Fractional Radiofrequency Microneedling is a Safe Monotherapy for Acne Scarring

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A systemic review determined that fractional radiofrequency microneedling (FRM) is an effective monotherapy for facial acne scarring.¹ In all of the included studies, the highly popular and minimally invasive therapy showed significant improvement in skin rejuvenation.

The investigators utilized literature found in PubMed and EBSCO databases up to July 2024. All searches used the terms “radiofrequency”, “fractional radiofrequency”, “micro needling”, “acne scar”, and “acne scarring.” Trials were assessed with the Cochrane risk-of-bias tool and the Newcastle-Ottawa Scale.

Initially, 148 studies were identified. After the screening and exclusion processes, 16 studies were included in the final count. These involved a total of 481 patients 15 years of age and older. Only 1 comparative trial was used; the rest were prospective studies (6), randomized clinical trials (6), and retrospective studies (3). Most of the studies had follow-up periods between 1 and 6 months after treatment.

10 of the studies compared FRM to controls while 6 studies compared FRM to another treatment modality.FRM showed equal efficacy to other therapies such as the 1550 Er:Glass and fractional ablative CO2 lasers and platelet-rich plasma.

Additionally, FRM was found to be more effective than other therapies like bipolar radiofrequency for certain scar types including Icepick, M-shaped, and Boxcar types. Most participants had skin of color III to V but 2 of the studies did not report the Fitzpatrick skin type.

“None of the patients in our review fell into the type I or VI extremes,” the authors wrote. “Despite this, few studies reported PIH as a complication after FRM, which mostly resolves during the follow-up period. Therefore, FRM may be considered safer for treating acne scarring in darker skin types.”

Overall, FRM had good adherence and effectiveness with shorter downtime and fewer adverse effects. The most frequently reported adverse event was transient erythema, which resolved within hours to a few days. Others such as pain, edema, scaling, crusting, oozing, swelling, burning, dryness, bleeding, and post-inflammatory hyperpigmentation were less frequently reported. In the 8 studies that evaluated pain using the Visual Analog Scale, the score ranged from 3 to 5, which equated to mild-to-moderate pain that subsided within 24 hours.

In terms of patient satisfaction, results were moderate-to-high in patients treated with FMR, especially after 3 months. One study showed that almost half of the participants reported excellent improvement in scarring while another had a high satisfaction rate of 89%.

In 40 patients, DLQI scores improved drastically from baseline, showing the positive impact of FRM treatment on patient psychosocial well-being and overall quality of life. Participants were less bothered by scars and negative comments associated with them while feeling more willing to socialize with friends and family.

Investigators were unable to conduct a meta-analysis due to the variations in scoring systems, which was the main limitation of this study. Further randomized controlled trials with follow-up periods longer than 6 months are needed to establish and standardize safe treatment parameters.

Current evidence comparing FRM to combination therapies or fractional laser treatments is inconsistent. Although multiple studies have already demonstrated its efficacy in reducing lesions/pores and improving skin texture, this is the first systemic review to analyze FRM as a monotherapy.²

References

1. Niaz, G., Ajeebi, Y., Alshamrani, H. M., Khalmurad, M., & Lee, K. (2025). Fractional Radiofrequency Microneedling as a Monotherapy in Acne Scar Management: A Systematic Review of Current Evidence. Clinical, Cosmetic and Investigational Dermatology, 18, 19–29. https://doi.org/10.2147/CCID.S502295

2. Cho SI, Chung BY, Choi MG, et al. Evaluation of the clinical efficacy of fractional radiofrequency microneedle treatment in acne scars and large facial pores. Dermatol Surg. 2012;38(7 Pt 1):1017-1024. doi:10.1111/j.1524-4725.2012.02402.x