Fractional microneedling radiofrequency and fractional 1927 nm thulium laser treatment offer synergistic skin rejuvenation: A pilot case series.

Background and aims: Facial rejuvenation has become an increasingly patient-driven procedure with speedy but significant results and minimal downtime being the holy grail of both patient and practitioners. Fractional techniques with both laser and radiofrequency sources have attracted attention with some good results, but still with some downtime. Combination therapy could offer the best points of the separate techniques to give synergistic results with minimal downtime. The present pilot mini-study investigated the safety and efficacy of facial rejuvenation with a combination of microneedling fractional radiofrequency (MFR) and fractional minimally-invasive thulium laser (FTL) treatment.

Subjects and methods: Four Korean females, ages from 53-63 yr (mean age 58.25), Fitzpatrick skin type Ⅲ-Ⅳ with mild to moderate photoaging-related sequelae participated in the study. On the first pass an MFR system was used with insulated microneedles to deliver a single pass of RF energy to a depth of 1.5 mm-1 mm in the dermis (7.5 W, 30 ms exposure). This was immediately followed by an FTL (5 W, 10 mJ) with 2-3 passes over the whole face, and a further 4-5 passes over the target wrinkles. This was repeated for 6 treatment sessions with 2-weekly intervals, and with a follow-up of 16 weeks after the final session. An analytical digital clinical imaging system captured gross and analytical images, and an independently-scored Physician Global Assessment (PGA) scale was used to assess efficacy in addition to patient satisfaction.

Results: Apparent smoothing of wrinkles and general improvement in skin condition was seen following the 3rd to 4th sessions. At the 16-week assessment very clear improvement was seen both with the naked eye and with specific analytical software from the imaging system. The total mean PGA score was 3.35 (out of 4), and all patients were extremely satisfied with the results. No adverse events were reported and pain was minimal.

Conclusions: The combination of MFR and FTL was safe and effective, and produced synergistic results in skin rejuvenation in the Asian skin type which were judged to be better than either system used on its own. Further larger population, split-face and controlled trials are warranted to confirm these optimistic results.