At RealSelf, we believe that loving the skin you’re in and wanting to enhance it are not mutually exclusive ideas. Whether you’re aiming to repair decades-old sun damage, restore your facial contours to previous proportions, or simply protect your complexion with a summer-smart regimen—we’ve rounded up the ultimate skin-rejuvenation advice for you, here, in our new series, The Skin You’re In.
In aesthetics, there’s always a latest-and-greatest—that hot-now fix suddenly overshadowing all the old reliables. Given time—and the rigors of trial and error—trending treatments will either fall off the map or establish true legitimacy. So a few years back, as the buzz around radiofrequency (RF) microneedling approached fever pitch, we waited, somewhat skeptically, for these heat-fueled skin-retexturizing tools to meet their fate. But the tech continued to evolve; more and more devices earned FDA approval; and doctors found creative new uses for the gun-like gadgets—slowly cementing their staying power as a mainstay in dermatology.
“Originally, my outlook on [RF microneedling] was that it was an alternative for people who couldn’t do laser or maybe who’d had bad experiences with laser—that was the population I initially felt fit the niche,” says Dr. Paul Jarrod Frank, a board-certified dermatologic surgeon in New York City. (RF needling is thought to be safer for those with darker skin, since its energy bypasses the melanin-rich epidermis when the procedure is performed properly.) “Now I think everyone is a candidate for some variation on the theme of RF microneedling, [partly because] there are so many different machines—which, in my opinion, have different uses.”
At their core, all RF needling devices are united in their mechanism and mission. Offering a galvanized take on traditional microneedling tools, they insert an array of charged pins into the skin, releasing radiofrequency energy from the tips, to heat the dermis and trigger a wound healing response, and ultimately spark collagen production. “This new collagen is tighter and behaves more youthfully, providing some tightening,” says Dr. Catherine DiGiorgio, a board-certified dermatologist in Boston. “The heat also softens lines, wrinkles, and scars by remodeling [existing] collagen.”
Doctors are equally quick to point out the differences between devices—related primarily to the number and size of pins on their respective handpieces, the insulation of those needles, their reach into the skin, and the degree of control each tool offers by allowing providers to adjust needle depths and the duration of time for which energy is emitted. (The Vivace, for instance, is said to be exceedingly tolerable and versatile, because its settings can be tuned in a very precise and incremental manner.) These nuances affect not only the intensity of treatment, pain and downtime, and outcomes but also how and where the machines are used, with certain models frequenting ORs and others inhabiting medspas.
As RF microneedling’s popularity grows, so too does confusion surrounding the tech. Is it really the holy grail anti-ager that social media makes it out to be? Is one brand honestly that much better than another? We asked top dermatologists and plastic surgeons to reality-check the hype, reveal the scenarios in which RF microneedling truly shines, and level with us about the risks and limitations of treatment so you can decide if it’s right for you.
Is RF microneedling really safe for all skin tones?
When positioned appropriately, the electrified needle tips “inject heat into the deep tissue,” Dr. Frank explains, without traumatizing the layer of skin that houses our melanin-producing cells—which is why doctors lean on these devices when treating dark-skinned patients who may be prone to laser complications. (All the experts we interviewed said that RF needling is their go-to for correcting acne scars on skin of color.) However, no heat-based technology is 100% risk-free for melanated skin, and safety is ultimately determined by the person holding the handpiece. “If the microneedles are not inserted properly, you can have heat delivered to the top layers of the skin—which can cause burns, scars, and pigmentary changes,” warns Dr. DiGiorgio.
While the majority of modern RF microneedling devices have insulated needles—meaning only the tips are charged rather than the entire length of the pins—it’s a good idea to confirm this feature with your provider, says Dr. Frank, since the “older, non-insulated ones are much more aggressive and give more downtime and less control.”
What skin concerns can RF microneedling treat?
Like basic, energy-free microneedling pens or rollers, RF needling can enhance the look of the skin by disrupting it in order to provoke a healing response, which encourages cell turnover and rejuvenation. RF-infused instruments, however, drive greater collagen production, thanks to the heat they generate, making them “more effective at improving skin texture and acne scars and also providing some tightening of loose skin,” says Dr. DiGiorgio. (Full disclosure: Only select RF microneedling devices are truly powered to handle lax, crepey skin, our doctors say, and even those engineered for the job produce understated effects—more on that in a bit.)
