With and without radiofrequency (RF) energy, “microneedling is a treatment that every office should offer,” said Suneel Chilukuri, M.D., a board certified dermatologist based in Houston, Texas.
Microneedling provides colorblind, cost-effective treatment for multiple indications and body areas, including acne scars, striae and crepey skin. Furthermore, patient and practice costs of traditional (non-RF) microneedling are reasonable, and “results can be remarkable,” Dr. Chilukuri reported.
“Microneedling is probably one of the most frequently used tools in our office,” Dr. Chilukuri shared. It can be used to enhance penetration of topical agents such as vitamin C, vitamin E and tranexamic acid for melasma, and as a heat-free therapy, traditional microneedling is a great adjunct to chemical peels and other traditional at-home melasma treatments, he indicated.
Conversely, RF-based microneedling requires more knowledge and finesse, Dr. Chilukuri noted. “But results are often that much more dramatic. It is one of the few machines in our office that we can use for every skin type and many different skin concerns.”
Dr. Chilukuri’s most popular RF microneedling indication is acne scarring, because it works well for rolling, ice pick and boxcar scars. “Microneedling in general, as well as RF microneedling, has changed what we can do to treat scars in all skin types. Particularly, it has been remarkable for acne scars in skin types IV through VI.”
Previously, Dr. Chilukuri would try CO2 or Er:YAG lasers combined with other modalities, but these lasers were not safe for all skin types. “We couldn’t reach the depth we wanted.” While CO2 and Er:YAG lasers penetrate between 200 µ and 800 µ, traditional microneedling can reach 2.5 to 3 mm deep, and RF microneedling reaches 3.5 to 4 mm.
Combining microneedling and RF energy mechanically releases the fibrous bands under scars, he explained, while the RF-generated heat provides immediate contraction and stimulates fibroblasts to produce collagen and elastin – without the downtime associated with CO2 laser treatments.
For brand new scars or very early striae, traditional microneedling often suffices, Dr. Chilukuri noted. For moderate striae, he often combines non-ablative fractional Er:YAG with traditional microneedling. For severe striae, he generally chooses RF microneedling immediately. “You’re going to get more contraction and greater clinical results,” he stated.
One of Dr. Chilukuri’s patients is a mom in her late 30s who had four children, including triplets. “She had already undergone liposuction and abdominoplasty, but she still had this loose skin with wide stretch marks.”
One session of RF microneedling, combined with Sculptra (poly-L-lactic acid) from Galderma, to the abdomen, restored her swimsuit swagger for a ten-year anniversary catamaran cruise.
Most patients will need periodic touch-ups. Dr. Chilukuri advises his patients to return six-months and one-year post-treatment to reevaluate. “Usually we find that after two or three treatments, they continue to improve for about six months,” he shared. “From there, most patients can prolong results with topical agents, fillers or more superficial treatments.”
Body shaping and skin tightening
Dr. Chilukuri also uses RF microneedling for laxity of the face, neck, inner and outer arms and for crepey skin above the knee or on the inner thigh. In recent years, he has added topical regimens for procedure preparation and post-procedural care.
For hyperhidrosis, Dr. Chilukuri said topical agents such as aluminum chloride and glycopyrrolate provide modest results. “We can also use oral anticholinergics, but side effects include dry mouth, constipation, blurred vision and other undesirable symptoms. Neurotoxin improvements last six to nine months, and microwave technology provides some improvement, but it is painful and serves only one indication.”
Dr. Chilukuri and colleagues have published a protocol, for use with various RF microneedling devices, that provides long-term results for axillary hyperhidrosis.1 “Usually with one treatment, we’re seeing 80% to 85% improvement. With the second treatment, we’re seeing a 90% to 95% improvement.”
1. Chilukuri S, Robb CW, Weiner SF, Grossman J. Primary axillary hyperhidrosis treatment using high-intensity focused fractional radiofrequency microneedling. J Drugs Dermatol. 2018;17(7):745-748.
Dr. Chilukuri has been a speaker, researcher or advisory board member for Aclaris, Alastin, Allergan, BTL Aesthetics, Cynosure, Galderma, InMode, Lutronic, Merz Aesthetics, PCA Skin, Sinclair, SkinMedica and Theravant Lasers.