Aesthetic Medicine
Aesthetic Medicine


Two of a kind

When considering treatment for patients with prematurely aged, sun damaged and lax skin, there are many options available. Two of the most popular energybased treatments are fractional CO2 laser resurfacing and RF microneedling.

CO2 laser resurfacing has been used for skin rejuvenation for over 20 years and is still considered to be the gold standard but is associated with significant downtime and potential side effects. Fractional CO2 laser resurfacing was developed over ten years ago and offers reduced downtime and minimised side effects, as the majority of the epidermis remains intact and heals quickly. The fractional C02 laser creates controlled injury in thin columns of light through the epidermis and dermis. This thermal injury results in neocollgenesis and skin tightening as well as improved pigmentation.

RF microneedling works on a similar premise of creating micro-injury to stimulate collagen production but does so in a different manner. It uses an array of very fine insulated needles to penetrate the epidermis and deliver bursts of heat directly to the dermis. The depth of penetration can be customised by adjusting needle depth depending on whether you are treating superficial lines or deeper scars. With less injury to the epidermis with RF microneedling, the downtime is much less, with minimal adverse side effects.

In determining which modality achieves best results and patient satisfaction, it is important to consider the application. For sun damaged skin with lines and wrinkles, fractional CO2 will achieve excellent results by combining resurfacing and reduction of photodamaged, pigmented lesions with new collagen production and dermal thickening, the result being smoother, brighter more youthful skin with long-lasting results. It can however carry a higher risk on darker skin types due to the impact on the epidermis and melanocytes.

“ Two of the most popular energy–based treatments are fractional CO2 laser resurfacing and RF microneedling”

RF microneedling can treat all skin types as it has less impact on the epidermis, though it is less effective on treating pigmented lesions. It does however deliver heat deeper in the dermis and can be more effective on deeper scars and lax skin. So, for acne scars and skin laxity RF microneedling may have the advantage, as well as less downtime and a reduced risk of PIH.

However, the two procedures are not mutually exclusive. As with many approaches to skin rejuvenation, combination treatment is the way to go. In doing so you can optimise skin resurfacing from CO2 with skin tightening from RF and a boost to collagen production by combining both. Generally a course of three sessions is recommended, four weeks apart.

Two of the latest devices on the market are the SmaXel CO2 Laser and the Astra RF microneedling device, distributed in the UK by Cosmeditech. Both devices have “smart protocol” software to allow practitioners to choose the optimal settings for each patient case and to deliver the full range of applications.

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This article appears in the February 2022 Issue of Aesthetic Medicine

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This article appears in the February 2022 Issue of Aesthetic Medicine