that benzoyl peroxide may improve investigators' global assessment (RR 1.77, 95% CI 1.37 to 2.28; 6 trials, 4110 participants, long-term treatment (12 weeks)) compared to placebo. Thirteen trials including 4287 participants over 10 to 12 weeks suggested benzoyl peroxide may increase the risk of a less serious adverse event compared to placebo (long-term treatment), but the evidence is very uncertain (RR 1.46, 95% CI 1.01 to 2.11; very low-certainty evidence). Benzoyl peroxide versus topical retinoids: Benzoyl peroxide may increase the percentage change in total lesion count compared to adapalene (long-term treatment), but the evidence is very uncertain (MD 10.8, 95% CI 3.38 to 18.22; 1 trial, 205 participants, 12 weeks; very low-certainty evidence). When compared to adapalene, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): percentage change in inflammatory lesion counts (MD -7.7, 95% CI -16.46 to 1.06; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), percentage change in non-inflammatory lesion counts (MD -3.9, 95% CI -13.31 to 5.51; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.96, 95% CI 0.86 to 1.06; 4 trials, 1123 participants, 11 to 12 weeks; low-certainty evidence), investigators' global assessment (RR 1.16, 95% CI 0.98 to 1.37; 3 trials, 1965 participants, 12 weeks; low-certainty evidence), and incidence of a less serious adverse event (RR 0.77, 95% CI 0.48 to 1.25, 1573 participants, 5 trials, 11 to 12 weeks; very low-certainty evidence). Benzoyl peroxide versus topical antibiotics: When compared to clindamycin, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): total lesion counts (MD -3.50, 95% CI -7.54 to 0.54; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), inflammatory lesion counts (MD -1.20, 95% CI -2.99 to 0.59; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), non-inflammatory lesion counts (MD -2.4, 95% CI -5.3 to 0.5; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.95, 95% CI 0.68 to 1.34; 1 trial, 240 participants, 10 weeks; low-certainty evidence), investigator's global assessment (RR 1.10, 95% CI 0.83 to 1.45; 2 trials, 2277 participants, 12 weeks; very low-certainty evidence), and incidence of a less serious adverse event (RR 1.27, 95% CI 0.98 to 1.64; 5 trials, 2842 participants, 10 to 12 weeks; low-certainty evidence). For these clinically important comparisons, no review collected data for the following outcomes: frequency of participants experiencing at least one serious adverse event or quality of life. No review collected data for the following comparisons: topical antibiotics versus placebo or no treatment, topical retinoids versus placebo or no treatment, or topical retinoids versus topical antibiotics.
Authors' conclusions:
This overview summarises the evidence for topical therapy, phototherapy, and complementary therapy for acne and acne scars. We found no high-certainty evidence for the effects of any therapy included. Randomised controlled trials and systematic reviews related to acne and acne scars had limitations (low methodological quality). We could not summarise the evidence for topical retinoids and topical antibiotics due to insufficient high-quality systematic reviews. Future research should consider pooled analysis of data on new emerging drugs for acne treatment (e.g. clascoterone) and focus more on acne complications.
Background
Semaglutide, a glucagon‐like peptide‐1 receptor agonist, has been utilized for the treatment of type 2 diabetes. Recently, it has gained popularity for its ability to aid in weight loss. However, rapid weight loss induced by semaglutide has been shown to lead to noticeable facial volume loss and the appearance of a prematurely aged face referred to as “Ozempic face.” As this term gains more popularity and increasingly more nondiabetic patients seek rapid weight loss options, there is growing concern among patients and healthcare providers regarding using semaglutide for weight loss as it may have a negative impact on facial esthetics.
Objective
The purpose of this paper is to investigate the semaglutide face phenomenon associated with GLP‐1 agonist use for the treatment of obesity.
Methods
A comprehensive search on PubMed was conducted to identify the available information related to semaglutide regarding Ozempic face. The search was conducted using a combination of keywords, including “semaglutide,” “semaglutide face,” and “Ozempic face.”
Results
“Semaglutide face” is recognized as having similar characteristics to a naturally occurring aging face. However, the characteristics of an Ozempic face occur in people much younger than what is seen with the natural aging process. While some believe that this phenomenon is attributed to acute weight loss at a faster rate than normal, many physicians argue that the semaglutide face phenomenon is more likely to occur with the amount of weight lost overall rather than whether that individual used a semaglutide medication to achieve the weight reduction or not. Overall, the semaglutide face phenomenon is characterized by elastin and collagen loss, fat and muscle volume loss, and excessive sagging skin.
Conclusions
The semaglutide face phenomenon highlights the esthetic implications of using semaglutide for the promotion of accelerated weight loss. While this term is not medically recognized, the hollow or sunken look following rapid weight loss sheds light on the effect of semaglutide in facial fat redistribution and volume loss. The metabolic changes induced by GLP‐1 agonists can impact adipose and muscle tissue, which can lead to changes in facial contour and overall appearance. While semaglutide‐induced facial changes may resemble signs of premature aging, they are distinct in their rapid onset and association with significant weight loss. Individuals experiencing semaglutide face have treatment options available depending on their own treatment goals.
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.
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.
Objective
This article provides a comprehensive overview of recent advancements in cosmetic dermatology and aesthetics. It covers topics including dermal fillers, botulinum toxin (BTX anti‐aging cosmeceuticals, artificial intelligence (AI) applications, and energy‐based devices.
Methods
The review summarizes the current literature on dermal fillers, BTX, cosmeceuticals, AI applications, and energy‐based devices. It explores emerging technologies, new treatment methods, and ongoing research in these areas. The sources of data include peer‐reviewed journals, clinical trials, and expert opinions to provide a thorough understanding of recent developments and future trends.
Results
Dermal fillers, particularly hyaluronic acid (HA), are popular in cosmetic treatments, with innovations like Bioorthogonal strategies and thiomer‐based technology emerging. Biostimulators such as poly‐ l ‐lactic acid and calcium hydroxyapatite promote neo‐collagenesis. BTX remains a cosmetic standard, with new recombinant toxins, hybrid BTXs, and delivery methods enhancing safety and efficacy. Anti‐aging trends include cellular senescence‐targeting treatments like exosomes, NMN, and PDRN, which need further validation. AI improves diagnosis, personalized treatments, and patient consultations but faces data privacy and bias challenges. Advanced energy‐based devices (RF, HIFU, lasers) and treatments like cryolipolysis and MFU‐V enhance skin rejuvenation and body contouring.
Conclusion
Recent advancements in cosmetic dermatology and aesthetics, including innovative dermal fillers, BTX developments, anti‐aging cosmeceuticals, AI applications, and energy‐based devices, are transforming the field. These innovations provide enhanced treatment options and improved patient outcomes, although further research is necessary to validate efficacy and address emerging challenges. The future of cosmetic dermatology is promising, with ongoing technological advancements driving continuous improvements in aesthetic medicine.
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.
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.
Nonsurgical facial skin tightening treatments are becoming more popular, and many people are interested in learning how they can address their skin laxity concerns. Aesthetic patients specifically complain about their drooping lower face or sagging neck; however, certain areas of the body are also of concern to some. The increased interest in nonsurgical skin tightening options has led to improvements in technology as well as better results for patients.
There are several different modalities currently being used, and they include radiofrequency (RF), micro-focused ultrasound (MFU), high-intensity focused ultrasound (HIFU), lasers, infra-red (IR), microneedling, or a combination of these. Patient selection and expectations are very important aspects of the consultation and treatment plan because results vary widely. Some patients may not appreciate significant differences after treatment until they compare treatment results to photographs taken prior to treatment.
A potential disappointment for patients who want to see immediate results is the length of time it generally takes to note improvement in skin laxity. In many cases, 3–6 months is required to stimulate collagen production and subsequent skin tightening however, some note improvements sooner. Younger patients with mild skin laxity tend to demonstrate more noticeable results, while older patients with higher BMI and moderate skin laxity may notice less improvement.
Considerations of determining appropriate candidates for skin tightening are the age of the patient, quality of the skin, and amount of subcutaneous fat. The cost of the procedure is also a consideration. Unfortunately, patients with moderate to severe skin laxity in the lower face and neck area are the exact patient category who need and want skin tightening but usually enjoy the least improvement without surgical intervention.
https://ikm.mk/ojs/index.php/kij/article/download/6731/6523/10880
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.