The textural boost RF needling breeds can also help diminish stretch marks—but “you get only moderate results when using RF microneedling alone, and it does take a number of sessions to reduce their hypertrophic appearance,” Dr. Frank says. He’ll typically augment the treatment with lasers, taking the redness out of fresh marks with the Vbeam before aiming to flatten them with a one-two punch of Vivace RF needling and Fraxel, when the patient’s skin tone allows. Dr. DiGiorgio takes a similar approach, alternating the Genius RF with Fraxel. “After about five or six monthly treatments, patients will tell me that they feel the skin is smoother and that the stretch marks are less noticeable,” she says. In her opinion, though, outcomes can be rather underwhelming, so you’ll want to keep your expectations in check.
RF microneedling is also being investigated as a solution for excessive sweating under the arms, says Dr. Flora Levin, a board-certified oculoplastic surgeon in Westport, Connecticut. It works via the same principle as MiraDry, she explains, damaging sweat glands with heat in order to stymie wetness and odor, over the course of four to six monthly treatments.
How do the various RF microneedling devices differ?
Much like resurfacing lasers, RF microneedling tools vary in intensity. There are the big guns—namely, the Profound and the Morpheus8—which are reportedly more painful and involve greater downtime but deliver more impressive results in a single treatment. And then there are lighter versions—the RF equivalent of “baby Fraxels,” if you will—that include names like Vivace, Secret, Genius, EndyMed, Virtue, and more. While there are certain distinctions between milder machines, they all require numbing cream and a series of treatments; side effects include skin that’s pink and swollen for a few days; and they tend to give comparable results, according to Dr. DiGiorgio, who’s used many of the aforementioned devices over the years to attack wrinkles and scars. These minimal downtime options that use less RF energy are also ideal for “prejuvenation in younger patients and as a bridge between more aggressive treatments,” she says.
When attempting a heavier lift and a greater improvement in skin laxity, like lessening jowls to sharpen a jawline, she relies on the more powerful Profound. Before treatment, she numbs patients with anesthetic cream in addition to lidocaine injections, sometimes providing anti-anxiety medication, to make the needle sticks more bearable, and routinely giving an antiviral, to ward off cold sores during the healing process. Patients are swollen, red, and bruised for up to two weeks after.
In the same league as the Profound is the Instagram-famous Morpheus8. (Actress January Jones posted about her treatment last fall.) Board-certified plastic surgeon Dr. Sheila Nazarian offers both the Morpheus8 and the Vivace in her Beverly Hills, California, practice, finding the Vivace more suitable for nonsurgically refreshing the face and neck and the stronger Morpheus8 better for body toning, since “it can go deeper, up to seven millimeters, to kill fat,” she says. In the aftermath of Morpheus8, expect small bumps and pinpoint scabbing, she adds.
Since the Morpheus8 requires more than just numbing cream or a topical anesthetic, surgeons frequently use it in the OR, on patients who are already anesthetized for other procedures. “I’m using it in most face and neck surgeries for additional tightening [and] I also use it on the knees, abdomen, and elbows if there is crepe skin,” Dr. Nazarian says. “I tell patients that a neck lift doesn’t change the quality of the skin. We have to use devices like Morpheus8 to maintain results, put collagen/elastin back in, and improve the skin itself.” Dr. Frank also reserves his Morpheus8 for surgical cases: “I’ll do lipo of the neck or arm and then do it on top of that,” he says.
When operating on eyelids, Dr. Levin will sometimes use the Morpheus8 to rejuvenate the skin post-blepharoplasty in patients who don’t qualify for CO2 laser.
What kind of results can I expect to see—and when?
With all these devices, “you can see some textural improvement after a month—you might notice that your sunscreens and moisturizers go on much smoother—but I do remind patients that it takes at least three months to see tightening,” says Dr. Nazanin Saedi, a board-certified dermatologist in Philadelphia. Bear in mind, if your doctor suggests a series of treatments with a lighter technology, you won’t see the optimal results until several months after your final session. “When treating acne scars or texture, more treatments give more benefits,” notes Dr. DiGiorgio—and they continue to build for about three months after each visit.
