For optimal results when treating patients with radiofrequency (RF) microneedling, anecdotal and personal experience guide Elizabeth L. Tanzi, MD, as there are “no significant comparison studies to date” on the topic.  Dr. Tanzi shared her practice insights on the treatment at the Music City SCALE Symposium for Cosmetic Advances & Laser Education 18^th annual meeting being held this week in Nashville, TN.

“With RF microneedling, there’s a lot of new technology out there and there’s a lot of variability in technology,” she said. Dr. Tanzi, who is director of Capital Laser & Skin Care in Chevy Chase, MD, and associate clinical professor of dermatology at George Washington University School of Medicine, reviewed the latest advances in RF microneedling, starting with insulated vs non-insulated needles and noting that the non-insulated needles cause more epidermal turnover. She finds that “insulated needles are better because you don’t have that epidermal response.” Variable vs fixed-length needles and manual vs mechanical insertion are other areas of advancement but “Where the rubber meets the road is when you’re looking at temperature and impedance feedback,” said Dr. Tanzi. Because RF microneedling is about the creation of energy and the delivery of that energy, the impedance of the skin will dictate the overall energy delivery. However, the impedance of the skin varies in different areas of the body, she said.

Insulated needles represent an important advancement in technology as they provide real-time impedance monitoring as well as improved depth and delivery of treatments. “Real-time impedance monitoring, in my opinion [allow] “you to know the energies that you are delivering and getting in the end for more reliable treatments. We also see an improved depth of delivery of those treatments so that the treatment you are delivering is actually the treatment you are getting.”

Dr. Tanzi also noted that earlier RF microneedling treatments were “unreliable” but she now finds that the results are reliable “if I choose my patients correctly.”

As there have been no significant comparison studies to date on RF microneedling, “every single device company will tell you theirs is the best,” she cautioned.

Another advancement in RF microneedling technology reviewed was a device that combines monopolar and bipolar in single unit. It is customizable                                                                                                                                                                                                                                                                                                                                                                        with semi-insulated and insulated tips which drive topicals into channels as the needles retract, she explained.

For a thorough treatment, maximize analgesia in patients by pretreating with a procedure enhancement product, then maximize number of pulses for best response. “In my opinion, density is more important than depth,” she said.

She often recommends two treatments of RF microneedling with 3 to 6 months between treatments as she prefers new collagen to be in place because new collagen is much more amenable to heat tightening.

What about comfort? Patients should be cautioned that the treatment is uncomfortable. “Anyone who says it isn’t [painful] isn’t treating adequately, in my mind,” Dr. Tanzi noted.

To ensure that her patients are comfortable, they are offered Valium and staff confirms that the patients have a ride home. Low-dose Demerol is also an option to reduce patient discomfort as Dr. Tanzi’s technique involves as many as 1500 pulses of the lower face and upper neck.

“What the patients enjoy is that the recovery time to this procedure, compared with other treatments is easy–1 day of pink, maybe some swelling if you’re treating around the eyes. This is a tolerable recovery time,” she related. It also provides notable improvement of the neck without significant recovery."

As for acne scars, “It’s almost my exclusive go-to treatment,” she said. “I’ve switched a lot of patients over from ablative fractional resurfacing because I find I get better recruitment with less recovery time. Which is really a win-win situation.”

Finally, it was recommended that clinicians prepare patients for more than one treatment and emphasize realistic expectations. Dr. Tanzi summarized by underscoring that advanced technology yields more reliable results. She noted that research continues regarding the best parameters and indications for RF microneedling and the optimal depth of treatment vs density of treatment to achieve results. “RF microneedling has earned a place in our toolbox,” she concluded.