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.
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).
This systematic review and meta-analysis has provided initial evidence of the efficacy and safety of microneedling technology for SD.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Lasers and other light sources are popular treatment options for facial rejuvenation in recent years. In this study, we aimed to compare the efficacy and safety of fractional radiofrequency (RF) and fractional Erbium :YAG (Er:YAG) laser for facial and neck skin wrinkles, objectively. Three hundred and thirty‐three patients treated with fractional RF and fractional Er:YAG laser were evaluated by two blinded dermatologists. Fractional Er:YAG laser was more effective for the periorbital area; whereas fractional RF treatment was more effective for perioral, nasolabial and jawline areas. There was no statistically significant difference in side effects between two treatment groups. In conclusion, both modalities significantly improve skin wrinkles, however, it should be considered that there may be regional differences between the treatment outcomes of them. This article is protected by copyright. All rights reserved.
Striae distensae (SD) cause a cosmetic problem to many patients. Recently, fractional micro-needle radiofrequency (FMR) device has been introduced in treatment of SD. Also, fractional CO2 laser has been used as a resurfacing laser technique in the treatment of SD. The aim of our study was to assess and compare between the efficacy of FMR and fractional CO2 laser in treatment of SD. Seventeen female patients with SD were enrolled in this study. Detailed history was taken and dermatological examination was done to determine the type of striae, the location, and measurement of the width of the largest striae on each side. In each patient, one side was randomly assigned to treatment by FMR (area A), and the other side to treatment by fractional CO2 laser (area B). Our results showed that both techniques were effective. A slight better efficacy was encountered with FMR, but the difference was not statistically significant (p = 0.716). The current study concluded that FMR and fractional CO2 laser are almost equally effective in the treatment of SD (rubra and alba). Development of post inflammatory hyper-pigmentation (PIH) was evident with fractional CO2 in contrast with FMR, and the difference was statistically significant (p = 0.001).
Background:
Laser toning using a low-fluence 1,064 nm Q-switched Nd:YAG laser is one of the most frequently used treatment modalities for melasma. However, this therapy is time consuming because it requires a lot of treatment sessions. Recently, it has been reported that transdermal radiofrequency (RF) is effective for the treatment of melasma.
Objective:
To determine whether microneedle RF conduction could be an adjunct therapy for melasma, we have studied the effect of simultaneous treatments with laser toning and RF for melasma.
Methods:
Fifteen patients with melasma underwent five sessions of laser toning and microneedle RF on the right side of the face, and only laser toning on the left side. Responses to treatments were evaluated using the Mexameter® (Courage Khazaka, Germany) score, the pigmentation and severity index (PSI) score, and the patient's overall assessment. Additionally, an electron microscopic study of a skin biopsy was performed.
Results:
Both laser toning and combination therapy showed significant decreases in the Mexameter® and PSI score after five treatment sessions. Combination therapy showed a more significant improvement of melasma than laser toning. No remarkable side effects were reported. Electron microscopic analysis showed a greater number of vacuolar changes and increased loosening of melanocytes and adjacent epidermal cells after combination therapy.
Conclusion:
The combination treatment of laser toning and microneedle RF therapy showed a better therapeutic effect for melasma than laser toning alone. Therefore, the microneedle RF technique could be a new and safe adjunct therapy for the treatment of melasma.
An optimized therapeutic regimen involving a non-ablative fractionated laser or radiofrequency therapy for acne scars has not yet been established. To evaluate whether the combination of a non-ablative fractional laser (NAF) and fractional micro-needling radiofrequency (FMR) has clinical advantages for the treatment of atrophic acne scars compared with NAF alone, a 16-week prospective, randomized split-face study was performed. Each facial side of a patient was treated with 3 sessions of either NAF with FMR or NAF alone, with a 4-week interval between each session. Although both sides demonstrated significant decreases in the échelle d'évaluation clinique des cicatrices d'acné (ECCA) score, the facial side treated using the combination regimen demonstrated greater improvement in ECCA score regarding degree and onset time than the NAF-treated side. Histopathological and immunohistochemical results confirmed the clinical findings. This study demonstrated that a combination regimen involving NAF and FMR could be a viable option with satisfactory efficacy.
Background:
There is no gold standard treatment for facial acne scars, and overall, little literature exists about the combination therapy for treatment of acne scar.
Aims:
The aim of this study was to evaluate the efficacy of fractionated microneedle radiofrequency (FMR) vs FMR combined with subcision for the treatment of atrophic acne scars.
Patients/methods:
This was a randomized, split-face clinical study of 25 patients with II-IV Fitzpatrick skin types with moderate to severe facial atrophic acne scars. Initially, standard subcision by Nokor needle was performed on one side. Two weeks after subcision, FMR treatment was performed on both cheeks of each participant. Second and third FMR treatment sessions were performed within 4-week intervals. Two-blinded dermatologists performed clinical assessments using a quartile grading scale, and patients were also asked to judge their satisfaction using a visual analog scale (VAS) scoring system.
Results:
The age of the patients varied from 24 to 40 years (mean: 30.08±4.94 years). Only nine patients (36%) were males. Clinical assessment by two-blinded dermatologists showed statistically significant improvement in the combination (FMR+subcision) group (P=.009). Patient satisfaction was statistically significantly better in the combination group (P=.001). A darkening of skin phototype was associated with a decrease in patient's satisfaction VAS score (P=.07).
Conclusion:
The combination of subcision and FMR is a safe and effective modality for mixed type acne scars. Additional randomized clinical study with long-term follow-up is necessary for further evaluation of FMR in combination with other procedures. The full trial protocol can be accessed in: http://www.irct.ir/searchresult.php?keyword=%20%20IRCT2016103130597N1&id=30597&number=1&field=a&prt=1&total=1&m=1. The clinical trial registration number is IRCT2016103130597N1.
. A consistent treatment has not been proposed for treatment of Striae Alba (SA). The present study was designed to compare the fractionated microneedle radiofrequency (FMR) alone and in combination with fractional carbon dioxide laser (FMR + CO
2
) in the treatment of SA.
Methods
. Forty-eight pairs of SA from six patients were selected. Right or left SAs were randomly assigned to one of the treatment groups. The surface area of the SA before and after treatment and clinical improvement using a four-point scale were measured at the baseline, after one and three months.
Results
. The mean age of the patients was
30.17
±
5.19
years. The mean difference of the surface area between pre- and posttreatment in the FMR + CO
2
group was significantly higher than that in the FMR group (
p
=
0.003
). Clinical improvement scales showed significantly higher improvement in the FMR + CO
2
group than in the FMR group in the first and second follow-up (
p
=
0.002
and 0.004, resp.). There were no major persistence side-effects in both groups.
Conclusions
. The results showed that FMR + CO
2
laser was more effective than FMR alone in the treatment of SA.