As for Profound, you can gauge success at the four-month mark. While Dr. DiGiorgio believes this procedure provides unparalleled tightening in the category, she still stresses that while it can keep the skin youthful and perhaps delay the need for surgery, “the results are modest and subtle, and it’s not a replacement for a facelift,” she says. “My patients usually tell me that they can feel and see a difference and notice an improvement of the skin laxity that bothered them”—and even a minor hike of the jowls makes them more confident. Still, to her eye, a measurable difference isn’t always evident in before and after photos, she adds.
How do I choose between RF needling and resurfacing lasers?
Fractional resurfacing lasers generally give a better overall refresh on fair complexions, since they can do much more for discoloration. As previously noted, radiofrequency microneedling provides a solid alternative for dark skin types. It also excels at smoothing and shrinking crepey skin and restructuring scar tissue, says Dr. Frank, who’s even used it to flatten laser-resistant keloids.
In appropriate patients, the two can be used in tandem to simultaneously tackle spots, fine lines, and laxity. “I will very commonly do an epidermal resurfacing with Fraxel and, during the same appointment, do a RF microneedling treatment,” says Dr. Frank.
How does RF microneedling compare to noninvasive skin tightening treatments like Thermage and Ultherapy?
According to Dr. Saedi, “Thermage and Ultherapy are better for laxity, but when you need [to address] texture as well as laxity, RF microneedling devices are better”—but that doesn’t necessarily mean the latter are less efficient at tightening. Rather, laxity can exist at various levels and present in different ways. When it affects the upper layers of skin, it tends to show as bunching or crinkling. When deeper tissues go slack, they fall and hang.
“RF microneedling is better able to target the crepey texture of the skin, whereas Thermage or Ultherapy work well in targeting deeper tissue in an area right above the SMAS, [the connective tissue covering our muscles], which is responsible for keeping the skin taut,” Dr. Frank tells us. But, again, teaming up these distinct modalities can create synergistic effects—benefiting the aging neck, in particular, he adds, which often demands both deep and superficial attention in order to conquer sagging and crepiness.
What are the risks involved with RF microneedling?
Operator error is the biggest risk—rushing through the treatment or not securing needles at the right depth can allow energy into the epidermis. “If you’re coming out too soon, the heat goes into the top layer of skin and you can have little bumps that look like chicken skin for a few months,” explains Dr. Frank. Complications can be more serious in dark skin types. “Burns, scars, and hyperpigmentation can occur when the needles are not fully inserted during the treatment pulses,” adds Dr. DiGiorgio.
Can RF microneedling melt fat or dermal fillers?
There is a growing concern that energy-based devices—radiofrequency and ultrasound, in particular—may thin out the facial fat layer, leaving us gaunt. “I do have patients ask me about this occasionally,” Dr. DiGiorgio says, “but there’s no evidence that this happens.” Dr. Saedi agrees that the majority of the RF microneedling devices are not able to penetrate deep enough to affect fat. (The body-specific Morpheus8 handpiece can destroy fat, as Dr. Nazarian mentioned earlier, but the tips designed for facial treatments operate in shallower territory.)
Since fillers are sometimes placed in the dermis, where RF microneedling devices do their thing, there is a chance that the heat “can possibly dissolve or evaporate filler that’s placed superficially,” says Dr. DiGiorgio, who points to a 2019 study as evidence of the phenomenon. While the researchers used abdominal skin samples to test the effects of RF microneedling on hyaluronic acid fillers—and “abdominal tissue responds differently than facial skin would,” Dr. DiGiorgio adds—she always considers this risk when needling over Belotero, a thin HA that’s often injected into the dermis to inflate fine lines around the mouth and on the cheeks.
Moreover, there’s recently been discussion in aesthetics circles that RF needling can theoretically disturb freshly inserted threads in a similar fashion. “It takes about two months for threads to dissolve,” says Dr. DiGiorgio, and microneedle RF should not be performed during that window. When patients request both procedures, she’ll either perform the thread lift after the RF needling or have them delay the energy treatment until threads have degraded.
