What is best treatment for tightening facial skin post filler use?

Question

What is the most effective RF treatment for tightening facial skin following prolonged filler use, particularly the under-eye and cheek areas. I've had one session of microneedling with PRP, which worked great, but the under-eye area wasn't addressed. Any recommendations for effective treatments? Also is there risk of permanent scarring if the procedure is performed by an inexperienced professional. In my area, there are many new clinics with inexperienced staff.

Falguni Patel, MD, FACOG · Answer

Thanks for your question. We have seen great results with the Morpheus8 which is RF with Microneedling. The microneedling penetrates high depths then your regular microneedling which is used more for skin tone and texture. The Morpheus8 also has a different tip that works great for the undereye area. I would always recommend someone who is highly trained and experienced in using the machine, improper use of any device can cause scarring or burns. Providers at our office do almost upwards of 30 Morpheus treatment per week so they are very comfortable and experienced using the machine.

Anna Chacon, MD, FAAD · Answer

I completely understand your concerns—after years of filler use, the skin can lose a bit of elasticity, especially under the eyes and in the cheek area, and you want something that’s effective but safe.

1. Radiofrequency (RF) treatments:

RF is one of the most reliable non-surgical options for tightening skin. It works by gently heating the dermis, stimulating collagen remodeling and new collagen growth.

For delicate areas like the under-eye, lower-energy, precise devices (like Morpheus8, Profound, or Infini) are preferred, as they can target thinner skin without causing damage.

Results are gradual but can be long-lasting, especially with maintenance treatments.

2. Microneedling with PRP:

You’ve already had this, and it works well for texture and mild tightening.

It’s great for the cheeks and can help with under-eye skin if done very gently. However, aggressive microneedling under the eyes can risk bruising or pigment changes, so experience is crucial.

3. Combination approaches:

Many patients get the best results by combining RF with microneedling, or alternating with gentle laser treatments.

This can help address both superficial texture and deeper collagen support.

Risks:

If the provider is inexperienced, there is a risk of burns, scarring, or pigment changes, especially around the eyes where the skin is very thin.

That’s why it’s important to choose a provider who has extensive experience with delicate areas and knows how to adjust settings for your specific skin type and filler history.

Key takeaway:
RF-based treatments are highly effective post-filler, but the under-eye area requires special expertise. Always prioritize experience over cost—an experienced provider reduces the risk of permanent issues and gives results that look natural.

Donald B. Yoo, MD, FACS · Answer

Despite the abundance of RF microneedling devices available, it's crucial to research and find the best one for your needs thoroughly. Potenza stands out as the first RF microneedling device offering four distinct modes (monopolar, bipolar, 1MHz, 2MHz) and various needle tip options. This versatility allows it to cater to individual needs, providing highly personalized results. Suitable for all skin types and backgrounds, Potenza Microneedling RF is a great option for facial skin tightening in the under-eye and cheek areas. Outcomes vary depending on the provider, so it is highly recommended to seek out an experienced professional.

Chad Deal, MD · Answer

I own eight medical spas and have a vast amount of experience with multiple modalities of facial skin tighteners. In my opinion, the best I have ever seen is the Sylfirm device by BENEV. Combine your treatments with topical exosomes and I think you’ll be very pleased with the results.

Ryan Rebowe, MD · Answer

Skin tightening on the face is best addressed non-surgically by either ablative lasers for loose skin around the eyes or mouth, or RF microneedling (around the mouth). Lateral skin (jowls) can also be helped with muscle stimulation (TriLift/EmFace). Always be sure that the medical director of your spa is abl board certified plastic surgeon or dermatologist to ensure those overseeing your procedure avoid untoward complications.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Camille Cash, MD · Answer

You may want to consider Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  It is safe to use around the eyes.  Three treatment sessions are recommended for optimal results.  It is important to see an experienced provider who can answer your questions and deliver the best outcomes. See my website or a provider near you to learn more.

Lisa Vuich, MD · Answer

Thanks for your question. Two of the most effective devices I have worked with for this indication are:
Sofwave- utilizing microfocused ultrasound to deliver heat to the deep dermis at a depth of 1.5mm, generating new collagen and elastin in the skin. It's a very popular treatment also as it has no downtime!
Morpheus8- utilizing RF energy delivered at the tips of micropins. With this approach you get the collagen stimulation of the heat PLUS the collagen stimulation of the microneedling, so you can potentially get more result per session, but at the expense of 'some downtime'- puffiness, faint redness for a day or two, potential bruising. Morpheus8 could of course also be combined with PRP.
Both work very well, both require topical numbing. 
Both have smaller handpieces designed for use in delicate regions such as the under eye- the Sofwave one is called the "Precise" handpiece, the Morpheus has the "Prime" Tip.
Both are very safe though in particular with the Morpheus8 I would be careful to go to a provider you can firmly 'trust'- based on reputation, reviews, and/or recommendations of others, as this one can cause a burn if technique is not good on the part of the provider. I hope that helps!

What is best treatment for tightening facial skin post filler use?

Answers (8)

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