Everything you need to know about radiofrequency

Radiofrequency treatments are among some of the most popular non-invasive face ‘lifting’ tweakments, and best known for their firming powers. Experts love them as an alternative to the scalpel. “Radiofrequency treatments can tighten the tissues just underneath the skin surface and contour the face, creating firm, toned, youthful-looking skin,” says facial plastic surgeon Dr Maryam Zamani. But apart from sculpting sagging facial contours, they can also even out skin your tone, plump out wrinkles, smooth cellulite, and have a side hustle in body contouring to help you lose the odd inch.

If you’re wondering how one treatment can call do all this, it’s because there are different radiofrequency machines and technologies depending on the result you are after. Like ultrasound and laser treatments, radiofrequency is not ‘a machine’ but a type of energy that generates heat. It’s used, primarily, to ‘injure’ skin in a controlled way and set off fresh collagen and elastin production, resulting in greater firmness.

Different treatments will use different degrees of heat, with varying discomfort and downtime. That’s why we’re here to unpick the differences between radiofrequency devices with the help of the country’s foremost non-surgical treatment experts.

Radiofrequency treatments to tighten skin

If you’re looking to tighten skin and plump out wrinkles, you want to consider bipolar/multipolar radiofrequency devices such as Venus Freeze and Endymed Tighten, or monopolar/unipolar machines such as Thermage and Pellevé (don’t worry, the ‘polar’ thing be explained below). These devices ‘bulk-heat’ the tissues just below the surface of the skin but are non-ablative, which means they don’t remove layer of skin or damage the surface in any way. Instead, they cause a level of injury in the deeper skin layers, resulting, over time, in a wound-healing and subsequent firming, smoothing response.

Radiofrequency microneedling, made famous by machines such as the Morpheus 8 and Focus Dual, is the ‘turbo-charged’ tightening option – we’ll go into this a bit later in this article.

Full-face ‘polar’ RF treatments take about 45 minutes with usually no downtime apart from slight reddening of the skin. That’s when they’re done by a skilled practitioner. There are no restrictions on who can perform these treatments though. A machine that can heat skin significantly and even melt fat (more about that later) in the hands of a cosmetic cowboy can cause burns, blisters and unwanted fat loss – all have been reported. So always choose a reputable clinic!

For slow and steady tightening and fine line reduction 

Bipolar (or multipolar) radiofrequency – machines include Venus Freeze, Endymed Tighten and NuEra Tight

Best for: Those in their 30s and 40s who have fine lines and the first signs of loss of tone around the cheeks and eyes
How often? Six to 12 treatments, about two weeks apart
Downtime? None. No numbing cream is needed.
Expect to pay: Roughly £200 per treatment

In a bipolar RF facial, radiofrequency energy is conducted in and back out of the skin between two or more electrodes in the same handset, like a sort of ‘loop’ or ‘stitch’ of light.

You have a gel applied to your skin and a headpiece is slid back and forth along your face and neck, which allows your therapist to control the heating of the skin: it should be brought to and kept between 40 and 43 degrees C but no higher, says aesthetic practitioner and clinical director of Essex’s Facial Aesthetics Clinic  Julie Scott. If not, the heat will become unbearable and side effects such as burns and unwanted fat loss might ensue (more about that later).

The heat only goes as deep as 2mm max, which affects the collagen-generating epidermis and superficial dermis to a point where the production of these plumping, firming cells is revved up. Dr Sophie Shotter tells us that “the partial collagen injury achieved in this way is quite minor,” which is why it’s the type of treatment you need to have a series of, with regular top-ups every few months, to see and maintain the subtle tightening effect.

Scott says it’s definitely effective, just in a more ‘slowly and surely’ sort of way. She likes it especially for “those in their 30s and ‘40s who have fine lines and are maybe just beginning to lose some firmness”.

You initially need six to 12 treatments spaced about two weeks apart, with the improved collagen and elastin production delivering a ‘plumped from the inside’ softening of lines and wrinkles, glowier skin and subtly firmer, denser skin contours. When executed right, we can report the procedure is painless – even quite nice and soothing.

