By Audrey Noble and Jesa Marie Calaor
You’ve probably heard of radiofrequency (RF) microneedling. You may even know it’s supposed to tighten skin. But what, exactly, is it? As the name says, the treatment combines microneedling — which studies have shown can help alleviate the appearance of acne scars, fine lines, and uneven texture — with heat. To what end? "It can effectively reduce the prominence of fine lines, improve the evenness of skin tone, and offer some skin tightening,” says Darren Smith, MD, FACS, a board-certified plastic surgeon in New York City. Laser Nd Yag Q-Switch
Ahead, Dr. Smith and other skin experts explain everything you need to know about the treatment, including how it works, where you should set expectations, and how much it hurts.
Age, sun exposure, and habits like smoking can cause the breakdown of collagen and elastin, but board-certified dermatologist Arianne Shadi Kourosh, MD, MPH, says treatments like RF microneedling can help restore some firmness to the skin.
Regular microneedling involves making micro-injuries to the skin to trigger a wound-healing response that promotes collagen production. RF microneedling combines this treatment with radiofrequency energy, “to heat the underlying tissue, stimulating even more collagen production, as well as elastin and hyaluronic acid,” Kourosh says. “It also has a tightening effect on the skin.”
Most adults are able to safely get RF microneedling, regardless of skin tone or skin type. Dr. Smith says that those with mild to moderate skin tone and texture concerns (such as slight sagging or minor discoloration) that don't need the power of deeper laser treatments (like Fraxel) are great candidates. RF microneedling is not going to address more significant skin laxity or serious sun damage.
There are a number of different RF microneedling devices out there, and the differences between them are in part just differences in their marketing budgets and ad campaigns. They all use the same core technology, but “they are slightly nuanced in how deeply the needles penetrate the skin,” says Mona Gohara, MD, a board-certified dermatologist at Dermatology of Physicians of Connecticut. She goes on to explain that deeper penetration can result in increased collagen production. These are some of the most popular brands:
Shereene Idriss, MD, a board-certified dermatologist in New York City, offers Secret RF in her office to patients with darker skin tones who are especially susceptible to post-inflammatory hyperpigmentation from the microneedling component of the treatment. Secret RF “has been shown in studies to have less risk of post-procedure hyperpigmentation when compared to other RF microneedling devices,” she says.
Idriss also offers Morpheus8 at her practice. Morpheus8 is an RF microneedling device that “can treat up to 8mm deep into the skin, while other RF microneedling devices typically can only treat up to 3mm deep which makes it ideal for melting fat,” says Dr. Idriss.
Genius. The device has 49 needles per tip, compared to 24 needles per tip on other devices. “The primary benefit of more needles is that the practitioner can treat a larger surface area with each pulse, thereby increasing the speed of treatment (particularly in larger areas) and decreasing the duration of each treatment session,” says Jina Kim, senior vice president of global marketing of Lutronic, the aesthetic device company behind Genius.
In Idriss’ opinion, having more needles on your applicator “isn’t always a good thing, due to over-delivery of energy which poses a risk of hyperpigmentation.” Kim explains that Genius’s technology ensures the delivery of a precise dosage of RF energy with each pulse, as it is measured and modulated in real-time with a proprietary monitoring feature. “The high-torque motor in the Genius handpiece ensures that each needle is consistently inserted to the proper depth, maximizing consistency and outstanding outcomes.”
Vivace and Vivace Ultra received US Food and Drug Administration (FDA) clearance in October 2022. While there is no clinically significant difference between the radiofrequency heat used by Vivace and other RF devices, Dr. Idriss highlights how Vivace adds LED light therapy to the treatment. Its red LED light has anti-inflammatory properties and plumping and smoothing effects, while its blue LED light targets acne.
Of the two, Vivace Ultra provides a more precise application of RF energy because it is equipped with ultrasound imaging and mapping. This provides your practitioner with visuals of the skin’s dermis, epidermis, and tissue layers — a view that is unique to the device. “Everyone’s skin is different, meaning the quality and thickness of skin differs from person to person, based on age, the individual’s anatomy and other factors,” says Dr. Idriss. “With visual mapping we can determine what needle depth will penetrate into the dermis, which is where you want all microneedling devices to reach if you want to build collagen.” Dr. Paul Jarrod Frank, MD, a board-certified dermatologist in New York City. has previously explained to Allure that this ultrasound feature is especially helpful in treating darker skin tones: “We can deliver the energy deeper in the skin while minimizing trauma to the epidermis [that can cause hyperpigmentation].”
