Split-Face Histomorphological Study of Radiofrequency Microneedling Versus Fractionated Ablative 2940 nm Er:YAG Laser Resurfacing for Perioral Skin Rejuvenation

Ablative laser resurfacing has long been considered the gold standard for facial skin rejuvenation. However, the results came at a price including prolonged erythema, shedding, scarring, and dyspigmentation.^1,2 Advancements in laser technology such as ablative fractionated laser resurfacing (AFLR) have focused on minimizing side effects and speeding recovery.^1,2 AFLR obliterates microcolumns of epithelium and dermis to achieve a similar resurfacing benefit. Because islands of intervening tissue are left intact, skin regeneration is quicker, allowing for shortened healing time and reduced side effects. However, patients still experience at least a week of skin shedding and peeling with variable erythema that can take weeks to months to fade, and the risk of pigmentation alteration precludes treating darker skin phototypes.^1,2

In recent years, radiofrequency microneedling (RFMN) has gained rapid popularity as an effective skin rejuvenation technique with minimal downtime that is safe to use with all skin types.^3,4 RFMN uses microneedles that deliver radiofrequency energy directly to the dermis. This mechanical and thermal trauma induces neocollagenesis and matrix organization, producing skin tightening and rejuvenation.^3,4 Patients may experience transient erythema and edema for a few days.

Although there are studies comparing non-AFLR with RFMN, there are no studies directly comparing RFMN and AFLR treatment, and none with histological anlaysis.^5,6 We aimed to determine among patients undergoing perioral rejuvenation, how does RFMN compare with AFLR in a split-face study as measured by histology and validated surveys.

We conducted a prospective, randomized, single-blinded, and split-face comparison of RFMN and AFLR for perioral skin rejuvenation. IRB approval was obtained. Ten female adult participants with fair complexions (Fitzpatrick I-II) underwent RFMN treatment utilizing the Morpheus8™ device (Inmode, Irvine, CA, USA) and AFLR with the Icon™ 2940 nm fractional Er:YAG laser (Cynosure, Westford, MA, USA).

Treatment settings were as per manufacturer recommendations with one AFLR treatment (2 passes at 9 mJ/mB per 250 ns and 3 passes at 9 mJ/mB per 250 ns and 7 mJ/mB per 3 ms; density = 469 mB/cm²), and three RFMN treatments (3 passes at 2 mm 35 kW, 1 mm 30 kW, 0.5 mm 20 kW) spaced a month apart. Results were measured by validated surveys (Global Aesthetic Improvement Scale [GAIS] and Fitzpatrick Wrinkle and Elastosis Scale [FWES]) and biopsies from treated areas under the chin at 3 months analyzed by pathologists in a blinded manner.

GAIS and FWES scores indicated equal satisfaction with both treatments (Fig. 1). Four patients preferred AFLR, three preferred RFMN, and three had no preference. Patient preferences were strongly swayed by factors such as downtime and convenience. RFMN treatment was felt to be more painful and required three visits, whereas AFLR caused more erythema and prolonged recovery (Fig. 2). Of the 10 participants, 4 exhibited better overall histological changes with RFMN, 3 showed equal improvement, and 3 had better results with AFLR (Supplementary Data S1).

Fig. 1.

Aggregate GAIS and FWES scores at 1 week, 1 month, and 3 months after AFLR and RMN treatments. FLR, ablative fractionated laser resurfacing; FWES, Fitzpatrick Wrinkle and Elastosis Scale; GAIS, Global Aesthetic Improvement Scale; RMFN, radiofrequency microneedling.

Fig. 2.

Representative patient at 2 days (top), 1 month (middle), and 3 months (bottom) after perioral treatment with AFLR on patient's left side and RMFN on patient's right side.

Fisher's exact test provides a p-value of 1.0 and an odds ratio of 0.643. The p-value of 1.0 indicates that there is no significant difference between the two treatments in terms of their effectiveness. The odds ratio <1 suggests noninferiority of RFMN compared with the laser treatment in this small cohort.

Results of our split-face pilot study indicate that RFMN and AFLR are equally effective options for perioral rejuvenation. This could represent a potential change in approaches to skin rejuvenation as RFMN has minimal downtime and can be used safely in all skin phototypes. Our study is limited by a small sample size and treatment confined to the perioral area using currently available devices in a homogeneous patient population from a single center. Further research will be necessary as technology evolves to establish whether RFMN is superior to AFLR.