Should RF skin tightening be painful to be effective?

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• Should radiofrequency treatment be painful to be effective for cellulite removal / skin tightening?

• Pain and “destructive” radiofrequency

• Most people think radio frequency has to be painful to be effective

• Why do most people think radio frequency treatment is painful?

• Does RF microneedling hurt? Pain with fractional microneedling radiofrequency.

• Pain with HIFU (High-intensity focused ultrasound)

• Pain with bipolar radiofrequency

• Pain with ignorant application

• No pain, no gain?

• The fact is that properly applied radiofrequency treatment does not have to be painful

• How should a proper radiofrequency treatment feel?

• When is radiofrequency painful?

• Check our professional consultancy in radiofrequency, ultrasound cavitation, cellulite and skin tightening

Should radiofrequency treatment be painful to be effective for cellulite removal / skin tightening?

High-power, deep-acting radio frequency treatment is now the indisputable technology for cellulite, non-surgical but lift and skin tightening, especially body skin tightening.

But should it be painful to be effective? Absolutely not.

Properly applied, safe radiofrequency should be a painless - even comfortable - procedure and should never require the use of anaesthetic (numbing) cream. Never. In fact, numbing cream requiring RF treatments are known for their adverse reactions - and no better results than strong but painless radiofrequency.

Unfortunately radiofrequency treatment is known in the public’s imagination to be painful and/or dangerous, due to its erroneous application by doctors in the first few years of its use for aesthetic purposes (early 2000s).

Pain and “destructive” radiofrequency

This type of extremely high-intensity, stationary RF technique application, requiring the use of numbing cream/topical anaesthetic, calls for literally burning the inside of the skin (euphemistically called “coagulation”, when it is actually good old burning).

The flawed theory is that this trauma will consequently create inflammation and scar tissue (euphemistically called “neocollagenesis”, when it is actually good old scar tissue), which is then baptised “skin tightening”.

Oh well…

The problem with those procedures is that sometimes the skin does not even respond with the building of scar tissue to replace the burned tissue, so you are left with nothing. Your previous collagen damaged by the procedure and no new scar tissue collagen created. End result? You are left with paper thin skin.

Sadly this kind of application (creating scar tissue with intense heat) still continues today amongst many practitioners, especially doctors, for non-surgical as well as for surgical procedures (such as vaser, cellulaze, smart lipo etc).

The latest iterations of this internal skin burning technique are:

• Extreme intensity HIFU (high intensity focused ultrasound)

• Fractional / microneedling radiofrequency

The popularity of the “burn > inflammation > scar tissue = skin tightening” theory is due to the widespread ignorant notion, even among doctors and surgeons, that hardened, inelastic, scar tissue collagen is the same as real, healthy, elastic, functional collagen.

However, as we all know, from different scars that we have in our bodies, this is clearly not the case.

On this article we explain:

• What types of radio frequency treatment are painful

• Why those treatments are not as effective as the safe, non-painful forms of RF and can be even be dangerous

• Why good radiofrequency need never be painful

Most people think radio frequency has to be painful to be effective

Most new clients I meet at the clinic think that radio frequency treatment is painful, and some are actually really scared.

It takes some time to explain to them:

• How RF works

• That pain does not equal better results

• That the treatment is generally comfortable

• That some people find it so relaxing they even almost fall asleep

Of course, 10-20 minutes into the treatment they relax and they realise that even a strong RF treatment does not need to be painful at all to be effective. Most find it relaxing and many find it soothing.

There is a small minority of clients (less than 5%) that find it uncomfortable.

And there is a very small minority (around 1%) that find it painful. Of course, to adhere to our health and safety protocol, we do not provide the treatment to those who find it painful.

But the vast majority of clients find the treatment comfortable and even relaxing, despite the high intensity used.

This is due to us using the best equipment in the world, combined with advanced protocols and our 11,000+ treatment experience, at the time of updating this article (December 2023).

Why do most people think radio frequency treatment is painful?

Most have have heard of what we call ‘destructive RF’, which I mentioned above.

This is the “one-session miracle” gimmick RF treatment which promises to give results in one extortionately expensive (£2,000-£4000 per session), very painful session, based on burning the hypodermis and dermis and creating scar tissue.

That treatment requires numbing cream to be applied, can be extremely painful and can cause burns and scar tissue bumps.

Does RF microneedling hurt? Pain with fractional microneedling radiofrequency.

Others hear of the pain, swelling, irritation, inflammation and hyperpigmentation that can be caused by fractional radiofrequency, a type of destructive RF used for superficial facial skin tightening and facial skin resurfacing (also used with topical anaesthesia).

Lately, this painful/destructive type of treatment is seeing a resurgence with fractional RF microneedling for face and body - with needles going as deep as 7mm for “cellulite reduction”.

Those treatments are advertised as “you only need one” (very expensive) session. But real life experience has shown with these “one-off” treatments that you never need just one. You need 6 or more for good results - which is what is required for normal, safe, painless RF. However, in contrast to safe RF which can be safely repeated for dozens of sessions, having repeated “destructive” treatments increases the risk of damage exponentially.

So, for whomever is having hyped up gimmicks such as RF microneedling, all I have to say is “good luck with that”, both in terms of poor results and adverse reactions.

Pain with extreme intensity HIFU (High-intensity focused ultrasound)

Extreme intensity HIIFU works in the same way.