But Dr. Jessica Weiser, MD, FAAD, a board-certified dermatologist and assistant clinical professor of dermatology at Columbia University, suggests that all patients manage expectations when it comes to any of these devices. The hype may not always match up with the reality. “Each device allows the operator to select the amount of energy delivered and the depth of needle penetration,” she says. "But I saw data from a skin pathologist who did a private set of studies and found that many of these devices are not penetrating to the depth selected or delivering the energy selected. Some devices create a zone of destruction in the dermis, but do not deliver enough heat to cause tissue coagulation." And without tissue coagulation, “there is an empty hole under the skin that slowly fills in but doesn’t tighten or stimulate collagen as robustly.” Weiser says that based on the data she's seen, Secret RF and Genius are more accurate in what they are able to deliver within your skin than other RF microneedling devices.
First, the skin is cleansed to prevent infection. Then, a topical anesthetic is applied and left on the skin for an hour to help reduce pain. Dr. Kourush says that if someone doesn't want to wait an hour for the numbing cream to be absorbed in the skin, a local anesthetic such as lidocaine might be injected instead.
The head of an RF microneedling applicator — which is usually about the size of a postage stamp — uses micropins to poke tiny holes in the skin surface, says Dr. Gohara. The tips of the needles also release radiofrequency waves into the openings to heat the surrounding tissue. It can take about 30 minutes to stamp the applicator across the entire face.
The experts we talked to all say that RF microneedling can cause discomfort even with numbing cream, but there are a few things done during the procedure to help you feel more at ease. In addition to numbing cream, Dr. Smith gives offers patients nitrous oxide (a.k.a. laughing gas) for added comfort. "Without this approach, RF microneedling can feel like a combination of sharp pokes and electric zaps," he explains.
Dr. Idriss adds that patients have described RF microneedling as rubber band snaps all over the face, with the most sensitive and painful areas being around the eyes and upper lip. "Pain is very subjective," she says. "So it's a bit difficult to anticipate exactly what it will feel like from person to person."
Senior Commerce Writer Angela Trakoshis, who underwent one session of Morpheus8, had a very unique experience. “Morpheus8 didn’t hurt at all,” she said. She did, however, endure a bout of painful sunburn after her treatment, despite applying and reapplying sunscreen.
Before (top) and after (below) images of a patient who underwent Morpheus8 for fine lines around the mouth.
Dr. Kourosh says that if the treatment is not done correctly, you might see hyperpigmentation and scarring. There is also a small risk of facial fat loss and infection. “If the after-care instructions are followed, the risk of infection is low,” Dr. Gohara adds.
Laws vary state to state and in some places an aesthetician can legally perform an RF microneedling treatment. But, because of the potentially serious risks involved, the experts we spoke to all said you should only see a board-certified dermatologist or plastic surgeon, who is trained to deal with complications. You can go to certificstionmatters.org to check if a doctor is certified by the appropriate board.
Recovery is dependent on each person, but Dr. Kourosh says that most people will experience mild warmth and soreness for the first 24-48 hours. You’ll likely be red immediately after your treatment (so perhaps put any errands you might have on hold), but Dr. Idriss says that the skin should start to calm over the next 24 hours. Some people might see areas of bleeding, swelling, and bruising, which can last for up to a week. Most people feel comfortable going back to work the next day with no more than a little makeup. (Trakoshis says her skin felt normal shortly after her Morpheus8 treatment but she experienced a sunburn weeks later, despite following her doctor’s recommendations.)
"When recovering from RF microneedling, you should be extremely gentle with your skin as you have tiny, open wounds on your skin," Dr. Idriss says. "I tell my patients no skin care for 48 hours and [then they can use] gentle skin care for the week following." That means just the basics: cleanser, moisturizer, and sunscreen. And then another layer of sunscreen. It’s imperative that you apply SPF 30 to minimize the chances of post-procedure hyperpigmentation. You should be especially serious about reapplying every two hours for the first week, says Dr. Gohara.
As for what to completely avoid, Dr. Idriss recommends steering clear of anything with fragrance and anything formulated with an exfoliating acid, such as alpha hydroxy (AHAs) and beta hydroxy acids (BHAs). She says you'll also want to press pause on your retinols and retinoids until your skin is completely healed, which can take up to a full week. And even when using SPF, she says you'll want to avoid being out in the sun for a few days following treatment.
You can see improvements in your skin after a few days but it can take two or three weeks for full results. To see optimal results, Dr. Gohara suggests returning one to two more times. The doctors we spoke to said that just one treatment is often enough to help slightly firm the skin, but they will do up to three on patients who are looking to alleviate lines and wrinkles, mild or moderate laxity, and crepiness.
Dr. Smith says you can expect it to cost anywhere from $1,000 to $1,200 per treatment but, of course, pricing varies. Dr. Kourosh says that pricing depends on where you live and the credentials of the professional giving you the treatment.
Here’s the thing: RF Microneedling is a treatment you don't want just anyone performing on your skin. "When it comes to your body, your health, and your cosmetic results, it's safer to invest in someone with the [highest level] of credentials over a cheap deal,” says Dr. Kourosh. After all, we are talking about heated needles that are being inserted into your face.
Now, watch a day in the life of a dermatologist:
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