Dual-Energy Approach Boosts Skin Hydration

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While the benefits of hyaluronic acid (HA) in dermal health are well-established, the current clinical standard still relies heavily on exogenous fillers to address age-related volume loss and hydration decline.¹ However, these interventions do not stimulate the skin's native regenerative processes.² In light of increasing patient demand for noninvasive yet biologically active treatments, recent research investigates a novel technology that shifts the paradigm—utilizing a dual-energy approach combining monopolar radiofrequency (RF) with targeted ultrasound (TUS) to induce in situ HA synthesis. By harnessing both thermal and mechanical stimulation to activate fibroblasts in the reticular dermis, this method presents a compelling alternative to injectables, aiming not just to fill but to rejuvenate the extracellular matrix from within.³

Methodology

The open-label, single-center clinical study enrolled 7 healthy adults aged 51 to 64, divided into 3 groups: 1 treated with RF + TUS (n=3), 1 with RF only (n=3), and a control (n=1). Each treatment group underwent 4 60-minute sessions spaced 7 to 14 days apart. Biopsies from the infra-auricular area were collected before treatment, and at 1 and 3 months post-treatment, and analyzed histologically for HA presence using HA binding protein staining.

Key Findings

Researchers stated histological analysis showed a statistically significant increase in HA production in the RF + TUS group. At 1 month, the HA-stained area increased by 48.65%, and by 3 months, the increase reached 67.69%. This contrasts sharply with the RF-only group, which showed minimal, statistically insignificant changes (6.76% at one month and 9.56% at 3 months). The untreated control group exhibited no changes.

Digital imaging and evaluator-based scales further validated these results. Subjects treated with RF + TUS demonstrated visible improvements in skin laxity and wrinkle reduction, corroborated by scores on the Global Aesthetic Improvement Scale (GAIS) and Fitzpatrick Wrinkle and Elastosis Scale (FWES). The GAIS score in the RF + TUS group improved from an average of 1.22 to 1.88 over 3 months, while FWES scores decreased significantly, reflecting reduced wrinkle severity.

Safety and Tolerability

Both treatment modalities were reported to be well-tolerated, with no reported adverse events or required downtime. However, subjects in the RF + TUS group rated the experience as more comfortable, with lower pain scores (2.3/10 compared to 5.3/10 in the RF-only group), and expressed greater overall satisfaction.

Discussion

The combined RF and TUS technology appears to act synergistically by leveraging thermal effects from RF and mechanical stimulation from ultrasound to activate fibroblasts in the reticular dermis. This dual-stimulation likely enhances gene expression and protein synthesis relevant to HA production. These findings align with prior animal studies and contribute to a growing body of evidence supporting the efficacy of this technology in human skin rejuvenation.

Limitations and Future Directions

While promising, the study's small sample size and short follow-up period (3 months) limit generalizability. Investigators stated future research should include a larger cohort, longer-term follow-up, and analysis of additional extracellular matrix components like collagen and elastin to provide a more comprehensive understanding of the treatment’s regenerative impact.

Conclusion

This human histology study provides compelling evidence that the combination of RF and TUS significantly enhances the skin’s natural production of HA, resulting in visible facial rejuvenation without invasive procedures or exogenous HA. The technology presents a safe and effective alternative for patients seeking natural and sustained aesthetic improvements through intrinsic skin remodeling mechanisms. As noninvasive therapies continue to evolve, approaches that support the skin’s self-renewing capacity, such as this, are likely to play a central role in the future of cosmetic dermatology.

References

1. Murthy R, Roos JCP, Goldberg RA. Periocular hyaluronic acid fillers: applications, implications, complications. Curr Opin Ophthalmol. 2019;30(5):395-400. doi:10.1097/ICU.0000000000000595
2. Wongprasert P, Dreiss CA, Murray G. Evaluating hyaluronic acid dermal fillers: A critique of current characterization methods. Dermatol Ther. 2022;35(6):e15453. doi:10.1111/dth.15453
3. Goldberg DJ. A novel technology to boost natural production of hyaluronic acid in the skin tissue: Human histology study. J Cosmet Dermatol. 2025 Apr;24(4):e70159. doi: 10.1111/jocd.70159. PMID: 40243133; PMCID: PMC12004441.