RF microneedling for cellulite and skin tightening: does it work?
RF microneedling for cellulite and skin tightening vs deep-acting, high-power radiofrequency: what is best?
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Microneedling radiofrequency for cellulite and skin tightening: does it work, is it safe and is it worth all the pain and adverse reactions?
Part One: Microneedling Radiofrequency
What is microneedling radiofrequency and how does it work for skin tightening and cellulite?
Invasive, inherently unsafe and still largely ineffective
Cellulite removal with RF microneedling? It’s complicated…
Radiofrequency microneedling adverse reactions and drama
A shot in the dark: guessing the right intensity under anaesthesia
Needles are too long for safety and not nearly long enough for effectiveness
You never “only need one” RF microneedling session, for either cellulite or skin tightening
In the long term, RF microneedling is an unsustainable hardship
The “Would I do it?” test
Part Two: Deep Tissue Radiofrequency
Deep-acting, high-power radiofrequency: stimulating, not destructive
Why puncture the skin in a medieval torture fashion, when you can focus radiofrequency at an exact depth with technology?
Cellulite removal with deep tissue radiofrequency: natural and sustainable
Knowing the exact right intensity, by always working under the pain threshold
With deep tissue radiofrequency, we are honest and upfront: typically 6-12 sessions are needed for good results
Would I have/do deep tissue radiofrequency? Absolutely.
Superficially acting and/or low power radiofrequency is pointless, of course
Combination with deep acting, high-power ultrasound cavitation
Disclaimer
Check our professional consultancy in radiofrequency, ultrasound cavitation, cellulite and skin tightening
Radiofrequency microneedling for cellulite and skin tightening: does it work, is it safe and is it worth all the pain and adverse reactions?
Microneedling radiofrequency was the ultimate hype of 2023 and set to gradually decline in 2024, after people gradually realise it is more about pain, high cost and skin damage and less about results.
For the last 2-3 years everyone talked about it and everyone sunk their hard-earned money for the imagined instant, permanent miracle results in 1-4 sessions, despite the pain and the downtime.
And of course, just like liposuction, no one is ever informed about all the adverse reactions.
But are the money, the pain, the adverse reactions and the downtime worth it?
And how does RF microneedling compare to the safe and trusted deep-acting, high-power radiofrequency?
Let’s have a look.
Part One: Microneedling Radiofrequency
What is RF microneedling and how does it work for skin tightening and cellulite?
Radiofrequency microneedling, as applied for body skin tightening and cellulite reduction, is based on multiple needles inserted in a “stamp” action up to 7mm into the skin, with an extremely intense bipolar radiofrequency current passing through the needles, aiming to literally burn the dermis (middle skin layer) and sometimes hypodermis (deepest skin layer) at 60-90ºC (depending on the machine).
The injury from the multi-needle punctures and the burn occurring by the extremely intensive radiofrequency used, damage those deep tissues on the areas of application, followed by inflammation, consequent scar tissue formation (with randomly aligned collagen type I fibres and little elastin) and resulting in skin hardening.
The deep tissue burn occurring has been baptised. by the developers of RF microneedling as “coagulation” (note: it’s a burn, not coagulation), while the scar tissue has been baptised “skin tightening” (note: it’s scar tissueing / skin hardening, not skin tightening).
Furthermore, after a ‘destructive treatment’ such as microneedling RF sometimes skin does not react with new scar tissue building, but with, well, nothing.
In this case, skin becomes thinner and damaged (not thicker and stronger) and the treatment ends up making skin looseness worse.
Many such cases can be found in forums around the web. Here are some examples from real people in one third (!) of the cases: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15.
Plus the latest RF microneedling disaster story in all its glory here.
Invasive, inherently unsafe and still largely ineffective
Needless to say that such brutal “treatment” necessitates the need of anaesthetic cream - and in many cases even anaesthetic injections - to cover the intense pain produced by the long needles and the extreme intensity RF.
Most people consider as invasive treatments only those that involve surgery. However, inserting multiple 7mm needles into the skin with the aid of anaesthesia, and setting them on fire with intense RF deep inside the skin, is indeed invasive and also inherently unsafe, as we will see below
And the bad news for microneedling RF is that it is also ineffective, as we will also see below.
I recently saw a client who spent £10,000 on three RF microneedling sessions, all with anaesthetic injections due to the severe pain, and had zero results to show for it, expect from some mild skin tightening - and no cellulite reduction at all.
Thankfully, she did not have any tissue injury from the treatment, but other people are not so lucky.
The first rule of medicine is “First do no harm”, so if 10% or even 5% of any procedure leads to damage, it should not be offered. An aestetic procedure should be offer if:
it is absolutely necessary for medical reasons
or unless injury potential stands below 1%
and if injury is minimal and/or reversible
This should be even if the rest 90-95% of people get results, as you do not know in advance if you will belong to the lucky 90-95% or the the unlucky 5-10%…
And this is why we would never offer radiofrequency microneedling at the clinic.
