Damage from RF microneedling - what treatments will help orange peel skin? (Photos)

Hello, my name is Ranen and I am an aesthetic nurse at Aesthetic Skin in Chicago. I’m really sorry you’re dealing with this — RF microneedling complications can be emotionally and physically draining, and the combination of rosacea + texture changes can make things feel worse than they actually are over time. I’ll give you clear, dermatologist-aligned information so you know what usually improves, what sometimes doesn’t, and what options genuinely do help — without causing further irritation. Yes — many texture irregularities after RF microneedling can improve over time. RF microneedling delivers heat into the dermis. If the settings were too aggressive or poorly matched to your skin type, this can cause: Prolonged inflammation, Worsening of rosacea. Collagen contraction → “orange peel” texture. Linear marks from needle cartridges (“track marks”). These issues often improve slowly as inflammation settles and collagen remodels. True collagen remodelling takes 6–12 months, sometimes longer. Because your treatment was in January 2025, you are still within the healing window. Track marks specifically, Track-like impressions often soften significantly within 6–12 months. They rarely stay fully permanent unless there has been deeper scar formation, which is less common.
But — rosacea complicates recovery. Rosacea-prone skin is: More reactive more prone to prolonged inflammation. Less tolerant of procedures Inflammation can freeze collagen in an abnormal state. So calming the rosacea is essential for the texture to improve.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

RF microneedling can sometimes lead to textural changes like orange peel skin, especially if there is underlying rosacea. Here are a few treatment options that might help improve your skin texture and manage rosacea:

Topical Treatments: Consider using products containing niacinamide, hyaluronic acid, or peptides to help improve skin texture and hydration. Prescription treatments like azelaic acid or metronidazole may help manage rosacea symptoms.

Laser Therapy: Pulsed dye laser or intense pulsed light (IPL) therapy can be effective in reducing redness and improving skin texture associated with rosacea.

Chemical Peels: Superficial chemical peels may help in smoothing the skin texture. However, they should be used cautiously and under professional guidance to avoid aggravating rosacea.

Gentle Skincare Routine: Use a gentle, fragrance-free cleanser and moisturizer to maintain skin barrier function and avoid further irritation.

Lifestyle Modifications: Identify and avoid triggers that may worsen rosacea, such as spicy foods, alcohol, and extreme temperatures.

Consultation with a Dermatologist: A thorough evaluation by a dermatologist can help tailor a treatment plan specific to your needs and monitor your progress closely.

While some improvement can be expected over time, a combination of treatments and lifestyle adjustments is often necessary to achieve optimal results.