Abstract
Background: Primary axillary hyperhidrosis (PAH) is a chronic idiopathic disorder causing major stress in patients. Among the common therapies for PAH, only surgical interventions have proven feasible as a permanent solution. Objective and Aim: The aim of this study was to evaluate the efficacy and safety of fractional microneedle radiofrequency (FMR) as an alternative permanent treatment for PAH with long-term follow-up. Materials and Methods: This was a single-blind, sham-controlled comparative study. Twenty-five patients with severe PAH were provided three treatments of FMR at 3-week intervals (the treatment group), and a control group was provided the sham treatment. Clinical efficacy was evaluated using the hyperhidrosis disease severity scale (HDSS) at baseline and the end of the study, as well as during the 1 year follow-up phase. Results: HDSS demonstrated significant improvement after treatment in the treatment group compared to the sham control. The mean (±standard deviation) of HDSS in the group being treated with radiofrequency was 2.50 (±0.88) after 1 year follow-up, and that of the control group was 3.38 (±0.49; P < 0.001). Follow-up results show that there were 10 patients (41.6%) with no relapse and 11 patients (45.9%) with relapse after 1 year. There was a significant correlation between HDSS changes in relapse and body mass index (BMI) (P = 0.03). Conclusion: Treatment of PAH with FMR is a safe and noninvasive procedure with a positive therapeutic effect on HDSS. It is recommended, however, that sessions of FMR be repeated after 1 year, particularly in overweight patients with high BMIs
Fractional microneedling radiofrequency (FMR) is one of the promising methods in acne treatment. Moreover, bipolar radiofrequency (BR) generates heat thereby which induces neocollagenosis. FMR may have the potential to be a safe and effective treatment for the patients both with acne and acne scar. This study was performed to compare the efficacy and safety of FMR and BR in acne and acne scar treatment. Furthermore, mechanism of the FMR treatment was investigated through skin tissues obtained from subjects. Twenty subjects with mild-to-moderate acne and acne scars were treated in a split-face manner with FMR and BR. Two sessions of treatment was done 4 weeks apart in a total 12-week prospective single-blind, randomized clinical trial. Clinical assessment and sebum measurement were carried out for the evaluation of efficacy and safety. Skin tissues were acquired for investigation of molecular changes. FMR was more effective for acne scar especially in icepick and boxcar scar compared to BR. Both inflammatory and non-inflammatory acne lesions decreased by 80 and 65 % in the FMR-treated side at the final visit of 12 weeks, respectively. FMR treatment resulted in significant reduction of sebum excretion. Both treatments showed no severe adverse effects other than erythema. The FMR showed superior efficacy in acne and acne scar compared with BR. Increased expression of TGFβ and collagen I and decreased expression of NF-κB, IL-8 are suggested to involve in the improvement of acne scar and acne lesion by FMR.
Background:
A minimally invasive fractional bipolar radiofrequency (FRF) was developed.
Objective:
To evaluate safety and efficacy of FRF in reducing face and neck rhytides and laxity.
Materials and methods:
This prospective, open-label, multicenter clinical trial enrolled 100 subjects with mild to severe facial and neck rhytides and laxity at seven centers in a per-protocol analysis. One single-pass FRF treatment was administered through five 32 g-needle electrode pairs at a preselected real-time fixed temperature of 62 to 78°C, energy duration for 3 to 5 seconds, and impedance restrictions of 200 to 3,000 Ohms, ensuring intradermal delivery. Five blinded dermatologists and plastic surgeons graded randomized standardized baseline and follow-up photographs of 53 and 42 subjects at 3- and 6-month follow-up intervals, respectively, using the Fitzpatrick wrinkle and Alexiades-Armenakas laxity scales. Subject assessments and adverse events were recorded in 100 subjects.
Results:
Blinded evaluations revealed correct pre- and post-treatment identification in 100% of scored cases, mean improvement of 25.6% on the Fitzpatrick Wrinkle Scale and 24.1% on the Alexiades-Armenakas laxity scale at 6 months, and 100% response rate for rhytides and 95% for laxity. Subgroup analysis revealed maximal rhytid reduction in the mean target temperature of 66.7, energy duration of 4.2 seconds, and volume of denatured collagen of mm(3) denatured collagen group. Adverse events included transient erythema, edema, and ecchymoses, resolving within 1 to 5 days, and two incidents of temporary pinpoint depressions. More than 90% of subjects were satisfied or very satisfied.
Conclusion:
Real-time temperature-controlled FRF is a highly reproducible, safe, effective nonsurgical treatment of face and neck rhytides and laxity and provides important insights into neocollagenesis, neoelastogenesis, and clinical outcomes.
To quantify the improvements in laxity from the surgical face-lift and to perform a randomized, blinded comparison with the clinical effects of a novel, minimally invasive fractional radiofrequency (FRF) system.
Randomized, blinded, comparative trial.
Fifteen sequential patients with facial skin laxity enrolled in the trial and completed FRF treatment and follow-up. Baseline and follow-up digital photographs of patients undergoing FRF were randomly mixed with 6 sets of baseline and follow-up images of patients undergoing surgical face-lift with equivalent baseline facial laxity grades.
Five independent blinded evaluators graded randomized baseline and 3- to 6-month follow-up photographs using a comprehensive quantitative 4-point laxity grading scale. Quantitative changes in laxity grades were calculated and compared statistically for FRF treatment vs surgical face-lifts. Patient satisfaction and adverse events were also evaluated.
Blinded grading of unmarked, randomized baseline and follow-up photographs of patients undergoing FRF treatment randomized with baseline and follow-up photographs of patients undergoing surgical face-lift demonstrated statistically significant improvement in facial laxity, with a mean grade improvement of 1.20 for patients in the surgical face-lift group and of 0.44 for FRF-treated patients on a 4-point laxity grading scale (P < .001). The improvements relative to baseline were 16% for FRF treatment compared with 49% for the surgical face-lift. The mean laxity improvement from a single FRF treatment was 37% that of the surgical face-lift. Patient satisfaction was high (dissatisfied, 0%; neutral, 7%; satisfied, 60%; and very satisfied, 33%). All participants in the FRF treatment group experienced transient erythema, mild edema, and mild to moderate purpura that resolved in 5 to 10 days, and they returned to normal activities within 24 hours. There were no adverse events or complications in the FRF group. All patients in the surgical face-lift group experienced scarring at surgical margins, erythema, edema, and ecchymosis, and they returned to normal activities on suture removal at 7 to 10 days.
This randomized, blinded, quantitative assessment using a validated grading scale of skin laxity improvement from the gold standard treatment, the surgical face-lift, and comparative analysis to a novel, minimally invasive FRF treatment has demonstrated 49% improvement in skin laxity relative to baseline for the surgical face-lift, compared with 16% for FRF. The surgical face-lift resulted in a mean 1.20-grade improvement on the 4-point laxity grading scale. In comparison, a single, minimally invasive FRF treatment demonstrated a 0.44-laxity grade improvement, or 37% that of the surgical face-lift, without the adverse effects and complications of surgical procedures. This study provides a basis for quantifying cosmetic outcomes from novel treatments with comparative analysis to the gold standard. It also suggests that minimally invasive FRF treatment may provide an important nonsurgical option for the treatment of facial skin laxity.
Microneedle radiofrequency (FMR) for the treatment of primary axillary hyperhidrosis radiofrequency (RF) technology is a new modality that applied deep heat energy directly affecting the epidermis and dermis. Limiting data about FMR for axillary hyperhidrosis is concerning. To compare clinical efficacy between fractional microneedle radiofrequency and intradermal bot-ulinum toxin type A injection. This study was a randomized, intraindividual split-side comparative study. Twenty female subjects clinically diagnosed of primary axillary hyperhidrosis were enrolled. All subjects randomly assigned to receive either FMR device on one side of axilla or 50 units of intradermal botulinum toxin A on contralateral side of axilla. Treatment with FMR device was scheduled for 2 sessions for 4 weeks apart. After treatment, mean Hyperhidrosis Disease Severity Score (HDSS) of both groups revealed remarkably better reduction from the baseline (p < 000.1). By comparing between the two groups at the endpoint visit (12th week), the botulinum toxin A group had significantly better reduction of mean HDSS score than the microneedle RF group with 1.60 (0.59) versus 2.05 (0.68), respectively (p = 0.0332). At the week-12 visit, the botulinum toxin A group had significantly better participant's satisfaction score by quartile rating scale than the microneedle RF group (2.55 + 0.69 versus 1.70 + 1.03, respectively, p = 0.004). Therefore, the botulinum toxin A group also demonstrated with significantly better improvement for their quality of life by DLQI score at the 12th week than the microneedle RF group (p = 0.013). Intradermal botulinum toxin A had better efficacy than fractional microneedle radiofrequency for the treatment of primary axillary hyperhidrosis.
Background
Various treatment modalities have been applied to treat striae alba with low satisfaction rate. Fractional microneedling radiofrequency provides deep dermal coagulation, thereby inducing collagen synthesis and tissue tightening. The addition of platelet‐derived lyophilized growth factors may add to the effect of fractional microneedling radiofrequency.
Objectives
To evaluate and compare the efficacy and safety of fractional microneedling radiofrequency alone or combined with lyophilized growth factors in the treatment of striae alba.