More about our rationale below.
Cellulite removal with RF microneedling? It’s complicated…
One would think that the damage to the hypodermal and/or subcutaneous tissues would eliminate fat and therefore cellulite from the area treated.
However, one forgets that damaged fat tissue does not mean forever eliminated fat tissue, as fat tissue can easily regenerate itself.
Providers of such treatments usually do not know the meaning of the terms ‘mesenchymal stem cells’ and ‘adipocyte differentiation’, which together describe fat tissue regeneration from stem cells.
That’s how you new fat tissue grows again even on areas treated with liposuction, which physically removes the actual fat away. In fact, as opposed to liposuction, RF microneedling leaves the fat tissue inside the body, so good luck with permanent cellulite or subcutaneous fat elimination.
This fat tissue regeneration (when we eat too much and move too little) is the reason why people have repeat liposuction procedures at the exact same body area and also the reason why repeat courses of cellulite treatments are necessary every few years (more on that below).
Radiofrequency microneedling adverse reactions and drama
It is easy to see that the chances of adverse reactions with the long (up to 7mm) needles and the extremely high intensity bipolar RF are very high:
If low RF intensity is used to make the treatment safer, not much happens RF-wise and there are still the adverse reactions from the needle punctures, including inflammation scar tissue, hyperpigmentation and more
If high RF intensity is used to make the treatment effective, adverse reactions are very common
If a happy medium RF is used, to combine some safety and some effectiveness, and provided there are no adverse reactions from the needle punctures, then the client is happy (kinda, see below), but still the overall results are no better than normal deep-acting, high-power radiofrequency, which can have 99.5%+ safety, without the pain and the dangers
So what’s the point of microneedling radiofrequency?
A shot in the dark: guessing the right intensity under anaesthesia
Given that the procedure is applied with local anaesthesia and given everyone’s skin is different, it is impossible to gauge which RF intensity is right (low, medium or high) for good results and with not too many/too common adverse reactions.
So it is literally a shot in the dark.
(When we apply normal RF the clinic, some clients can take 150W on a specific area and some can take 250W on that same area. With the pain sensation we get a very accurate idea of what exact intensity to provide. With a numbing cream this feedback is lost and one may end up applying 250W on a client who can only tolerate 150W. Such shots in the dark can be disastrous - hence all the disaster cases posted on forums and review websites by distressed people who had microneedling RF treatments gone wrong.)
And given that cellulite, subcutaneous tissue and muscles lie deeper or more superficially at different parts of the body (even within the same body area, such as the thigh or the stomach) it is impossible to gauge what needle length is the correct one for safe and effective treatment.
That’s another a shot in the dark.
Needles are too long for safety and not nearly long enough for effectiveness
Superficial cellulite is located on average 3-6mm deep in the skin
And deep cellulite is on average 4-25mm deep inside the skin
The microneedling RF needles have a maximum length of 7mm, i.e. they affect the superficial cellulite but do nothing for deep cellulite.
(In contrast, deep tissue RF can be focused with accuracy anywhere between 5mm-25mm, without the use of barbaric long needles - read more below.)
You never “only need one” RF microneedling session, for either cellulite or skin tightening
Microneedling radiofrequency is quite often marketed as a “You only need one - or maximum two” treatment, which allows for exorbitant prices to be charged for treatment on a small area (nobody would pay the exorbitant prices needed for a course of 6x or 12x sessions on large body areas).
The problem with this approach is that with cellulite and skin tightening you NEVER “only need one or two”, NEVER, with ANY method of ANY kind.
At the same time, having a course of 6x or 12x of those treatments significantly increases the chances of adverse reactions. It is not a thing to repeat again and again and again.
This is another reason why RF microneedling makes no sense.
Overall, we believe that destructive treatments, i.e. those that are based on:
burning > inflammation > scar tissue formation > skin hardening
…or, as they euphemistically sell them:
coagulation > inflammation > scar tissue formation > skin tightening
…are a disservice to clients.
Not to mention that we consider the whole approach a quite cruel and medieval.
We want our clients (and ourselves) to sleep well at night, instead of worrying about a potential client visit to the A&E.
And we want to provide natural, effective, sustainable results, with predictable safety.
But hey, some people inject silicon oil in their own buttocks without a second thought, so each to their own…
In the long term, RF microneedling is an unsustainable hardship
Furthermore, RF microneedling is an unsustainable gimmick, as after all the drama, pain, discomfort, downtime and lack of safety, it still does not eliminate cellulite or skin tightening.
