Microneedling Radiofrequency RF

Dr William Hoo - March 5, 12:33 PM

Radiofrequency (RF) energy has been widely used in the field of medicine over past 80 years. RF device creates an electromagnetic field that propagates to the surrounding structures. It then produces heat when the current interacts with tissues. 
 When the energy is concentrated and controlled, it can be used for skin lifting and tightening, body contouring and cellulite reduction. Innovation to this technology by combining fractional technique with RF has expanded the use of RF technology to treat more skin problems. 
 Fractional RF microneedling system is a novel and innovative use of fractional RF. It uses sterilized, tiny needles to deliver an exact amount of RF energy at accurate depth directly into the deep dermal area. The deep dermal layer within our skin contains collagen, the substance which gives support to the skin and prevents sagging and wrinkle formation. By delivering energy to the deep dermal layer of the skin, it encourages collagen growth and promotes skin tightening at the predetermined depths in the skin. At the same time, due to the highly specific nature of the treatment, the epidermis (the superficial layer of the skin) is spared from the effect of the heat. There is no concern of the epidermis sustaining burn injury or there is no profound redness over the treated area. It is an excellent treatment modality for various skin conditions with little to no downtime. 
 I would like to demonstrate its use in a few skin conditions. 
 Active acne treatment 
Currently there are many therapeutic options available for patients with acne. In most treatment options, the initial result is encouraging but relapse is common once the treatment is stopped. 
 One of such examples is the use of isotretinoin. Isotretinoin is used to treat severe cystic type of acne. It is a medicine taken orally which will decrease facial oil (sebum) production, thereby reducing clogging of pores due to overproduction of sebum. Relapse may occur once the medicine is stopped and a second or even third course of the medicine needs to be initiated. The downside of isotretinoin is the inherent side effects such as dryness of lips and eye, as well as elevation of liver enzymes and cholesterol. As such, patients may have difficulty in complying with isotretinoin treatment due to its side effects. 
 Selective sebaceous gland electrothermolysis is a new and a clinically effective treatment for acne and it is associated with minimal complications. As the name suggests, the treatment involves applying heat to destroy selected sebaceous glands using partially insulated micro-needle RF. Partially insulated needle is used to prevent epidermal burn. The treatment provides long term remission rate with low recurrence rate for acne. In addition, it does not have any systemic side effect like those seen with oral medications (chronic antibiotics use, hormone therapy or oral vitamin A, Isotretinoin).
Syringoma is a benign skin growth derived from sweat glands overgrow or over activity. It predominantly occur in women at puberty or later in life. Conventional therapies for syringomas such as surgical excision, electrodessication, chemical peeling, cryosurgery or laser therapy can cause hyperpigmentation or scarring due to epidermal damage.

Fractional RF microneedling targets the sweat ducts location specifically, hence providing a good cosmetic outcome due to its selective destruction of the overgrown sweat glands. It is an effective and highly satisfying treatment for syringomas although it takes time and a few sessions of treatment to achieve the desired outcome.
Pictures courtesy of Anna Hoo Clinic

Sylfirm is another of such pulsed fractional RF microneedling treatment. It selectively coagulates vessels to safely heal specific areas of the skin while destroying only the abnormal vessels. One of such skin condition it is most apt for is in the treatment of Melasma – dark discoloured patches over the skin. Melasma is notoriously difficult to treat, due to its deeply seated position which typically worsens if it is too aggressively treated. This fractional RF microneedling can stop Melanin migration by strengthening the basement membrane which is weakened by factors such as UV rays and ageing. Once the basement membrane is strong, it will keep what is within well protected and away from harm. It is ideal for those who have Melasma, extreme blushing, and rosacea. 
One of the best thing about this treatment is its ability to improve the overall appearance of skin, making it the first multi-treatment that deals with all skin concerns.  Fine lines, dull skin, acne scars and large pores are some of the problems it is great at tackling.
Lifting and skin tightening
Also known as the Collagen Induction Therapy (CIT), the fractional radiofrequency microneedling delivers radio frequency energy leading to “fractional” heat zones, leaving the normal tissue in between the heated zones for shorter recovery time. This treatment helps generate collagen in two ways: (a) the microneedles cause micro-injuries in the deeper dermis which encourages healing with collagen production. (b) the fractional radiofrequency heats up the deeper dermis around the microneedle tip for further collagen tightening and synthesis.
Upper eye lids and lower eye skin tightening by fractional RF microneedling (Pictures Courtesy of Anna Hoo Clinic)
Skin tightening and Lifting (Pictures Courtesy of Anna Hoo Clinic)
1. Lee JW et al. Selective sebaceous gland electrothermolysis as a treatment for acne: a prospective pilot study Int J Dermatol. 2012 Mar;51(3):339-44.
2. Chandrashekar BS et al. Evaluation of Microneedling Fractional Radiofrequency Device for Treatment of Acne Scars J Cutan Aesthet Surg. 2014 Apr-Jun; 7(2): 93–97. 
3. Simmons BJ et al. Use of radiofrequency in cosmetic dermatology: focus on nonablative treatment of acne scars. Clin Cosmet Investig Dermatol. 2014 Dec 12;7:335-9
Dr. William Hoo
Dr. William Hoo is a medical graduate from USM (Universiti Sains Malaysia). He holds a diploma in Aesthetic Medicine awarded by the American Academy of Aesthetic Medicine - AAAMR. He is a experienced medical aesthetic practitioner and a credentialed (Letter of Credentialing & Privileging AMP- 001/2016(2)) Medical Aesthetic Practitioner in Malaysia by Ministry of Health. 

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