Methods
In this left‐right comparative study, 25 patients suffering from striae alba on the abdomen received 4 sessions of fractional microneedling radiofrequency with lyophilized growth factors on one side and with saline (as placebo) on the other side at 4 weeks interval. Photographic and biopsy documentation of the progress of the striae alba was carried out before the start of the treatment and 4 weeks after the last session. Calculation of the width of striae alba before treatment and after 4 sessions was done by Adobe photoshop CS6.
Results
There was a significant improvement in striae alba width after treatment in both the lyophilized growth factors (p= <0.0001) and placebo sides (p= <0.0001), the lyophilized growth factors being superior (p= 0.002). Patient satisfaction was more on the LGF side (p=0.034). Erythema and hyperpigmentation were less on the lyophilized growth factors side. Histopathologically, both showed improvement with no difference between LGF and placebo (epidermal thickness (p= 0.456), collagen content (p= 0.297), elastin content (p= 0.239)).
Conclusion
The combination of fractional microneedling radiofrequency and lyophilized growth factors improves striae alba outcome.
Backgrounds:
Striae distensae (SD) has a known psychological impact due to the resulting cosmetic disfigurement. Many treatment modalities have been used over the years, but no standard interventions or evaluation methods have been proposed to date.
Objective:
We compared the efficacy and safety of non-insulated microneedle radiofrequency (NIMRF) and fractional CO2 laser treatments of SD by objective measurements with dermoscopy and VISIA.
Methods:
Fourteen females with severe SD were enrolled. These subjects had been treated three sessions of NIMRF and fractional CO2 laser for the right and left abdomen, respectively. Dermoscopy and VISIA imaging data, and photographs were collected at baseline and 2 months after the last treatment session. The global aesthetic improvement scale (GIAS) was scored by patients, and blinded investigators, pain score and satisfaction score were also documented. Any side effects were recorded.
Results:
Ten patients completed the study. The GIAS from investigators and patients showed an overall improvement but without a significant difference (P = 0.18, P = 0.17, respectively). The decreased width measured by dermoscopy was between 5% and 32% (right side) and 6-31% (left side). There was no significant difference between both sides in either the per-protocol or intention to treat analyses (P = 0.149, P = 0.161, respectively). The mean pain score was 5.35 and 2.35 on the right side and left side, respectively, which was significant (P = 0.0016). Postinflammatory hyperpigmentation (PIH) manifested in six patients on their left sides and four patients on their right sides. In most cases, this had resolved by the 3-month follow-up.
Conclusion:
Non-insulated microneedle radiofrequency and fractional CO2 laser are both effective and safe treatment options for SD. PIH is a possible side effect but is more likely with fractional CO2 laser treatment. However, it clears up in most cases. Dermoscopy and VISIA are both convenient, digitalized methods of tracking subtle changes and monitoring the efficacy of SD treatments.
Purpose:
Radiofrequency equipment, including invasive fractional microneedle radiofrequency (FMR) and noninvasive fractional radiofrequency (FR), has facilitated progress in the field of active acne treatment, but clinical data are limited. This study aimed to compare the efficacy and safety of FMR and FR in the treatment of moderate-to-severe acne vulgaris.
Methods:
Ten patients with moderate-to-severe acne were enrolled in a 24-week, prospective, single-blind, randomized, comparative clinical trial with a split-face design. Fractional microneedle radiofrequency treatment was provided on one side of the face and FR on the opposite side. Three consecutive treatments were performed at 4-week interval. Objective assessment of efficacy was performed using the Acne Severity Index (ASI), and acne inflammatory lesions and noninflammatory lesions were evaluated.
Results:
After the first treatment, ASI and both inflammatory and noninflammatory lesions of the FMR-treated side were improved to a greater degree than the FR-treated side. Patients' subjective satisfaction was also better regarding the FMR-treated side. After subsequent treatments, efficacy improves for both groups, and no significant differences in the above efficacy parameters between the two groups were observed. Pain scores were significantly higher for the FR-treated side than the FMR-treated side.
Conclusion:
Fractional microneedle radiofrequency is faster and more effective than FR for the treatment of moderate and severe acne after only one treatment. However, after several treatment sessions, both FMR and FR proved to be safe and effective for long-term treatment of moderate-to-severe acne. Therefore, invasive radiofrequency, such as FMR, or noninvasive radiofrequency, such as FR, can successfully treat active acne.
Background:
Acne scarring occurs at a young age and causes distress for many patients. Various treatment modalities have been tried.
Objective:
This study investigated the efficacy of combination therapy with topical poly-lactic acid and microneedle fractional radiofrequency (MFRF) for acne scars.
Materials and methods:
Patients with acne scars on both the cheeks were included. Poly-lactic acid was applied to the acne scars on one side of the face before MFRF treatment. The other side of the face was treated with MFRF and normal saline. Patients received 3 treatment sessions and were evaluated based on visual assessment and patient satisfaction. After the last treatment, objective scar assessment of scar smoothness, size, brightness, and overall improvement was performed.
Results:
Both acne scar assessment scores and patient satisfaction were better with combination therapy (p = .036 and p = .009, respectively) than with monotherapy. Combination therapy resulted in significantly better efficacy for scar smoothness (p < .001), scar size (p = .003), and overall improvement (p < .001), but not for brightness (p = .151).
Conclusion:
Combination therapy resulted in significantly better clinical outcomes, including better scar smoothness and smaller scar size. Therefore, we believe this combination therapy is a safe and effective treatment for acne scars.
Background: Treatment of periorbital wrinkles is a challenging task because of its anatomical significance and delicate nature.
Objective: The aim of this study was to evaluate the efficacy and safety of a microneedle monopolar radiofrequency (RF) device for treating periorbital wrinkles.
Methods and Materials: This retrospective study involved 21 patients who were treated for periorbital wrinkles using a RF device. The type of microneedle used, clinical photography, VISIA wrinkle score, and adverse events were collected from the medical chart. Two independent dermatologists assessed the photographs.
Results: There were 18 female and 3 male patients with a mean age of 50.24 years. The severity of wrinkle was improved according to photographic assessment and VISIA wrinkle score at 6-month post-treatment. When 21 sites treated with a long microneedle (LMN, 1.5 mm) and the other 21 sites treated with a short microneedle (SMN, 0.8 mm) were compared, significant improvement in the VISIA wrinkle score was observed only in those treated with the LMN. No serious adverse events, including scarring and postinflammatory hyperpigmentation, occurred.
Conclusions: We demonstrated the efficacy and safety of the microneedle monopolar RF device in treating periorbital wrinkles. The LMN was superior to the SMN in reducing VISIA wrinkle score.
Background and objectives:
The selective electrothermolysis of the sebaceous glands was suggested as a novel therapeutic option for facial acne. However, there has been no randomized controlled trial to evaluate the effectiveness and safety of the monopolar radiofrequency (RF) device using single microneedle with proximal insulation. The objective of the study was to evaluate the efficacy and tolerability of intralesional electrothermolysis using monopolar RF device and proximally-insulated single microneedle in acne patients.
Study design/materials and methods:
The prospective randomized controlled clinical trial was performed to treat moderate-to-severe facial acne. Subjects randomized to the treatment group received three treatments at 4-week intervals with an RF device, whereas the control group received micro-needling and extraction. For efficacy evaluation, reduction rate of acne lesions were evaluated by two independent physicians.
Results:
Sixty-three patients completed the study and the results showed statistically significant improvement of inflammatory acne at 12 weeks. The number of inflammatory lesions was significantly reduced at 12 weeks (20.86 vs. -5.13; P = 0.03) compared with controls.
Conclusions:
Selective sebaceous gland electrothermolysis can be a safe and effective method of achieving consistent improvement in acne. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
Background
Acne scars lead to social and psychological problems for patients, and they should be treated effectively. Ablative and nonablative lasers have been used for the treatment of acne scars in recent years.
Aims
The aim of this study was to evaluate the effectivity of combined FCL and FmRF treatment for acne scars retrospectively.
Methods
A total of 72 patients with acne scars who received FCL + FmRF treatment between 2014 and 2016 were included in this study. Photographs of patients before treatment and 1 month following the last treatment session were scored by two blinded researchers, according to the ECCA acne scar scoring method. Patients were contacted via telephone after 1 month following the last treatment and asked to evaluate their satisfaction with the treatment outcome using a 5‐point Likert‐type scale.