It may make it temporarily better (if you are lucky), but other, much safer techniques (such as deep-acting, high-power radiofrequency and high-power ultrasound cavitation) are more effective and comfortable, which means they can be repeated every year or every few months, as needed.
Few people maintain a healthy nutrition/exercise regime perfectly and forever after a course of cellulite / skin tightening treatments. So top up treatments almost always needed, with ANY treatment or ANY kind, and that principle includes microneedling RF too.
Imagine going through all the hardship of RF microneedling, with its pain and complications, every year or every six months? Unsustainable nightmare…
A harsh treatment like this makes sense (kinda) as an one-off, but it doesn’t make sense as a long-term sustainable solution.
For all these reasons, we do not offer RF microneedling at our clinic. We wish there existed a safe miracle treatment that would allow us to charge £1,000-£3,000 per session for a large area, as opposed to the £300-500 we charge for large areas. But no, such a thing doesn’t exist and microneedling radiofrequency is definitely not one.
(Even worse: some clinics charge gullible affluent people up to £3,500 for one session of “You only need one” destructive radiofrequency, as if it’s still 1999 and all people know about cellulite reduction is palper-rouler massages and body wraps.)
The “Would I do it?” test
When I choose a treatment for the clinic, I always think what “Would I do? Is it something I would be comfortable to do to myself, my partner, my mother?”
Would I choose to puncture my backside with burning needles continuously, on and off, for years on end? Absolutely NOT.
I would prefer a safe, sustainable method, whereby I should not need to go through pain and hardship, either as an one off course of treatments or whenever I would need to have my regular top up.
Part Two: Deep Tissue Radiofrequency
Deep-acting, high-power radiofrequency: stimulating, not destructive
Deep tissue radiofrequency, as applied for skin tightening and cellulite reduction, is based on deep acting (5-25mm), high-intensity (but never excessive) monopolar/unipolar radiofrequency. With some good equipment and some good training, treatment can be pinpointed at an exact depth and at high, but always safe, intensity.
The intense (but always set at SAFE levels) heat produced by deep tissue radiofrequency stimulates:
Hypodermal/cellulite fat release
Natural and functional collagen/elastin production
Circulation increase
The end result is less cellulite and more skin firmness.
No tissue damage, no burns, no inflammation, no scar tissue, no skin hardening, no needle punctures, no hyperpigmentation, no pain, no anaesthesia, no drama, which may characterise microneedling RF.
Why puncture the skin in a medieval torture fashion, when you can focus radiofrequency at an exact depth with 21st century technology?
At the clinic, we can pinpoint treatment at an exact depth of 5mm-25mm, without the use of barbaric needles - just with advanced technology applied skillfully.
As mentioned above:
Superficial cellulite is located on average 3mm-6mm deep in the skin
And deep cellulite is on average 4mm-25mm deep inside the skin
With deep tissue RF we can affect any depth of cellulite with accuracy and safety.
In fact, we could easily provide destructive amounts of heat in the deep tissues up to 60-90ºC, just like RF microneedling provides, without the medieval-style needle punctures. But we don’t do it anyway, because we don’t believe in destructive treatments. We believe in safe, stimulating treatments with high, but never excessive or destructive intensity.
Cellulite removal with deep tissue radiofrequency: natural and sustainable
Deep tissue radiofrequency provides, gradual, natural cellulite reduction and skin tightening (not hardening) after a typical course of 6-12 sessions.
However, any cellulite / skin tightening treatment (including any type of radiofrequency) is not forever. Due to lifestyle factors (overeating, lack of physical activity, medication, alcohol consumption, pregnancy, hormonal contraception etc):
Fat tissue can always regrow, either in the hypodermis (what we call ‘cellulite’) or anywhere else in the body (what we call ‘fat’)
And skin can become loose again
The difference between the two treatments, deep-acting, high-power RF and microneedling RF, is that you can repeat a treatment (or a course of treatments) of deep tissue RF as often as you wish, according to how your life and body has changed in the meantime. And you can do this without going through the pain, adverse reactions and drama of RF microneedling, all over again and again and again.
Deep-acting, high-power radiofrequency is a sustainable as a massage. The radiofrequency microneedling drama isn’t.
Knowing the exact right intensity, by always working under the pain threshold
With deep-acting, high-power radiofrequency, as with all traditional, non-destructive radiofrequency (and as practised since the 1960s for physiotherapy and since the 2000s for aesthetics), we follow the pain threshold rule.
If treatment feels like burning or pain, then intensity is too high and we reduce intensity to be under the pain threshold.
In fact, it is an important rule in the provision of responsible RF for both physiotherapy and aesthetics, that the patient/client must have intact heat sensation (i.e. no nerve damage in the area), so that they are able to report excessive heat and therefore prevent burns.