For deeper skin tightening

Monopolar (or unipolar) radiofrequency – machines include Thermage, Pellevé and Exilis Elite

Best for: those 45 and over, with more advanced sagging and deeper wrinkles in the cheeks, jowls, forehead and neck. Can also treat saggy and crepey eye skin.
How often? One to six treatments, depending on the machine.
Downtime? Usually none. Depending on the machine, the treatment can be pleasantly warm (Pellevé) or deliver uncomfortable jolts of heat (Thermage). A numbing cream may be used.
Expect to pay: about £250 per treatment for Pellevé, £2000 for Thermage.

Monopolar (sometimes called unipolar) radiofrequency forces focused heat (as opposed to more diffused heat in the case of bipolar rf) through the three main skin layers: the epidermis, dermis and subcutaneous (fatty) layer, aesthetic physician Dr Galyna Selezneva tells us.

The energy is conducted towards a stick-on ‘conductivity patch’ placed your body. So it goes straight down, as opposed being conducted sideways in a loop through the superficial skin layers, as is the case with bipolar RF.

The heat is either applied with a handpiece that’s moved over your skin after a layer of gel is applied (this happens with Pellevé), or delivered as deep ‘pulses’ all over the treatment area, using a grid pattern (Thermage). Because monopolar RF delivers more intense and sustained tightening, it’s sometimes described as ‘shrink-wrapping’ the face (something of an overstatement). But it does indeed affect the collagen-generating dermal layer more than bipolar RF.

Selezneva uses the Thermage FLX RF device and says 45 degrees C is “the exact temperature required to change the structures within the skin tissue and trigger collagen production, without causing unnecessary trauma.”

Monopolar RF can be more painful than bipolar RF, because it goes deeper and is more focused and therefore more intense. Your doctor might suggest a numbing cream.

Results, which take three to six months (the time it takes to generate new collagen) to become fully apparent, can be achieved in six (in the case of Pellevé) or just one (with Thermage FLX) sessions.

It’s the better ‘bulk-heating’ option if you have more advanced skin slackening, deeper wrinkles, or no time for long series of treatments

Radiofrequency treatments to resurface skin

To treat pigmentation, sun damage, scars, pores and wrinkles , you can resurface skin with RF. Look for ‘fractional RF resurfacing’ devices (or device modes) such as Endymed FSR, Venus Viva and InMode Fractora. 

Best for: fading brown spots, smoothing scars and minimising crepiness, wrinkles, pores and uneven skin texture from your 20’s onwards
How often? Three treatments, one month apart
Downtime? Expect dark patches and peeling for a few days. Your therapist will use a numbing cream before the treatment to make it bearable
Expect to pay: £400 per treatment

Fractional RF uses a handpiece with tiny pins that are pressed into the skin surface (the epidermis), where they deliver pin-points of intense radiofrequency. It’s called ‘fractional’ because only a fraction, rather than the entire surface of the skin, is treated (or ‘ablated’, meaning it is removed) via tiny dots. These ‘thermally injure’ (i.e. burn), minuscule channels in the top skin layer, triggering a wound-healing response and a shedding of the damaged tissue.

Fresh cells replace discoloured and old epidermal skin cells, resulting in more even-toned, even-textured skin. “It’s great for treating sun damage, dullness and crepey skin: it delivers a luminous complexion,” says Julie Scott. “But because it works very much on the skin surface, the process it sets in motion is very visible. So there’s a downtime after each treatment, involving temporarily darkened patches and peeling for a few days.”

Scott recommends a course of three, spaced a month apart, for best results, with top-ups every 12 months; even if you’re religious about applying daily SPF50 (which you MUST when you have these treatments, or your pigmentation will get worse than ever), there is always old sun damage underneath the skin surface, preparing to rise to the top.

There is another type of fractional RF, however. Radiofrequency microneedling, which combines resurfacing with skin tightening benefits, has made a lot of waves recently and may be the reason you’ve heard of radiofrequency in the first place. The lowdown is below.

Turbo-charged RF to resurface and tighten skin: radiofrequency microneedling

The Morpheus 8 is the best-known example of devices that combine RF energy and microneedling to deliver more even-toned as well as less saggy skin, with Intracel and Focus Dual just two examples of machines that do the same.