Results
A significant decrease was noted in ECCA scores after the treatment along with temporary side effects. Change from pretreatment scores was significantly higher in patients very satisfied vs satisfied with treatment. The number of treatment sessions was positively correlated with treatment‐related change in ECCA scores.
Conclusions
In conclusion, our findings revealed association of FCL + FmRF treatment with significantly improved ECCA scores, mild pain experience, and low rate of side effects in patients with acne scars, despite usage of high‐energy FLC dose and five sessions of treatment on average. More remarkable improvement in ECCA scores during treatment seems to be associated with higher patient satisfaction and to be more likely in patients with darker skin types.
Background
A new therapeutic device passes radiofrequency energy through microneedles to targeted tissue. Three‐dimensional photography may be useful for evaluating the clinical efficacy of microneedle fractional radiofrequency (MFR) used on the appearance of rhytids and to improve facial laxity.
Aim
To evaluate the efficacy and safety of MFR in the treatment of facial photoageing.
Methods
In total, participants with facial photoageing were enrolled in the study. All volunteers were randomized to receive split‐face treatments with MFR 2 months apart. The participants self‐evaluated at baseline, Days 1–7, and Months 1 and 3 after the final treatment. Objective evaluation was provided by a three‐dimensional in vivo imaging system. In addition, skin melanin index, erythema index, immediate reactions, healing times and other adverse effects were evaluated.
Results
Compared with the untreated side, the treated side of most participants improved, based on clinical assessments at the 1‐ and 3‐month follow‐up visits after treatment. Both objective and participative assessments were satisfactory. The participants demonstrated a decrease of roughness parameter (Sa) value at each follow‐up visit. Compared with pretreatment value, Sa decreased significantly at Months 1 and 3 on the treated side (P < 0.05). Minimal and reversible adverse effects and rapid healing were recorded.
Conclusions
MFR appears to be an excellent treatment for photodamaged facial skin in Chinese patients.
Background
Axillary osmidrosis is a distressing condition that can reduce quality of life and lead to personal and social problems. Fractional microneedling radiofrequency (FMR) treatment is a new minimally invasive procedure.
Objective
We sought to assess retrospectively the efficacy and safety of FMR treatment for axillary osmidrosis compared with subcutaneous surgery in a Chinese population.
Methods
In total, 48 and 42 patients receiving FMR treatment and subcutaneous surgery, respectively, were recruited. The treatments were assessed in terms of efficacy, complications, and malodor recurrence. Patient satisfaction and the Dermatology Life Quality Index (DLQI) were also evaluated.
Results
In total, 93.75% of patients in the FMR group and all patients in the surgery group showed good‐to‐excellent improvement in osmidrosis (P > 0.05). The patients’ satisfaction in the FMR group was significantly higher than that in the surgery group at 1 month after treatment, but there were no differences between the two groups at the 3rd and 6th months (P > 0.05). The DLQI score was significantly decreased after both treatments. Two patients in the surgery group experienced hemorrhage complications, and no patients in the FMR group showed severe adverse effects. There was no significant difference in the malodor recurrence rate between the groups.
Conclusions
Fractional microneedling radiofrequency treatment offers a safe and effective method for treating axillary osmidrosis with minimal recovery time and no strict postoperative immobilization.
Background:
A bipolar fractional radiofrequency (RF) device was developed to generate cutaneous thermal injuries using a temperature-controlled microneedle electrode array.
Objective:
Evaluate safety and efficacy of a novel subcutaneous microneedle RF for treatment of posterolateral thigh cellulite.
Methods:
The study design was an institutional review board-approved multicenter clinical trial after a per-protocol analysis. Fifty subjects with Nurnberger-Muller Grade II or III cellulite were enrolled at 4 treatment centers and received 1 subcutaneous microneedle RF treatment (67°C/4-second duration). Efficacy was evaluated by blinded grading by 3 dermatologists using randomized, standardized photographs and investigator grading at baseline, 1-, 3-, and 6-month follow-up. As per the Food and Drug Administration, treatment success was defined by ≥1-point improvement on dimple number or severity of undulation irregularities scales by at least 2 of 3 blinded physicians. Study subjects' self-assessments and satisfaction questionnaires and procedural pain levels and adverse events were monitored.
Results:
Blinded physician evaluations revealed a procedural success rate of 93% at 6-month follow-up. Procedural pain level was 3.74 ± 1.96 on a 10-point scale. There were no adverse events. Seventy-five percent of subjects were satisfied with the results at 6-month follow-up.
Conclusion:
The results indicate that subcutaneous microneedle RF treatment is safe and effective for long-term treatment of Type II and III cellulite in a single session.
Background: While low fluence Q-switched Nd:YAG laser (QSNY) demonstrates moderate efficacy in the melasma treatment for darker skin types, this single regimen still remains challenges. Fractional microneedling radiofrequency (FMR) is known to enhance dermal microenvironment, possibly offsetting pathogenic factors of melasma aggravation.
Objectives: To compare the effectiveness and safety of combination therapy using low-fluence QSNY and FRM with QSNY monotherapy in Asian melasma patients.
Methods: A retrospective study was undertaken for melasma patients to compare clinical data between 56 patients receiving combination regimen and 58 patients with QSNY only. For the 10 sessions at 1-week intervals, combination group was consecutively treated with QSNY and FRM, while QS toning group with QSNY alone. Two blinded dermatologists evaluated the efficacy based on modified Melasma Area and Severity Index (mMASI) and the physician’s global assessment (PGA) at baseline and 3 months after the final treatment. Treatment related side effects and disease course was recorded in detail.
Results: Combination group demonstrated better efficacy compared with QS toning only group. Both median degrees of mMASI decrease (2.9 vs. 1.8) and proportions of PGA achieving better than “good” grades (68% vs. 54%) showed superior efficacies of combination group. No significant difference was observed for treatment related side effects between two groups, while the prevalence of mottle hypopigmentation and rebound hyperpigmentation was higher in QSNY only group.
Conclusion: A novel dual mode of low-fluence QSNY and FRM represents a safe and effective treatment for melasma in Asian melasma patients.
Background
Various trials have been conducted on the management of male pattern hair loss (MPHL), but the outcomes often seem to be limited. Adjuvant therapies are urgently needed.
Aim
To evaluate the efficacy and safety of combined fractional radiofrequency microneedling (FRM) and 5% topical minoxidil in the treatment of male pattern hair loss.
Methods
In total, 19 Chinese men were enrolled in this randomized, controlled, split‐scalp trial. Participants received monotherapy with 5% topical minoxidil twice daily to one half of the scalp, while on the other half of the scalp the treatment with twice‐daily 5% topical minoxidil was combined with five sessions of FRM at 4‐week intervals. Mean hair count and hair thickness, global assessment by the investigators, subject self‐assessment and adverse effects were assessed.
Results
After 5 months of treatment, mean hair count increased from 44.12 ± 21.58 to 73.14 ± 25.45 on the combined‐therapy side and from 46.22 ± 18.77 to 63.21 ± 19.22 on the monotherapy side, while mean hair thickness increased from 53 ± 13 μm to 71 ± 15 μm and from 52 ± 16 μm to 66 ± 14 μm, respectively. Compared with the monotherapy side, the combined‐therapy side had a higher degree of improvement in both hair count (P = 0.01) and hair thickness (P = 0.02).
Conclusions
Combined treatment with fractional radiofrequency microneedle and 5% topical minoxidil could be an effective and safe treatment option for male pattern hair loss.
Background: Energy-delivering
devices can be used to induce thermal coagulation of
the eccrine sweat glands for treating primary axillary hyperhidrosis (PAH).
Objective: The objective of this study was to compare the efficacy and safety of invasive,
bipolar radiofrequency (RF) treatment for PAH.
Methods: A split-axilla
study was performed to compare the clinical outcomes of
0.5 MHz, invasive, bipolar RF treatment with treatment settings of a longer conduction
time and lower power (LC/LP) vs a shorter conduction time and higher power
(SC/HP) for treating PAH.