Furthermore, in responsible, stimulating radiofrequency a burn is considered something to avoid, while in destructive radiofrequency it is considered something to look forward too. Crazy, I know…
The ‘pain threshold’ has proven over the decades to also coincide with the ‘effectiveness threshold’ for radiofrequency:
Anything above the pain threshold gives minimal additional results, while the risk of an adverse reaction increases geometrically
Anything far below the pain threshold means minimal effectiveness
Anything just below the pain threshold represents the maximum effectiveness level
So by being just under the pain threshold you maintain both objectives: safety and maximum effectiveness.
At our clinic that intensity feels:
Comfortable for some (to the point of dozing off, if they are tired)
And uncomfortable but tolerable for others (but never painful)
But treatment is always safe. Over the last 11 years we have maintained a 99.5%+ safety record (with the 0.5%- of the cases being slight, temporary irritation).
So by following the pain threshold, we know what EXACTLY is the right intensity for each individual client on any specific spot at any body area.
No need for anaesthesia and no shots in the dark, as is the case with microneedling radiofrequency. The pain threshold ensures accurate, safe treatment every time. Simple.
(This doesn’t mean that in the wrong hands any type of radiofrequency can’t be unsafe and that all clinics and practitioners will always maintain a 99%+ safety record. Or that nothing more serious will ever happen in the future. However, this disclaimer applies to all treatments: in the wrong hands, even massage can be unsafe. With some good training though, deep tissue radiofrequency is far, far safer than microneedling RF.)
With deep tissue radiofrequency, we are honest and upfront: typically 6-12 sessions are needed for good results
Responsible practitioners and clinics know and communicate to their clients that for cellulite and skin tightening, you never “need just one session”. NEVER.
For a quick top-up, 3 sessions may be great
However, for good, long term results, 6-12 sessions are needed. This is how the body works - it needs regular, repeated stimulation to change. Just as with exercise, for example.
In more severe cases, up to 24 sessions may be needed for good, long-term results
And in some extreme cases no amount of non-surgical treatments will render a good result. In these cases we simply refer the client for surgery, e.g. thigh lift or tummy tuck to tighten the thigh or stomach skin. On the other hand, cellulite surgery is usually a disaster and is only a good idea when some extreme, very deep cellulite dents exist, usually found in older clients.
The good thing about deep-acting, high-power radiofrequency is that when practised skilfully the chance of irritation is so minuscule that repeat treatments or top-up extra treatments pose almost zero safety issues.
In contrast, repeat RF microneedling sessions will eventually almost certainly lead to an adverse reaction, as the chance of adverse reactions is too high to be avoided after repeat sessions.
(Again, nothing is certain in this world and an adverse/paradoxical reaction can occur to anyone at anytime after any kind of treatment (nothing biological can be guaranteed). But in general, skilfully applied deep tissue RF is very safe. Furthermore, nothing can stop unscrupulous practitioners from claiming that they will eliminate cellulite, with any type of treatment, including radiofrequency. But crazy claims are made for any type of treatment or indeed any type of service or product.)
Would I have/do deep tissue radiofrequency? Absolutely.
As mentioned above, when I choose a treatment for the clinic, I always think “What would I do? Is it something I would be comfortable to do to myself or my partner?”
I have worked for 13+ years with deep-acting, high-power radiofrequency and I do regularly apply it on myself and my partner. When applied skilfully, it’s super safe and it works - more than any other technology on the market.
If I was concerned with cellulite or skin tightening on me, I would try to personally have as many treatments as needed for improvement and I would also use it monthly for maintenance.
On the other hand, I would not touch microneedling RF with a bargepole.
Superficially acting and/or low power radiofrequency is pointless, of course
Of course the above comparison is between RF microneedling and deep-acting, high-power radiofrequency.
Superficially acting radiofrequency (such as ‘bipolar RF’, ‘tripolar RF’, ‘capacitive low frequency RF’ and other forms) do not help much, regardless of power. And low power RF does not help at all, regardless of anything.
Needless to say that the combination of superficial AND low power RF is an absolute waste of time, even though it is the RF found at most places.
Combination with deep acting, high-power ultrasound cavitation
At the clinic we combine deep-acting, high-power radiofrequency with deep acting, high-power ultrasound cavitation, depending on the needs of each individual client.
Deep acting, high-power ultrasound is equally safe and pain-free as deep tissue RF and is focused a few millimetres either side of the 5mm depth mark, which is ideal for cellulite.
Disclaimer
This article is based on two decades of experience, practice and constant research and analysis on cellulite and skin tightening and one decade of the same in radiofrequency and ultrasound. The above information is based on what we believe is in the client’s interest. However, we cannot guarantee 100% safety/effectiveness of treatment with our approach or 100% accuracy of claims/statements made above. The above do not constitute medical or professional advice and are provided for informational purposes only.
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