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- Presentation
Clinical Use of Non-Ablative Fractional Lasers and RF Microneedling
Description
The speaker reviews clinical use of non-ablative fractional lasers and radiofrequency (RF) microneedling, focusing on how tissue interaction determines indications, treatment settings, and patient outcomes. She explains that 1927-nm thulium lasers act superficially with high water absorption and are especially useful for photoaging, lentigines, actinic keratoses, melasma, and post-inflammatory hyperpigmentation, often requiring fewer sessions for photodamage and more for pigment disorders. In contrast, 1500-range erbium glass/fiber lasers penetrate deeper and are used for fine lines, wrinkles, acne, surgical scars, striae, and mild laxity; they typically require multiple sessions and careful counseling because improvements may be moderate. RF microneedling is presented as a safer option for darker skin types because it spares the epidermis while heating the dermis, making it effective for scars, texture, fine lines, striae, melasma, and some laxity. She emphasizes patient satisfaction strategies such as setting realistic expectations, managing pain, combining modalities when appropriate, adjusting density and energy based on skin type and treatment area, and using pre- and post-treatment protocols to reduce pigmentation issues, inflammation, acne flares, and HSV reactivation.
View moreConclusions
- Non-ablative fractional lasers and radiofrequency microneedling can improve photodamage, fine lines, texture, scars, striae, melasma, and mild laxity, but they work best for some indications than others.
- The 1927 nm wavelength is especially effective for superficial photodamage, lentigines, actinic keratoses, and PIH/melasma, with relatively few treatments needed for visible improvement.
- The 1540/1550/1565 nm wavelengths treat deeper textural concerns such as fine lines and atrophic acne scars, but they usually require more sessions and expectations should be conservative.
- Focal point 1550 technology may reach deeper tissue and can be more useful for laxity than standard 1550 nm devices.
- Radiofrequency microneedling is a safer option for darker skin types because it spares the epidermis and is well suited for skin types IV and V.
- Combination approaches, such as pairing 1550 and 1927 nm or adding subcision, TCA CROSS, fillers, IPL, or liquid nitrogen when appropriate, can improve outcomes.
- Patient satisfaction depends heavily on clear counseling about the number of treatments, expected degree of improvement, and need for maintenance.
- Comfort measures and complication prevention, including topical anesthetics, analgesics, cooling, antiviral prophylaxis when indicated, and PIH protocols, are essential to good results.
- Photodamage is generally easier to treat than wrinkles, scars, or laxity, so outcome expectations should be adjusted accordingly.
- Overall, the best results come from matching device choice and settings to the lesion depth and skin type while minimizing downtime and adverse effects.
- Chen, Stella, et al. Dermatologic Surgery, April 2022.
- Chen, Stella, et al., in Dermatologic Surgery, April 2022.
- Chen, Stella, et al., "Review of Lasers and Energy-Based Devices for Skin Rejuvenation and Scar Treatment With Histologic Correlations," Dermatologic Surgery, April 2022.#10.1097/dss.0000000000003397