Radiofrequency Skin Tightening and Radiofrequency Microneedling: What Can You Expect?

What is radiofrequency and how does it work?

Radiofrequency is an electrical current that oscillates at a certain frequency. As this current passes through tissue, it meets the tissue's resistance and heat is produced. In aesthetic treatments, the aim is to heat the lower layers of the skin in a controlled way so that existing collagen fibres contract somewhat and, over time, new collagen (the support protein that gives the skin its firmness) is produced.

Unlike lasers, radiofrequency energy does not target the pigment in the skin. It is therefore considered less dependent on skin colour; even so, the risk of pigmentation on darker skin should not be overlooked, especially with the microneedling types.

Radiofrequency devices are divided into several groups according to how the energy is delivered to the skin:

There are radiofrequency devices on the market with very different technical specifications. The result of a study done with one device may not apply to another device.

What is it used for?

• Mild laxity of the face, under the chin and the neck
• Fine wrinkles and irregular skin texture
• Depressed (pitted) acne scars (especially radiofrequency microneedling)
• Pore appearance and skin quality (evidence is more limited)
• Some body treatments for laxity and stretch marks (evidence is more limited)

Who is it suitable for?

Those who benefit most from radiofrequency treatments are usually people with mild to moderate laxity or texture problems who can accept a moderate change that appears slowly. For depressed acne scars, radiofrequency microneedling may be an option, either alone or together with other methods.

If there is marked sagging and excess skin, radiofrequency is usually not enough; in this case, surgical options should be discussed with your physician.

Who is it not suitable for, and what should you watch out for?

• Pacemaker, defibrillator or another electronic device implanted in the body: Radiofrequency can affect these devices; be sure to tell the physician beforehand.
• A metal implant in the treatment area
• There are not enough data on safety during pregnancy and breastfeeding; postponing is generally recommended.
• Active infection, an open wound, an active cold sore or inflamed acne in the treatment area
• A tendency to keloids (excessive scarring), especially for the microneedling types
• A bleeding disorder or use of blood-thinning medicines (risk of bruising and bleeding with the microneedling types): Do not stop your medicine on your own.
• Recent or current use of an oral vitamin A–derived acne medicine: Discuss the timing with your physician, especially for the microneedling types.
• If you have recently had filler in the area, tell your physician.

At the consultation, clearly mention all the medicines you use, any implants and devices in your body and your previous aesthetic procedures. Suitability can only be decided after a physician's assessment.

Who should perform it, and where?

Radiofrequency, especially in its microneedling and deep-heating types, is a medical procedure that can lead to outcomes such as burns, scarring and pigmentation. It is recommended that it be performed under the responsibility and supervision of a physician who can assess skin structure, contraindications and possible complications.

For microneedling treatments, single-use sterile needle tips should be used and hygiene rules followed. Make sure there is a physician you can reach if a problem arises.

Preparation before the procedure

• Talk openly about your expectations; ask which type of radiofrequency is recommended and why.
• Avoid sunburn in the treatment area in the days before the procedure.
• If microneedling is planned, your physician may ask you to pause retinoid or acid-containing products for a few days.
• If you have a history of cold sores, tell your physician, especially if the area around the lips is to be treated.
• On the day of the procedure, do not apply make-up or cream to the area; remove your jewellery and metal items.

The day of the procedure, step by step

1. Your medical history, medicines, implant and device status and expectations are discussed; the area is assessed.
2. The informed consent form is read; your questions are answered and the form is signed.
3. The area is cleaned. For microneedling treatments, an anaesthetic cream is usually applied some time beforehand.
4. With monopolar devices, a return plate may be placed on the body; with some devices, a gel is applied to the skin.
5. Energy is delivered by moving the handpiece over the skin or by treating section by section. You may feel heat, pricking or, with the microneedling types, a mild stinging.
6. If you feel excessive heat or burning, tell the practitioner immediately.
7. At the end of the procedure, the area is cleaned, a soothing product or cold application is used if needed, and aftercare advice is given.

After the procedure: the first 24 hours and the first week

After surface radiofrequency, mild redness and a feeling of warmth are common and usually go away within a few hours. After microneedling treatments, redness, swelling and small dot-like marks usually last a few days.

• After microneedling, it is recommended not to apply make-up to or touch the area on the first day; follow the period your physician tells you.
• Avoid saunas, Turkish baths, swimming pools and strenuous sport in the first days.
• Do not scratch the area or pick off scabs.
• Use a gentle cleanser and moisturiser; do not use acid-containing, retinoid-containing or irritating products until your physician allows it.
• Protect the area from the sun; use a broad-spectrum sunscreen.

Expected side effects

• Redness and mild swelling: Usually lasts hours with surface treatment, and a few days with the microneedling types.
• Heat, pricking or pain during the procedure
• With the microneedling types, small dot-like marks, mild crusting and bruising
• Temporary sensitivity or dryness

There are also rarer but important risks: burns and blistering, scarring, temporary or long-lasting darkening of the skin (especially on darker skin and with the microneedling types), infection and cold sore flare-ups. With deep-heating devices, depressions due to loss of fat tissue under the skin have rarely been reported.

When is the result seen and how long does it last?

Some people feel a slight tightness immediately after the procedure; however, this is partly due to temporary swelling. The change due to collagen production usually appears gradually over weeks and months.

The number of sessions varies depending on the device and the goal. Some surface systems are used in a single session, others as a programme of several sessions. With radiofrequency microneedling, especially for acne scars, more than one session a few weeks apart is usually planned.

How long the result lasts varies from person to person; because the ageing process continues, the effect decreases over time and your physician may recommend maintenance sessions. In studies, the results are generally moderate and vary markedly from person to person.

Realistic expectations: what can radiofrequency not do?

• It does not replace a surgical lift; it does not remove excess skin.
• With marked sagging, the result is often insufficient.
• It does not completely eliminate acne scars; it aims to reduce their appearance.
• The result appears slowly and is not the same for everyone.
• It is not a substitute for weight loss or spot reduction.

Alternatives