Radiofrequency (RF) microneedling uses low-frequency electromagnetic waves to generate thermal heating at the tip of tiny needles, which can be inserted at different depths into the epidermis, dermis, and subdermal fat in the hypodermis. As we age, our skin loses its fresh and smooth appearance because we lose collagen and elastin, develop areas of hyperpigmentation from sun exposure, form wrinkles and creases, and experience sagging skin. The thermal energy deposited into the layers of the skin promotes new collagen (neocollagenesis), elastin formation, and angiogenesis during the healing process. This creates a more youthful appearance with the added benefit of skin tightening, which occurs when thermal energy shrinks existing collagen and removes subdermal fat.
What are the main applications for RF microneedling?
Skin aging and sagging skin occurs as we age because of a number of factors, including the loss of collagen and elastin. Sagging skin or skin laxity tends to be more apparent on the face because of ultraviolet light exposure, facial movement and expression, and changes in facial fat distribution. RF microneedling is ideal for treating skin laxity in the face when the changes are too mild to require an invasive traditional facelift, patients who have had a prior facelift but desire additional skin tightening, and patients who want to avoid an invasive surgical procedure. This technology is also well suited to treat patients who do not want injectables such as toxins and dermal fillers.
Acne is one of the most frequently encountered issues in aesthetics with a broad range of treatments available, ranging from topical treatments, light-based therapies, systemic medications, and RF microneedling. Patients who are not able to tolerate topical prescription acne medication, not responding to topicals, or prefer to avoid prescription oral medication are good candidates for RF microneedling, which can treat acne vulgaris by causing micro-insults to sebaceous glands to promote dermal and follicular epithelial remodeling.
Scarring, including acne scarring, is the formation of dense, thickened collagen and decreased vascularity at the site of prior insult and can appear as either hypertrophy or atrophy with tethering to the deep dermal structures causing irregular skin texture. RF microneedling is effective at disrupting the abnormal collagen structure and stimulating neocollagenesis and angiogenesis to establish a more normal dermis.
Eyebags and raccoon eyes are a result of skin laxity, infraorbital fat pad prolapse, and impaired lymphatic drainage. RF microneedling has been shown to stimulate vascular endothelial growth factor to promote lymphangiogenesis (new lymphatics) and angiogenesis, which helps to improve drainage and localized edema.
Rosacea is an inflammatory skin condition that causes reddened skin and a rash, usually on the nose and cheeks. It most commonly affects middle-aged women with fair skin and can be mistaken for acne or other skin conditions. Treatments include lifestyle modifications to avoid triggers, topical or systemic antibiotics, immunomodulators, and laser and light-based therapies. RF microneedling can be used to treat the papulopustular subtype of rosacea by reducing expression of inflammatory mediators and stimulating angiogenesis.
Melasma is a disorder of facial hyperpigmentation that is characterized by brown patches on the face, most commonly in female patients with skin of color. RF microneedling has been shown to improve melasma by reducing inflammation, stimulating angiogenesis, and reducing mast cell activity. This leads to dermal remodeling and formation of microperforations that allows melanin clearance from the skin.
Removing fat in various parts of the face (periorbital, submental, jawline) and body can be achieved by the handpieces of the Morpheus RF microneedling device, which allow thermal energy to be deposited into the subdermal fat.
Resurfacing handpiece goes to a depth of 0.5mm into the epidermis
Morpheus 8 handpiece goes to a depth of 5mm and is used primarily on the face and neck
Morpheus Prime handpiece goes to a depth of 5mm and is used for small areas like the periorbital region and areas with curvature
Morpheus Body handpiece goes to a depth of 8mm and can be used just about anywhere in the body, as well as the face and neck (submental fat)
Why choose RF microneedling over surgery?
Today more people than ever are avoiding invasive procedures like the facelift because there are effective non-surgical options that allow them to return to work quickly with little downtime and discomfort. RF microneedling devices are safe and effectively treat skin laxity while removing excess fat.
Laser versus RF microneedling?
One of the main differences between fractional ablation with a laser and RF microneedling is that lasers must go through the epidermis into the dermis, which can stimulate the melanocytes at the epidermal-dermal junction. This can cause post-inflammatory hyperpigmentation (PIH) in patients with Fitzpatrick skin types IV-VI, so lasers should not be used in these patients. Because the needles of RF microneedling devices can be inserted to specific depths of 4mm and greater, we can avoid the epidermal-dermal junction and subsequent PIH. RF microneedling can be used safely in all skin types.
Advanced RF microneedling techniques
Pulse stacking is when the provider will insert the needles and deposit thermal energy for more than 1 pulse, often double and triple stacking pulses to deliver more thermal energy and better outcomes.
Burst mode is unique to the Morpheus 8 body handpiece. This is when the needles are inserted at depths of 6mm or 7mm, and the technology allows the needles to deposit thermal energy at multiple depths during a single pass.
Subdermal fat removal typically occurs at depths of 4mm and greater. Another unique feature of the Morpheus 8 body handpiece is that it goes to a maximum depth of 8mm, which is deeper than any other device.
All of these features increase the effectiveness of the device in causing skin tightening and removing subdermal fat, which improve outcomes.
Is RF microneedling painful?
It is important for patients to understand that delivering more thermal energy using RF microneedling devices makes the treatment more effective, which also increases the discomfort. There are a number of treatments we can offer to reduce or mitigate discomfort:
- Topical anesthetic such as 23% lidocaine with 7% tetracaine, which is one of the most powerful anesthetics available. Topical anesthetics should be applied for 45-60 minutes prior to the procedure.
- Lidocaine can be injected into certain areas for numbing, such as the periorbital region.
- Nerve blocks with lidocaine can be performed in the face.
- Tumescent lidocaine is the infusion of a very dilute solution of lidocaine combined with epinephrine and sodium bicarbonate, which allows numbing of larger areas.
- Pronox is a self-delivery nitrous oxide system that improves physical and emotional comfort for patients (shown in the face treament video below).
What does it look like after a Morpheus treatment?
Face treatment:
Body treatment:
Summary
RF microneedling with a device like the Morpheus 8 is a groundbreaking technology that can restore the youthful look through skin resurfacing and tightening. These devices are safe and effectively treat skin laxity while removing excess fat. Energy is deposited into the deep layers of the skin that stimulates natural regeneration of collagen and elastin, as well as tightens the skin and reduces skin laxity by shrinking collagen and removing subdermal fat. The end result is a more youthful look with increased volume and suppleness.
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