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Microneedling versus Fractional Radiofrequency

Microneedling is a procedure that uses thousands of small needles that pricks into the skin. The purpose is to create micro-injury to the skin tissue for regeneration of new collagen for smoother, firmer skin. 

Medical clinics in Singapore do not offer micro-needling. Instead, we offer a more advanced form called fractional RF.

What is the difference between microneedling and fractional RF?

Fractional RF produces significantly better results when compared to traditional micro-needling devices. This is achieved with deeper needle penetration and the added component of new collagen production by radiofrequency energy.

These results are scientifically proven and more well-established in research papers. The risks of fractional RF, as an energy device, holds slightly higher risk than micro-needling alone. These risks can be managed when performed by an experienced doctor. Improvements are expected with each session that takes about 1-2 months to surface and about 3 sessions are required to achieve better results. 

Evolution of microneedling – development of fractional RF/ microneedling RF

Since the recognition of microneedling in aesthetics in the early 2000s, and the known effects of radiofrequency in collagen stimulation by inducing thermal coagulation, a lot of research has been done to combine these 2 mechanisms for synergistic results. 

How does fractional radiofrequency skin tightening work?

Radiofrequency creates electrical current, causing vibration and collision between charged molecules, thus resulting in production of heat. Electrical energy is converted to thermal energy as resistance in the tissue is met. This energy is transmitted from the surface of the skin and transmitted to deeper layers of the skin.  However, the depth of heating as not precise.

Conventional transepidermal RF tightening treatments have inherent limitations because the energy is delivered through the skin surface. This limits the dermal temperature to 45 C to 60 C without burning the superficial layer of the skin. However to achieve optimal results for collagen production the temperature of 65 C to 70 C is required. This cannot be achieved deep into the dermis with conventional Radiofrequency devices without overheating and burning the skin.

The benefits of combining these Microneedling + Radiofrequency

The development of RF microneedling aims to deliver the desired energy through needles that penetrate the skin to a predetermined deeper depth. As the needle delivers this energy through the needle, there is minimal heat damage to the epidermis.

Microneedling Radiofrequency increases the reticular dermal volume, cellularity, HA and elastin content and this is clearly demonstrated in new dermal tissue in treated areas by 10 weeks. The profound neoelastinogenesis is not seen to the same extent in microneedling as a single therapy.

What does microneedling RF treat?

In addition to treating all the conditions that microneedling treats as mentioned above, Microneedling RF is also able to treat acne vulgaris and axillary hyperhidrosis. This is because the thermal energy is able to damage overactive oil and sweat glands. 

What are the factors that determine the efficacy of different microneedling RF systems?

Now that we understand a little more about this combination of microneedling and RF technology, do they all work the same? The answer is NO. They are designed differently. Here, we will discuss how they are different. 

Insulated needle versus non-insulated needle

Non-insulated needles will deliver larger area of coagulation throughout the entire depth of the needle, this usually results in slower healing and epidermal injuries from the ‘unprotected’ needle increases the risk of PIH.

The use of insulated needles allows RF energy to be delivered into the dermis, while protecting the epidermis from most of the heat, thereby minimising the risk of PIH and downtime. As you can see in the diagram, by using depths at 0.5mm the coagulation zone almost reaches the epidermis. By doing multiple passes using the different depths, theoretically, the entire depth of the skin can be treated to produce the same volume of coagulation zones as in the uninsulated needle.

Needle – Lengths, the number of needles, the make of needles

Some machines come only in fixed needle lengths, while some allow more flexibility. Flexibility is important as the different areas of the face have varying skin depths from 0.37mm to 2.0mm. Acne scars and hyperhidrosis require deeper penetration lengths as deep as 3.5mm to effectively target the problem areas.

The number of needles are important. When there are too few needles, the needles are more widely spaced apart, resulting in bigger untreated zones between needle-to-needle. However, having more needles does not necessarily mean that it is better as it has to match the motor power of the machines. Too many needles increases the resistance and that would require a higher power motor to drive the needles into the desired depth. It would be dangerous when it is coupled with a lower power machine when there is incomplete penetration of the needle, leading to treating a level shallower than intended depth. This could result in thermal damage to the epidermis leading to burns and PIH.

The make of the needles are as important as blunt needles increase the resistance of penetration and can result in more mechanical damage to the epidermis leading to increased downtime. Besides, increasing resistance of penetration could likewise result in insufficient power for the machine to drive through the needles, resulting in similar side effects of burns and PIH. The needles need to be well made to remain sharp throughout the entire procedure to minimise this risk. 

Manual versus Mechanical insertion

With mechanical insertion, the user variability is reduced – particularly operator fatigue. However, it is also not always true that mechanical is definitely better than manual insertion as there are MANY systems we know that have underpowered motors, which are unable to overcome the resistance of the skin to get to the desired treatment depth, resulting in added risk and suboptimal results.

Bulk versus Fractional heating mechanism

Bulk heating mechanisms result in a more uniform distribution of heat, creating a bigger coagulation zone. It can translate to better results. However, the downtime is longer and the risks are considerably higher. When the heating mechanism is fractionated, it means that unaffected tissue adjacent to the treated area creates more rapid healing and safer treatments. 

Upon considering all the above factors and each characteristic of microneedling RF available, we have chosen the Infini for Sozo for the following reasons:

  1. Insulated, well made gold-coated needles 
  2. Adjustable needle depth
  3. Highly powered motor 
  4. Fractionated heating mechanism 
  5. One of the most well researched microneedling RF with consistent, reproducible results
  6. Innovative Comfortflow technology unique to Infini is designed to enable smoother penetration minimising downtime and discomfort

Like in all machines, having the best machines doesn’t always guarantee you the best results! The experience of the operator can affect the the results of a microneedling RF session

  1. Technique of operator – if the operator does not hold the device perpendicular to the skin, the penetration will be uneven resulting in uneven distribution of coagulation zone and increasing the risk of burns 
  2. Choosing the appropriate treatment parameters 
  • depth of penetration for the appropriate indication
  • Judge the resistance of the tissue and adjust the depth accordingly – the operator may choose to set the depth slightly higher than the intended depth to account for the increase in skin resistance at particular areas
  • Pulse duration and energy for the respective indications and depths – choosing high energy setting at superficial depths increases the risk of PIH and prolongs downtime

Is microneedling fractional radiofrequency painful?

Fractional RF is tolerable by most patients with the correct pain killers such as topical numbing anaesthesia or nerve blocks.

What are the costs of microneedling fractional radiofrequency?

Charges for fractional RF ranges from $850 – $2000 depending on the machine used and doctor’s charges.

In general, microneedling RF is extremely safe with minimal downtime. The therapeutic benefits of microneedling RF has been well documented in many studies. Energy delivery is efficient into the dermis with minimal thermal effects on the epidermis especially for insulated needles, making it a safer treatment in darker skin type patients. Microneedling RF should be considered a standard treatment for acne scars.

Author

Medical Director

After graduating from the National University of Singapore, Dr Boey’s journey in aesthetics brought him to esteemed institutions such as Harvard Medical School, American Academy of Aesthetic Medicine and Queen Mary University of London in diverse cities like Seoul, London, Boston and New York.