Results: The in vivo study revealed median hyperhidrosis disease severity scale
scores of 1.5 (interquartile range [IQR], 1-2)
at 1 month and 1 (IQR, 1-2)
at 3 months
after treatment with the LC/LP setting, compared to baseline. Meanwhile, the other
side of the axillae treated with the SC/HP setting showed scores of 2 (IQR, 2-2)
at
1 month and 2 (IQR, 1.25-2)
at 3 months. Analysis via a linear mixed model revealed
a significant interaction (group, P = .011; time, P < .001; and group × time, P = .048)
between treatment group and time.
Conclusion: PAH can be effectively and safely treated with invasive, multilayered,
multiple-pass,
0.5-MHz,
bipolar RF treatment, particularly with LC/LP.
Background:
Facial photoaging has become a major cosmetic concern, and the microneedle fractional radiofrequency system (MFRS) is a novel method for rejuvenation that combines radiofrequency and microneedles.
Objective:
This study prospectively evaluated the efficacy and safety of an MFRS in the treatment of facial photoaged skin in Chinese patients.
Materials and methods:
Twenty-seven patients with moderate facial photoaging were recruited and received 3 treatments at 4-week intervals. Blinded clinical assessment was performed by 2 independent dermatologists on a 5-point global photoaging scale (GPS). Patients were also questioned on the extent of improvement of rhytides, skin tightening, and complexion with a 4-point global aesthetic improvement scale (GAIS) and satisfaction based on a 5-point scale. Adverse events and pain scores were also evaluated.
Results:
Compared with the baseline, there was a significant improvement in facial photoaged skin after 3 treatments, and these positive outcomes were maintained up to the 6-month follow-up, according to the GPS and GAIS scores. Most patients were satisfied with the treatment and reported mild to moderate pain and adverse effects.
Conclusion:
This MFRS is effective for facial skin rejuvenation in Chinese patients. The therapy also seems safe and well tolerated.
Background:
While device-based acne treatments are widely applied for patients not tolerating conventional medications, related controlled studies have been still limited. Recently, non-ablative 1,450-nm diode laser (DL) and fractional micro-needling radiofrequency (FMR) have been effectively used for acne, in addition to well-recognized dermal remodeling effects.
Objective:
To compare the clinical course for acne treatment between DL and FMR.
Methods:
Twenty five Korean patients with mild to moderate facial acne completed treatments with DL and FMR through a 20-week, randomized split-face study. One randomly assigned half side of each patient's face received DL and the other side by FMR. Treatments were scheduled to receive three consecutive sessions at 4-week intervals. Objective assessments including revised Leeds grades, lesion counts, sebum output measurements, and patients' subjective satisfaction were investigated.
Results:
Both DL and FMR demonstrated steady improvement of acne and seborrhea during treatment sessions. While results between two devices were similar during treatment sessions, FMR was superior to DL in the 12-week follow up. Patients' subjective assessments for seborrhea improvement were similar between two devices, while those for acne, skin texture, and acne scars were more satisfactory for FMR. For safety proflie, no significant difference was observed between two regimens, while mild post inflammatory hyperpigmentation was observed only in DL side.
Conclusion:
Both DL and FMR demonstrated efficacies for acne and seborrhea, with reasonable safety proflie. FMR was more effective than DL for the long-term maintenance, and subjective assessments for texture and scar improvements. Therefore, a few sessions of these devices would be a viable option for acne treatments. This article is protected by copyright. All rights reserved.
Background:
To date, no studies compared curative effects of thermal lesions in deep and superficial dermal layers in the same patient (face-split study).
Objective:
To evaluate skin laxity effects of microneedle fractional radiofrequency induced thermal lesions in different dermal layers.
Methods and materials:
13 patients underwent three sessions of a randomized face-split microneedle fractional radiofrequency system (MFRS) treatment of deep dermal and superficial dermal layer. Skin laxity changes were evaluated objectively (digital images, 2 independent experts) and subjectively (patients' satisfaction numerical rating).
Results:
12 of 13 subjects completed a course of 3 treatments and a 1-year follow-up. Improvement of nasolabial grooves in deep dermal approach was significantly better than the superficial at 3 months (P=.0002) and 12 months (P=.0057) follow up. Effects on infraorbital rhytides were only slightly better (P=.3531).
Conclusion:
Microneedle fractional radiofrequency system (MFRS) is an effective method to improve skin laxity. Thermal lesion approach seems to provide better outcomes when applied to deep dermal layers. It is necessary to consider the skin thickness of different facial region when choosing the treatment depth.
Background:
Fractional microneedling radiofrequency (FMR) is an emerging treatment modality, but its effect on rosacea has not been studied yet.
Objective:
To investigate the potential impact of FMR treatment on clinical improvement and histologic changes in rosacea patients.
Materials and methods:
A 12-week, prospective, randomized, split-face clinical trial was conducted. Two sessions of FMR were performed on one side of the cheeks with 4-week interval and the other side remained untreated. Erythema index from DermaSpectrometer and a* value from Spectrophotometer CM-2002 were measured at each visit for the objective measurement of erythema. Histologic analysis of skin samples was also carried out.
Results:
Clinical evaluation and photometric measurement revealed the reduction of redness in the treated side compared with untreated side and baseline. Erythema index decreased 13.6% and a* value decreased 6.8% at Week 12 compared with baseline. Reduced expression of markers related to inflammation, innate immunity, and angiogenesis was observed in immunohistochemical staining of tissue obtained after FMR treatment.
Conclusion:
Fractional microneedling radiofrequency treatment showed modest clinical and histologic improvement of rosacea, and it might be used as an alternative or in combination with other treatment methods.
Introduction:
Skin aging occurs through both intrinsic and extrinsic processes. Fractional radiofrequency (RF) with a microneedling array is the newest form of fractional therapy to be useful in treating aging skin. The current study utilized a noninsulated fractional RF microneedling system.
Methods:
This multicenter clinical trial saw 49 patients complete 3 monthly treatments with the new fractional RF microneedling treatments and be followed for 3 months following their last treatment. Pain during treatment was recorded as well as overall improvement using a GAIS scale. Adverse events were also noted.
Results:
Forty-nine patients completed all of the treatments and follow-ups. Mild to moderate erythema were reported immediately after treatment which lasted up to 12 hours after the treatment. Pain, as measured on a 1-10 VAS, was noted to 4, on average. The average Fitzpatrick's wrinkle scale score at baseline was 5.04 ± 1.22, 1 month after 3 treatments 3.829 ± 1.69 and 3 months after 3 treatments 3.5 ± 1.66. These results are statistically highly significant (correlated T-test, P < 0.001). Improvement was shown in 100% of patients while 65% of patients had significant improvement (GAIS levels 3-5). Significant skin tightening and skin lifting were also observed. No unusual adverse events were noted throughout the course of the study.
Conclusion:
This multicenter study showed significant wrinkle reduction, skin tightening, and lifting of the mid and lower face with the noninsulated fractional RF microneedling system. Lasers Surg. Med. 2016 9999:1-7. © 2016 Wiley Periodicals, Inc.
Background:
Microneedle fractional radiofrequency has been reported to be effective for improving wrinkles, enlarged pores and various scars. Sublative fractional radiofrequency has been shown to induce both fractional ablation of epidermis and upper dermal remodelling, which had rejuvenation effects in photoaged skin. Both modalities may have the potential synergy to improve acne scars.
Objective:
To evaluate the efficacy and safety of combined microneedle and sublative fractional radiofrequency for acne scars in Asian skin.
Methods:
Twenty subjects comprised 11 males and 9 females (mean age 23.65 ± 2.94, skin phototype III-IV) with moderate to severe acne scars. The subjects received three consecutive combined microneedle and sublative fractional radiofrequency at 4-week intervals over 12 weeks. Both blinded dermatologists and subjects assessed the clinical improvement based on the standardized photography and questionnaires, respectively. The quartile grading scale was utilized and defined as follows: grade 1, 0-25% improvement; grade 2, 26-50% improvement; grade 3, 51-75% improvement and grade 4, 76-100% improvement.
Results:
All 20 subjects were assessed to have grade 2 or more clinical improvement by physicians; four (20%) had grade 4, 10 (50%) had grade 3, and six (30%) had grade 2 improvement. The subjects' grading also showed a good concordance as indicated by Kappa index of 0.695. The mean duration of post-therapy crusting was 5.2 days and post-therapy erythema lasted 2.5 days.
