Everything You Need to Know About Radio-Frequency Skin Treatments

The popularity of in-office skin treatments has surged in the last two years, and with it, a renewed focus on overall skin improvement. This is partially owed to a phenomenon experts have dubbed the "Zoom Boom," as the world has shifted to remote work that requires virtual close-ups.

"The Zoom Boom has certainly contributed to a new focus on the quality, tone, and texture of the skin, [now that] high-definition cameras that are ubiquitous these days," says board-certified dermatologist Corey L. Hartman, M.D., who is based in Birmingham, Alabama. And since more patients are looking for treatments that address multiple concerns at once, radio-frequency treatments (or RF, for short) have once again become a top request at the dermatologist's office.

Here's everything you should know about the benefits, side effects, and costs of this face and body treatment before you book.

What is radio frequency?

The term "radio frequency" refers to the thermal energy that's delivered to the skin by a device with the intention of causing micro-injuries, which trigger the creation of new collagen. Radio-frequency treatments can be performed on the face and all over the body, and it's known to tighten, firm, and lift the skin with little to no downtime.

"[Many] procedures in cosmetic medicine are based on the concept of a 'controlled injury' to the skin," says Newport Beach, California-based board- certified dermatologist Tony Nakhla, M.D. In the case of radio frequency, he says, radio waves pass through the skin's surface to heat up the underlying tissue and cause a controlled burn. This triggers the body's innate healing process, resulting in the production of the skin's natural structural components like collagen, elastin, and hyaluronic acid. After the skin heals, the result is a tighter, firmer, and lifted complexion. RF can also be used to contour the face and body due to its skin-tightening and fat-reduction capabilities.

The treatment itself isn't new — as double board-certified oculofacial plastic surgeon Robert Schwarcz, M.D., points out, it's been around for 20 years — but it has evolved considerably over the years. Dr. Hartman refers to its current technology as "the most-innovative method" of treating skin laxity and crepe-y skin.

Who is radio frequency for?

"Patients of all ages are now more interested in RF than ever," says Newport, California-based board-certified dermatologist and cosmetic surgeon Stefani Kappel, M.D., and that she recommends radio-frequency treatments for those over the age of 20.

Radiofrequency can provide different benefits for different age groups: during their 20s, Dr. Hartman's patients typically seek RF to treat acne-scar-treatments-according-to-dermatologists' target='_blank' rel='noopener noreferrer' >acne scars and skin texture, while applications for skin tightening of the face, jawline, and neck become more popular in and after patients' 30s. Some older patients opt for RF treatments to delay, forego, or enhance the outcomes of facial surgeries.

Dr. Hartman also points out that RF treatments can be used on all skin tones and types without the risk of both hyperpigmentation and hypopigmentation — a rare and versatile attribute that sets it apart from other lasers and broadband light treatments.

What are the benefits of radio frequency?

Though efficacy will vary depending on the patient, modality used, and body part treated, one benefit of RF that Dr. Kappel notes is collagen banking, or preemptively mitigating the natural decline in collagen production that occurs with age. "We start to lose 10 percent of our total collagen stores each decade, [so] younger patients will often do RF treatments to increase their collagen reserves," says Dr. Kappel. This increase in collagen production means patients' complexions appear more tightened and lifted.

She adds that the collagen-boosting benefits improve over time, as the skin's fibroblasts — the cells in connective tissue that typically stiffen and becomes less efficient with age — remain accustomed to creating collagen. Dr. Hartman agrees that this prolonged tightening and lifting effect can be so pronounced that it can improve outcomes post-cosmetic procedure or even persuade a patient to delay or forego the decision to go under the knife altogether.

While plumper-looking, tighter skin is most common goal with RF, it can also retexturize skin when combined with microneedling. This can reduce the appearance of acne scarring on the face or stretch marks on the body. Board- certified dermatologist Jessica Weiser, M.D., uses Secret RF — a device that combines RF with microneedling — for the treatment of white stretch marks (aka striae albae) on her patients in New York City. "Both microneedles and radio- frequency heat induce a wound-healing response that can stimulate skin turnover and regeneration," she says.

The possibility of intentional fat reduction — especially when combined with skin tightening — allows for contouring of the face and body. For the body, treatments like EmSculpt NEO and truSculpt iD have become popular means of using RF to do so.

Board-certified dermatologist Dendy Engelman, M.D., who is based in New York City, explains, "[RF] raises [the treatment's] temperature, and then within four minutes, the heat causes apoptosis, which means the targeted fat cells are permanently damaged and naturally filtered out by the body."

Which device is best for me?

There are many types of devices that can deliver this type of thermal energy. Beverly Hills-based, board-certified plastic surgeon Ben Talei, M.D., notes that there are different classes of devices that deliver radio frequency via microneedles (i.e., Vivace, Potenza, Morpheus8, etc.), probes (i.e. FaceTite), and even wands (like TempSure Envi) that can penetrate deeply into the skin depending upon the desired result. Board-certified plastic surgeon Kevin Sadati, M.D., who uses multiple forms of RF at his practice in Newport Beach, California, chooses between them depending upon the degree of skin laxity, the area of the body being treated, and the downtime permitted by their schedules.