It aims to focus powerful soundwaves inside the skin with the aim to burn it and cause scar tissue, which is the baptised as skin tightening.

HIFU is sound, not radiofrequency, so I will not analyse it on this post but suffice to say that it is equally stupid.

• Low intensities provide poor results

• High intensities are very painful and dangerous

• Medium intensities are both painful and ineffective, requiring multiple sessions, not the promised “you only need one” session

Pain with bipolar radiofrequency

Some have heard of bipolar radiofrequency, which is very superficial and which consequently can be very painful and cause burns, if used at very high intensity by overzealous therapists.

The problem with bipolar RF is that it makes the epidermis (top skin layer) very hot while the dermis and hypodermis (where skin tightening / cellulite reduction occur) does not get hot at all. So what do some therapists do? Crank up the volume to properly heat the hypodermis - and as a result burn the epidermis.

I know, it’s stupid, isn’t it?

Pain with ignorant application

I even met a client a few weeks ago who was a victim of an ignorant and irresponsible therapist who actually needed an assistant to keep applying cream during treatment in order to stop the client from feeling burned.

This is so wrong on so many levels, I have no words to describe it.

No manufacturer suggests such a practice, so I assume the therapist believed that the more you burn the client, the better the results, as long as you cool them down with a cream.

Unbelievable…

(Needless to say that in the end the client predictably did get burned.)

No pain, no gain?

Some people perhaps imagine that it is all about “no pain, no gain”, as in laser hair removal, surgery, cosmetic injections etc, so “radiofrequency must hurt to be effective', right“?

Wrong. Just wrong. For radiofrequency to work, you don’t need pain.

The fact is that properly applied radiofrequency treatment does not have to be painful

Radiofrequency has been safely and effectively used for decades in physiotherapy before being adapted for use in aesthetic treatments, based on the principle of “never crossing the pain threshold”.

The “no pain” principle still remains the pillar of properly applied radio frequency today, both in beauty and physiotherapy.

Working for several modestly priced sessions just below the pain threshold with “stimulatory radiofrequency” (i.e. with the aim to stimulate collagen synthesis and contraction, as well as fat release) can provide up to 99.5% safety and better results than with one very expensive, very dangerous, “you only need one, darling” destructive radiofrequency session.

Unfortunately this approach does not generate 5x or 10x times more income for the doctor/therapist who provides it and it is not based on promising miracle/instant results (which don’t exist in real life, anyway). But it is the best option for the client.

In fact, if your radio frequency treatment is consistently painful, either you belong to 1% of the population who are sensitive or your therapist does something (or a lot of things) wrong. Even worse, if numbing cream needs to be used, you are having the really wrong type of radiofrequency.

According to both studies and practical experience, painful, ‘destructive radiofrequency’ has less benefits than ‘stimulatory radiofrequency’ and lots more chances of side effects (pain, scar tissue, burns etc).

How should a proper radiofrequency treatment feel?

At the clinic we have been using deep-acting, high-power radiofrequency and in the last ten years - and over thousands of sessions - it has been consistently pain-free and side effect-free (99.5% of the time), despite the high power used.

• Most people find it comfortable and some actually doze off for a few minutes, if they are too tired

• A small minority find it uncomfortable but not painful

• Whenever occasionally there is “pain” (i.e. feeling too hot) that is only for a a split of a second and afterwards the therapist makes sure treatment becomes comfortable / painless again, by lowering the intensity or changing other settings

So radiofrequency is safe, if focused on the right skin layer (dermis, hypodermis) and provided with high-yet-controlled intensity and with the right settings, right equipment and right contact creams/gels/oils.

Of course there is the opposite end of the spectrum: very comfortable treatment merely due to very low intensity, which is a sheer waste of money and time. But thats a story for another article.

When is radiofrequency painful?

• If stationary treatment is used (i.e. when the handpiece does not move during treatment), radiofrequency is bound to be painful and ineffective. A lot of high-tech solutions have been developed to (largely unsuccessfully) solve the problem or overheating with static RF provision, when the simple solution is to keep moving the handpiece (it’s more tiring for the therapist, but safer and more effective for the client). Furthermore, studies and practical experience have shown that treatment with continuous movement actually provides better results than stationary treatment.

• Fractional microneedling RF: painful, dangerous, expensive, largely ineffective and promoted with fake “before and after” pictures. What to like about it?

• If bipolar radio frequency is used at very high intensities, treatment can be painful and skin can be burned

• The same applies to other high intensity superficial types of radiofrequency, such as fractional radio frequency or some types of capacitive radio frequency

• If cooling is not applied, with certain types of RF

• If the wrong cream/gel/oil is used (this can make a huge difference)

• If intensity is simply excessive in order to produce “faster results” for the client. The body has its limits so excessive intensity is bound to be painful. Painful application may increase results by 10-20% but it also increases the chance of irritation by 200-300%. Clearly not worth it.

Check our professional consultancy in radiofrequency, ultrasound cavitation, cellulite and skin tightening

Do you want to deeply understand radiofrequency, ultrasound cavitation, cellulite and skin tightening? Attend an 1-hour, half-day, 1-day or 2-day professional consultancy / one-to-one masterclass and confidently offer your clients the safest, strongest and most effective treatment possible. Service available via Zoom or at our central London practice.