Best for: deeper wrinkles, pigmentation, textures issues including scars and pores, and moderately advanced facial sagging (including around the eyes) in your 40’s and upwards
How often: One to six initial treatments (a month apart), depending on the machine. Results last 18-24 months.
Downtime: 2-7 days of redness, peeling, temporary discolouration, and sometimes prolonged bruising and swelling
Expect to pay: A single treatment for the face can cost anywhere from £600 to £3000, depending on the machine, therapist, and your location.

In some ways similar to regular fractional RF resurfacing, radiofrequency microneedling uses tiny needles to deliver pinpoint RF energy to the skin.

The Morpheus 8 device, thanks to a very effective pr campaign featuring Judy Murray (her results weren’t just thanks to Morpheus 8, by the way), has become a byword for radiofrequency skin tightening. But the technology has been around for many years. Intracel, Endymed Intensif, Potenza, Secret RF and Profound are just some names of alternative RF microneedling devices, while Focus Dual is an example of a machine that can combine the technology with ultrasound, another energy-based collagen-booster.

With RF microneedling, the needles are pressed into the skin at pre-set depths to reach the collagen-generating dermis (which sits roughly 2mm under the facial skin), and deliver the radiofrequency heat there. Exactly how deep the needles go depends on the machine, the setting chosen by your doctor, and the thickness of the skin. The jowl area, for example, will require deeper needle penetration than the forehead and the area around the eyes, while body skin (more about that later), is thicker yet.

Unlike with fractional skin resurfacing, the skin surface doesn’t get burned or damaged bar the little ‘entry’ pin pricks. This is because the needles are insulated apart from at their very tip, so the intense heat is primarily shot deep into the dermis to tighten collagen structures and trigger the production of more the stuff and its fellow skin-support protein elastin.

The small (‘fractional’) injuries from the needles themselves set off an additional wound-healing response in the dermis, but also in the epidermis for a skin-resurfacing effect.

So what are the visible results? Radiofrequency microneedling will firm up, tauten and thicken visibly slackened skin all over the face over time – it can even slightly lift hooded eyelids (it is not for very loose skin, though. Listen to your doctor when they advise a face lift instead). But it will also soften pigmentation, crepiness and rough texture. “How dramatically depends on the format and length of the needles of the device used, and the amount of time or pulses it’s held on the skin for,” says Jack.

While the surface of the skin doesn’t get directly burned, “the nearer to the skin surface the heat is injected (with the Morpheus 8, there is an option to inject just 0.5mm deep), the more ‘epidermal ablation’ [resurfacing] there is,” says Dr David Jack, who also notes that this ablation happens on a deeper level than is the case with no-needle fractional resurfacing, meaning the smoothing, skin-evening results last longer.

The skin-tightening effect will take three to six months to show (the smoothing, evening effects should become apparent in 4-6 weeks), with overall results lasting 18-24 months.

Which radiofrequency microneedling treatment is best?

Which machine is ‘best’ is very much a matter of opinion, but the more treatments are advised (some require six initial sessions, others just the one), the less ‘strong’ (and, arguably, traumatic) the treatment is.

The best results are dependent on the skill and experience of your practitioner and on what your skin requires and is able to tolerate. The ‘most powerful’ doesn’t equate to the ‘best’ for everyone.

What is important is precision-delivery of the energy, which RF microneedling is much better at than bipolar or monopolar RF. Precision is important because you don’t want to accidentally heat the skin surface too much and cause burns or excessive downtime. At the same time, you don’t unwittingly want to go too deep either and end up with facial fat cells being destroyed, which could make you look gaunt. Unless of course fat melting, such as under the chin, is what you have booked in for (more of which coming up…)

As said, there are many good machines that can deliver this treatment – and they will all roughly get you the same results. Without going into too much detail, here are a few facts about the three latest, most written-about, and arguably most advanced devices.