Conclusion:
Combined microneedle and sublative fractional radiofrequency can have a positive therapeutic effect with no serious complications and may provide a new therapeutic approach on acne scars in Asians.
A previous multicenter clinical trial of a needle-based fractional radiofrequency (FRF) treatment for facial and neck rhytides and laxity counterintuitively demonstrated a mean target temperature and treatment duration of 69.5°C and 4.9 seconds for subjects with lesser improvement and 67°C and 4.2 seconds for greater improvement.
To determine optimal temperature and duration settings for maximal clinical results in rhytides and laxity from a single FRF treatment of the face and neck.
A randomized, blinded, 3-arm clinical evaluation of FRF at a series of temperatures from 52-57°C to 67°C. Three blinded plastic surgeons and dermatologists scored rhytides using the Fitzpatrick Wrinkle Assessment Scale and laxity using the Alexiades Laxity Assessment Scale at 1, 3, and 6 months.
Blinded grading showed optimal improvement at 67°C and 3 seconds and decreased efficacy below 67°C, with mean rhytide reductions of 40, 29, and 25% and mean laxity reductions of 34, 36, and 25% in Arms 3 (67°C), 2 (62°C), and 1 (52°C-57°C), respectively. A 100% response rate was observed for all subjects treated at 62°C to 67°C target temperature.
The optimal target dermal temperature for facial and neck rhytide and laxity treatment is 67°C and duration of 3 to 4 seconds with a 100% response rate after a single FRF treatment.
Periorbital wrinkles as a result of photoaging are a frequent cosmetic concern. Recently, the fractional radiofrequency microneedle system was introduced as a new device for facial rejuvenation, and it has received much recognition for its unique "deep dermal heating with epidermal sparing" feature.
The purpose of this study was to examine the clinical efficacy and safety of the system for the treatment of periorbital wrinkles in Korean patients.
Twenty Korean patients (Fitzpatrick skin Type IV-V) with varying degrees of periorbital wrinkles were enrolled in this study. The patients were treated 3 times at 4-week intervals with the system. Changes in periorbital wrinkling were evaluated by 2 independent experts with digital images of the subjects' faces using a 5-point Wrinkle Assessment Scale. At the end of the study, the patients rated their satisfaction with the overall treatment outcome on a numerical scale.
All patients completed the treatment regimen and were satisfied with the treatment. Most patients improved according to clinical and photographic assessments performed 6 months after the treatment. Two patients (10%) reported mild hyperpigmentation.
The system may be an effective and safe treatment option for periorbital wrinkles in dark-skinned Korean patients.
Background
The 1550 nm Er:Glass fractional laser is widely used for the treatment of atrophic acne scar. A novel fractional radiofrequency microneedle device has recently emerged as an alternative for treating acne scars.Objectives
To evaluate the clinical efficacy and safety of a Er:Glass fractional laser and fractional radiofrequency microneedle device in the treatment of facial atrophic acne scars and to assess the difference between the treatment modalities depending on facial compartment.MethodsA total of 40 patients were equally randomized into two groups. Each group of 20 patients received three treatments at 4-week interval using Er:Glass fractional laser or fractional radiofrequency microneedle device.ResultsScar severity scores (ECCA grading scale) improved by a mean of 25.0% and 18.6% in groups A and B, respectively (both P < 0.01). The difference in the degree of improvement was not statistically significant between the groups after three sessions of treatment. There were no significant side effects.Conclusion
Atrophic acne scars improved in both groups without significant side effects. Additionally, the fractional laser was a more effective treatment option for acne scars, but the fractional radiofrequency microneedle device offered good adherence and short downtime.
Background/ Objective
Primary axillary hyperhidrosis (PAH) creates social stress in patients. Although there are several options for treating PAH, only surgical modalities have conferred a permanent solution. This study evaluated the clinical effectiveness of fractionated microneedle radiofrequency (FMR) treatment for PAH.Methods
This study is based on a single-blind, sham control comparative design. In all, 25 patients with severe PAH underwent three sessions of FMR at 3-week intervals. One side was treated with FMR while the other was sham controlled. Efficacy was evaluated using the hyperhidrosis disease severity scale (HDSS), sweating intensity visual analogue scale (VAS) and patient satisfaction at baseline, 3 weeks after each session and at 3 months after the last. Skin biopsies were obtained from two enrolled patients.ResultsThe HDSS and VAS demonstrated significant improvement after treatment on the treated side in comparison with the control side. The mean ± SD of the HDSS after 21 weeks were 1.87 ± 0.61 and 3.38 ± 0.49 (P < 0.001) for the treated and the controlled side, respectively. The follow-up evaluation revealed that 79% of the patients showed a 1 or 2-score decrease in HDSS. In total, 80% of patients reported more than 50% satisfaction at the end of the study. Histopathological findings showed a decrease of the number of the sweat glands in the treated side, confirming the above findings.Conclusions
Treatment of PAH with FMR as a non-invasive modality can be a safe option with positive therapeutic effects on HDSS without any long-lasting side effects.
Background
Treatment of acne scars remains a challenge to dermatologists. Multiple modalities have been employed with variable results and adverse effects. Objective
To determine the efficacy and adverse effects of a fractional radiofrequency microneedle system (FRMS) on acne scars in Asians at 1-, 3- and 6-month follow-up visits after treatment. Methods
Thirty subjects with atrophic acne scars for more than 6 months were enrolled in the study. All volunteers were treated with a FRMS on affected areas. The subjects were treated for a total number of three treatment sessions at 1-month intervals. Subjective assessments were obtained at baseline, 1, 3 and 6 months after the last treatment session by self-evaluation and two blinded dermatologists. Objective evaluation using an ultraviolet A-light video camera was also performed. In addition, pain scores, immediate reactions, healing times and other adverse effects were evaluated. ResultsTwenty-six subjects with skin phototypes III–V completed treatment protocol. The average mean scar age was 7 years (range: 0.5–15 years). At 6-month follow-up visit, the majority of the subjects (42.3%) reported a 26–50% improvement on their acne scars. Percent reduction in scar volume corresponded to clinical evaluation. Adverse reactions of the treatment included pain, immediate oedema/erythema, minimal scabbing and transient pigmentary alteration on treated areas. The average pain score was 5.6 of 10. Worsening of skin texture or new scar formation was not observed in any subjects. Conclusion
Fractional radiofrequency microneedle system is a safe and effective device for treating acne scars in Asians with minimal risk of downtime and adverse effects.
Background:
For periorbital rejuvenation, injection of botulinum toxin A (BoNT/A) is known to improve both static as well as dynamic wrinkles. A microneedle fractional radiofrequency (MFR) device was recently developed and is a novel and promising tool.
Objective:
This study compares the effects of these two treatment modalities on periorbital static wrinkles and lines.
Methods:
Twelve healthy women aged 20-59 years with periorbital wrinkles participated in this study. Each patient received one session of intradermal injection of BoNT/A on the left periorbital area and three sessions of MFR on the right. Clinical improvement, skin elasticity and subjective satisfaction were evaluated at every visit (baseline, 3, 6 and 18 weeks).
Results:
BoNT/A injection showed superior effects at 3 and 6 weeks. However, the MFR device showed better improvement at 18 weeks. In skin biopsies, the expression of procollagen 3 and elastin was increased on the MFR side compared to the untreated skin and the BoNT/A injection side. The patient satisfaction surveys at 3 weeks showed better satisfaction on the BoNT/A treatment side compared to the MFR treatment side. At 18 weeks, there were no significant differences in patient satisfaction between the two sides.
Conclusion:
BoNT/A injection rapidly improved periorbital wrinkles, but the effect decreased up to week 18. Compared to BoNT/A injection, MFR therapy showed gradual and long-term improvement in periorbital rejuvenation.
Striae distensae are dermal scars with flattening and atrophy of the epidermis.
To evaluate the efficacy and safety of combination therapy with fractionated microneedle radiofrequency (RF) and fractional carbon dioxide (CO2 ) laser in the treatment of striae distensae.
Thirty patients (30 female; mean age 33, range 21-51, Fitzpatrick skin type IV) with moderate to severe striae distensae were enrolled in this study. Patients were divided into three groups: fractional CO2 laser only (n = 10), microneedle RF only (n = 10), and combination (n = 10).