Each provider will also have their preferred devices — in some cases, an entire armory of them — so it comes down to the trust you place in your provider and your long-term commitment to their recommended treatment plan.

Does radio frequency hurt?

Because RF goes deep into the skin, it is more painful than your average laser or microneedling session. Depending on the device used, your skin might be topically numbed, injected with a nerve-blocking agent, and at some practices, patients are offered nitrous oxide. Board-certified plastic surgeon Ashkan Ghavami, M.D., says he weighs the trade-off between efficacy and pain when choosing RF devices.

What are the side effects and risks?

"Yes, RF can cause breakouts in certain patients for a few weeks," Dr. Talei confirms, which is potentially due to the delivery of deep heat to the skin. He also notes that this temporary symptom can be exaggerated by the use of occlusive creams or gels.

As always, the efficacy of the device used is largely user-dependent, which is why it is so important to seek out experts in the field. In some cases, when delivered incorrectly, RF can cause unintended fat loss, dermal shrinkage, and deflation of the face, according to Dr. Talei. "This can happen from over- aggressive heating, heating of the wrong (i.e., deeper) layers, or repeat treatments causing repetitive cycles of healing and fibrosis, which stiffen the deeper layers of tissue."

With more aggressive or frequent treatments, Dr. Talei also notices differences in the subdermal tissue quality, which he sees firsthand when operating on patients. "The wand-based devices can certainly cause some trauma and contracture in the neck if not performed gently," he says, noting that he typically doesn't see this result with gentle, single-treatment devices.

What is aftercare like?

Downtime and aftercare depend on the type of treatment you receive and the degree of invasiveness the procedure entailed. When the radio frequency is applied alone, it can often feel soothing and warm and require absolutely no downtime. But when delivered with microneedling, the healing process will be more extensive.

"If it is a combination therapy [such as] radio frequency and microneedling, you will leave with nano-injuries to the skin's upper layers, which leave skin vulnerable in the first 48 hours," says Beverly Hills board-certified dermatologist Ava Shamban, M.D. "Practice full sun avoidance with a hat, sunglasses, and shade. That evening, you should avoid washing or touching the face."

Due to the vulnerability of the skin, your provider might choose to apply a serum of growth-factors and healing agents before you leave the office. For instance, Dr. Ava recommends patent-pending SoMe Skincare, which is made with the patient's own platelet-rich plasma (PRP) to aid with healing.

If you don't receive a specific healing serum in-office, Dr. Shamban suggests applying your own. "Generally, look for soothing, healing, and calming ingredients like hyaluronic acid, niacinamide, antioxidants, peptides, aloe, calendula, and petroleum- or glycerin-based [formulas]," she says. "Avoid any physical or chemical exfoliants, enzymes, or vitamin A derivatives."

The next morning and following day, you may notice inflammation and puffiness following a radio-frequency and microneedling session. Dr. Shamban recommends cleansing with lukewarm water and a gentle cleanser. You can also apply a serum from the provider or a light layer of a petroleum-based barrier balm like Aquaphor, but not much else.

"Avoid makeup that next day, and sunscreen can follow. I recommend a physical sunscreen, but not a chemical sunscreen," she continues, noting that sun avoidance should still be a priority. She also says that while ice packs are beneficial, it matters which kind you choose. "Do not use hard ice packs. You can use the soft, flexible kind, and have them [feel] cool, not cold." She also recommends sleeping on your back.

For the following 12 hours to two days, Dr. Shamban advises avoiding sweat- inducing workouts or practices — so forget hot yoga, and reschedule your trips to the infrared sauna or steam room. She says to be mindful not to use any anti- inflammatory medications (take Tylenol, if necessary) and you should still be avoiding anything abrasive in your skin-care or makeup routine.

"Do not use exfoliants, retinoids or retinols, dermal brushes, makeup brushes, or any other type of friction-creating material to the skin," says Dr. Shamban, noting that while it's preferred not to apply makeup at this stage, you can if necessary.

"On day four or five, you can usually return to your normal routine for morning and night in terms of cleansing, hydrating, and serum, as well as your preferred sunscreen," Dr. Shamban says. "I suggest easing back into the more aggressive and advanced-level exfoliating ingredients, active acids, or retinoids."

She clarifies that it is still recommended that you avoid any chemical peels or lasers for a minimum of two to three weeks following the treatment. Patience, here, is key. "There is time to get back to all the good stuff," she says, "but let the benefits of the treatment settle first."

How much do radio-frequency treatments cost?

Cost varies from about $500 to $5,000 depending on the treatment area and device used, with some devices requiring only single sessions and others performed in a series of two to four. Talk to your dermatologist about your goals and budget, and they can help you select the option that works for you.

More info about common cosmetic procedures:

• The First FDA-Approved Injectable for Cellulite Is Here
• More Black People Are Getting Fillers and Botox Than Ever
• The Truth About Those "Temporary Nose Jobs"

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