Morpheus 8: the versatile one

A favourite of Dr Jack’s, he likes the machine’s versatility and precise settings in terms of needle depth and energy delivery, allowing the practitioner to determine exactly how much tightening, resurfacing and even fat ‘melting’ can be achieved. “Its fine-tuning minimises the risk of accidentally heating of the deeper subcutaneous (fat) layer, but the Morpheus 8 is also the only machine that can be deliberately set to a ‘fat loss’ mode for the face,” says Jack (other machines can do this more or less accidentally – see below). Treatments cost from £600 upwards for the full face and a minimum of three initial ones are needed, with top-ups roughly every 18 months.

Profound: the most powerful one

Dr Shotter rates the Profound because it is unique in being able to monitor and control the temperatures reached deep inside the skin: “We get it to 67 degrees C [significantly higher than other machines, which stay below 45 degrees C for collagen remodelling], which is where collagen is properly denatured [damaged] but not destroyed, allowing for the most effective healing response and the most dramatic results.” It means only one treatment, which will last you 12-18 months, is needed. It comes at a price: roughly £3000 per face session, and some serious pre-treatment numbing cream action to dampen the ‘discomfort’ (read: pain!).

Focus Dual: the less painful one

You can either opt for tightening ultrasound or resurfacing-and-tightening microneedling RF with this brand-new machine (you can also have them one after the other). The difference here, says advanced skin therapist Debbie Thomas, is that “the microneedles are much finer than average, minimising pinpoint bleeding and bruising while still effectively improving skin texture.” Thomas also rates the device for improving acne: “the radiofrequency heat kills bacteria,” she says. You need 3-6 initial treatments at roughly £600 per session, and yearly top-ups.

What downtime can I expect from a radiofrequency microneedling treatment?

As for downtime, expect intense temporary redness and pinprick bleeding (not a good look on public transport), plus some peeling and sometimes prolonged bruising and swelling. It can last from a few days to a good week. Skin will also feel dry and rough for a few days as the old cells start flaking off.

The more ablation (removing of parts of the top skin layer), the more downtime in the form of peeling and temporary dark patches you’ll have to contend with.

The treatment is not pleasant so is performed after applying an anaesthetic cream, which makes the feeling of needles being stamped into your face to shoot hot heat under the skin tolerable. Three to four treatments are often required (spaced three to eight weeks apart), although the Profound prides itself on requiring just two sessions over six months.

Radiofrequency for facial fat melting

With radiofrequency treatments of every type, there is a possibility of fat loss. When enough intense RF energy reaches the subcutaneous (fatty) layer, fat cells can get destroyed. While in some cases (see below), this is exactly what a patient might be after, it can also be a real issue: if you have a relatively narrow or gaunt face, fat loss can make you look more tired and aggravate slackening skin.

Many brands and therapists are at pains to explain that fat loss only happens when a device isn’t used properly, or when it’s set to ‘fat loss’ mode. But when a machine doesn’t allow for very precise control of just where the energy travels, the therapist isn’t always the issue.

RF microneedling devices allow for more control than ‘bulk-heating’ monopolar and bipolar RF machines. However, plastic surgeon Dr Angela Kavouni says that with a next-generation device such as the Thermage FLX (used on the face and body for tightening skin), which distributes its energy in a controlled and uniform way, this simply can’t happen. “When used properly by a certified doctor, Thermage FLX should not melt away fat,” she says. Other mono and bipolar devices have their own technologies to control the energy as much as possible, but this is never 100% fool-proof. The risk of unwanted fat loss is small, but it does happen.

The risk is also present with RF microneedling devices, although the chances here are even smaller. As always, make sure you select an experienced therapist who can explain the risks and knows exactly how to get the right results out of her or his machines.

As we’ve seen, the Morpheus 8 is the one RF microneedling machine can be set to a ‘fat loss’ mode for the face on purpose. This causes visible contraction and adds another level of skin ‘remodelling’, improving things like jowls and double chins in fuller faces.

There are also monopolar RF devices that specifically aim to heat the subcutaneous fat layer and contract it: one example is the Exilis Elite, which is used for the face but also the body, as we shall see below.

Radiofrequency treatments for the body

On the body, radiofrequency treatments can be used to tighten skin and reduce the appearance of cellulite, minimise textural issues such as stretch marks, and ‘melt’ fat. Again, it requires choosing the correct machine and a skilled practitioner!