Improvement was evaluated using a visual analogue scale (range 1-4). Mean clinical improvement score of the dermatologist was 2.2 in the fractional CO2 laser-treated group, 1.8 in the microneedle RF-treated group, and 3.4 in the combination group. Through skin biopsy, we observed thickened epidermis and a clear increase in the number of collagen fibers in the microneedle RF- and fractional CO2 combination-treated sites. Consistent with these results, greater expression of transforming growth factor-β1 and stratifin was observed in treated sites.
Combination therapy of fractionated microneedle RF and fractional CO2 laser is a safe treatment protocol with a positive therapeutic effect on striae distensae.
Background and objectives:
For skin rejuvenation, microneedle fractional radiofrequency (RF) is a recently developed minimally invasive method for delivering RF energy directly into the skin using microneedle. Additionally, the use of growth factors in skin rejuvenation is emerging as a novel anti-aging treatment. We evaluated efficacy and safety of microneedle fractional RF for skin rejuvenation, and furthermore the synergistic effect of stem cell conditioned medium, composed of a large number of growth factors and cytokines.
Materials and methods:
Fifteen females were included for a split-face comparative study with a blinded response evaluation. One side of each subject's face was treated with fractional RF alone, and the other side was treated with fractional RF plus stem cell conditioned medium. Patients received 3 sessions of treatment at 4-week intervals.
Results:
All patients showed clinical improvement on physician's global assessment and patient satisfaction scores on both sides of their faces. Among objective biophysical measurements, improvement in hydration, melanin, erythema index and especially skin roughness was noticed. Stem cell conditioned medium provided a synergistic effect on improvement of skin roughness, which was statistically significant (p <0.05). Histologic examination revealed marked increase in dermal thickness and dermal collagen content. Side effects were minimal.
Conclusion:
Microneedle fractional RF is a safe and effective skin rejuvenation method, and the better results may be expected when combined with stem cell conditioned medium.
Non-ablative bipolar and monopolar radiofrequency devices have been shown to be effective for the treatment of facial wrinkles. Recently, novel fractionated microneedle radiofrequency (FMRF) devices have been introduced. The aim of this study was to evaluate the clinical effectiveness and safety of FMRF for the treatment of periorbital wrinkles. Eleven women, aged 34-59 years, with periorbital wrinkles underwent three sessions of FMRF at 3-week intervals with a follow-up period of 3 months after treatment. Clinical improvement was evaluated using the Fitzpatrick Wrinkle Classification System (FWCS) and subjective satisfaction on a visual analog scale (VAS). The FWCS scores demonstrated significant improvement in periorbital wrinkles after treatment (P < 0.001). A satisfaction VAS score of more than 5, indicating high satisfaction, was obtained from 10 of 11 patients (91%) 3 months after treatment, and the mean satisfaction VAS score (n = 11) was 6.7. Patients undergoing treatment reported minimal pain, and neither long-lasting side-effects nor significant downtime was noted. This clinical study suggests that FMRF is a safe and tolerable method for successful treatment of periorbital wrinkles.
Background:
A number of lasers and light-based devices have been reported as promising treatment options for acne vulgaris.
Objective:
To evaluate the efficacy and safety of fractional microneedle radiofrequency (MRF) device treatment compared to CO(2) fractional laser system (FS) for the treatment of acne vulgaris.
Methods:
Twenty healthy subjects underwent full-face treatment for acne vulgaris with CO(2) FS and MRF device. For each subject, two passes of CO(2) FS with a pulse energy setting of 80 mJ and a density of 100 spots/cm(2) were used on one side, and two passes of MRF device with a intensity of 8, density of 25 MTZ/cm(2), and a depth of 1.5-2.5 mm were used on the other. Patients were evaluated 3 months postoperatively and were also photographed.
Results:
Most of the patients improved based on clinical and photographic assessments 3 months after the treatment. No significant differences in physician-measured parameters, patient ratings, or intraoperative pain ratings were found, although downtime was significantly longer for the CO(2) FS treated side.
Conclusions:
MRF device and CO(2) FS can be used for acne vulgaris patients and MRF device is more convenient than CO(2) FS because of its short downtime.
For skin rejuvenation, microneedle fractional radiofrequency (RF) is a recently developed minimally invasive method for delivering RF energy directly into the skin using microneedle.
We evaluated efficacy and safety of microneedle fractional RF for skin rejuvenation in Asian skin and also conducted immunohistochemical analysis before and after treatment.
Twenty-five females (mean age 54.2, Fitzpatrick skin phototypes III-IV) received three consecutive fractional RF treatment at 4-week intervals. Outcome assessments included standardized photography, physician's global assessment, patient's satisfaction scores, objective biophysical measurements, and histologic analysis including immunohistochemical staining.
All patients showed clinical improvement on physician's global assessment and patient's satisfaction scores. Among objective biophysical measurements, improvement in hydration and skin roughness was noticed. Histologic examination revealed marked increase in dermal thickness, dermal collagen content and dermal fibrillin content. Side effects were minimal.
The limitations are the small number of patients and lack of long-term follow-up.
Microneedle fractional RF is a safe and effective skin rejuvenation method in Asians. Lasers Surg. Med. 44: 631-636, 2012. © 2012 Wiley Periodicals, Inc.
Nonablative radiofrequency (RF) devices have been shown to be clinically effective for the treatment of moderate to severe acne lesions.
To evaluate the efficacy and safety of a fractionated microneedle RF device in the treatment of inflammatory acne vulgaris.
Eighteen patients (15 male, 3 female; mean age 27, range: 19-33; Fitzpatrick skin type IV) with moderate to severe acne vulgaris who were treated with two sessions of fractionated microneedle RF at 1-month intervals were enrolled in this study.
Evaluation of improvement, which took into account number of inflammatory acne lesions, showed that two of the 18 patients had grade 4 clinical improvement, eight had grade 3 improvement, and six had grade 2 improvement. Improvement scores in terms of lesion severity were also evaluated. One of the 18 patients had grade 4 clinical improvement, eight grade 3, and seven grade 2. No patient had worsening of inflammatory acne lesions.
Fractionated microneedle RF can have a positive therapeutic effect on inflammatory acne vulgaris and related scars. In addition, this technique does not worsen active acne lesions.
We recently introduced Renesis, a novel minimally invasive radiofrequency (RF) device, for the treatment of human skin. The wound healing response post-fractional RF (FRF) treatment was examined in human subjects.
The FRF system delivered RF energy directly within the dermis via 5 micro-needle electrode pairs. Tissue temperature was held at 72 degrees C for 4 seconds using an intelligent feedback system. The wound healing response was evaluated histologically and by RT-PCR up to 10 weeks post-RF treatment. Neoelastogenesis and the role of heat shock proteins (HSPs) were assessed by immunohistochemistry.
FRF treatment generated a RF thermal zone (RFTZ) pattern in the reticular dermis that consisted of zones of denatured collagen separated by zones of spared dermis. RFTZs were observed through day 28 post-treatment but were replaced by new dermal tissue by 10 weeks. HSP72 expression rapidly diminished after day 2 while HSP47 expression increased progressively through 10 weeks. Reticular dermal volume, cellularity, hyaluronic acid, and elastin content increased. RT-PCR studies revealed an immediate increase in IL-1beta, TNF-alpha, and MMP-13 while MMP-1, HSP72, HSP47, and TGF-beta levels increased by 2 days. We also observed a marked induction of tropoelastin, fibrillin, as well as procollagens 1 and 3 by 28 days post-treatment.
Our study revealed a vigorous wound healing response is initiated post-treatment, with progressive increase in inflammatory cell infiltration from day 2 through 10 weeks. An active dermal remodeling process driven by the collagen chaperone HSP47 led to complete replacement of RFTZs with new collagen by 10 weeks post-treatment. Furthermore, using both immunohistochemical and PCR studies, we successfully demonstrated for the first time evidence of profound neoelastogenesis following RF treatment of human skin. The combination of neoelastogenesis and neocollagenesis induced by treatment with the FRF system may provide a reliable treatment option for skin laxity and/or rhytids.