Radiofrequency Microneedling With 1927 nm Thulium Laser Versus Radiofrequency Microneedling Monotherapy for Rejuvenation of Photoaged Skin

Abstract

Background: The combination of radiofrequency microneedling (RFMN) with fractional 1927 nm thulium (Tm) laser has gained popularity in clinical practice. However, comparative studies remain limited.

Objectives: To evaluate the efficacy and safety of combined RFMN/Tm laser treatment versus RFMN alone for rejuvenation of photoaged skin of the lower face and neck area.

Material and methods: A prospective, evaluator-blinded, clinical study. Patients were assigned to a combined protocol consisting of 1-3 RFMN treatment sessions immediately followed by Tm laser, supplemented by three additional Tm laser sessions at 6-8-week intervals. Study endpoints were compared with data from our previously published RFMN monotherapy cohort. Outcomes were assessed using validated clinical grading scales, computer-assisted analysis of submental volume, and a standardized color space system to quantify skin tone evening. Pain was assessed using a numeric rating scale. Adverse events (AEs) were monitored throughout the study period.

Results: 26 received the combined treatment, and 27 patients were treated with RFMN alone. Mean ages were 50.7 ± 7.4 and 55.6 ± 8.9 years, respectively. Both groups showed significant reductions in submental volume without significant differences between them. However, only the combination group demonstrated a distinct improvement in hyperpigmented lesions, as quantified by the color analysis. Blinded evaluations noted improvements in the melomental area, jawline, and neck in both groups, while greater improvements in skin tone evening and therefore overall appearance were seen only in the combination group. No serious AEs were reported.

Conclusion: Both treatment modalities effectively addressed lower facial and neck laxity. The addition of Tm laser to RFMN provided additional benefits in treating pigmentary irregularities and improving overall clinical outcome without notably compromising downtime. Larger studies are warranted to validate these findings and assess long-term outcomes.

Trial registration: This study was preregistered in clinicaltrials.gov (NCT06029725) on 23 August 2023.

Keywords: pigmentation; radiofrequency microneedling; skin rejuvenation; skin tightening; thulium laser.