Radiofrequency treatments for body fat reduction

If you want to minimise pockets of fat on your tummy, waist, thighs, knees or upper arms, body-sculpting radiofrequency machines designed to destroy the fat layer are an option. The cells will leak out their contents, which get transported out of the body by the lymph system. There are many devices, with some just using monopolar RF, some combining RF with ultrasound energy, and some using RF microneedling using a ‘body’ setting.

Dr Natalie Geary, medical director of the Light Touch Clinic, uses the Exilis Elite machine and says it can help you lose fat and tighten skin in your target area over four to six treatments, with results becoming visible after three months. Similar monopolar RF fat-loss devices are Vanquish ME, Accent Prime, and Cutera TruSculpt ID.

Don’t expect miracles, though. The amount is fat loss is not guaranteed and can often be so minimal as to be barely noticeable – that, at least, is our experience!

As for body fat loss with RF microneedling, look to the Morpheus 8 and Profound machines, which have ‘body headpieces’ with longer needles and more intense energy. Both treatments come with added skin-tightening (you’ll have to wait at least three months to see results) but are not for wimps. We tried the Profound on our legs and needed not just topical numbing gel, but lidocaine (an anaesthetic) injections. The procedure was intense enough to cause a lot of nasty bruising and visible veins, but did smooth away knee and thigh lumps.

Radiofrequency treatments for body tightening and cellulite

In the same way that monopolar, bipolar and microneedling RF treatments can smooth and tighten facial skin, they can tackle sagging and crepey skin on the tummy, knees and thighs. They are often advertised for cellulite reduction as well as they somewhat firm skin to smooth over the lumpy texture underneath, but these effects are temporary.

Dr Galyna uses Thermage FLX monopolar RF for skin tightening on areas of the body; the single treatments will take 90 minutes as opposed to 45 for the face. Alternatively, bipolar radiofrequency tightening with a machine such as the Venus Legacy (using a body headpiece) will smooth, plump and firm skin over the course of six to 12 treatments. Other tightening body options are PelleFirm RF Body and NuEra Tight, and Profound Microneedling RF, which can be set to tighten body skin.

Radiofrequency treatments for stretch marks

Similar to the way that skin-resurfacing fractional RF and RF microneedling devices can tackle scars and texture issues on the face, they can be employed on the body. Stretch marks are one concern that can be improved with this approach.

Morpheus 8, Endymed Intensif and Endymed RSF are examples of devices that can do this. Because of the size of the areas treated, all radiofrequency treatments for the body tend to be a tad more expensive than those for the face.

Are radiofrequency treatments safe for dark skins?

Overall, non-ablative radiofrequency treatments such as Thermage FLX and Venus Tighten are safe for dark skin tones as they don’t target skin pigment, as lasers do. Laser energy is attracted to melanin cells and will destroy them, meaning that in the case of dark skin tones, not only hyper-pigmented patches but also healthy pigmented skin may be lightened, and you don’t want that! Post-inflammatory pigmentation (reddening or darkening of the skin due to trauma) can occur if the skin surface gets burned or inflamed, but with a good machine in the right hands, this won’t happen.

Fractional RF treatments, applying heat to the skin surface as they do, are considered reasonably safe for dark skin tones but, in the wrong hands, there is some risk of post-inflammatory hyperpigmentation.

RF microneedling, which generally avoids applying too much heat to the skin surface, poses less of this risk. According to Dr Jack, the needles of the Morpheus 8 RF microneedling device “have a unique structure that creates minimal epidermal heating. This reduces the risk of post inflammatory hyperpigmentation (PIH) which can be an issue with other fractional devices.”

Are at-home radiofrequency devices any good?

The many at-home radiofrequency devices mostly rely on safe and painless bipolar radiofrequency energy. The technology is the same as that employed in professional devices but the gadgets are, as you might expect, a lot less potent. The Orlaya DermaDeep RF Pro, £429, is perhaps the most potent at-home option, reaching a collagen-boosting temperature of over 40 degrees C and uniquely employing unipolar energy, which travels more deeply into the skin. But as with all at-home radiofrequency devices, you need to be seriously consistent with it to see results; the Orlaya requires 20 minutes twice a week for eight weeks initially, with weekly treatments from there on in.