Aesthetic medicine and cosmetic surgery are two fields in which great innovations have often followed one another at a frantic pace. Previously, we would see news appearing almost every month on new injectables, new techniques and approaches with them, and new lasers with different wavelengths or with a different mode of energy delivery.

In recent years, however, the technological landscape has undergone a major slowdown. We have witnessed the merger between large and renowned companies, and an influx of cheap equipment to the market. Patients continue to ask for effective treatments but with the shortest possible downtime and the medical answer has often been to offer combined treatments.

Combining injectables and different energy sources aims to modify the form, volume, shape, and appearance of tissues. However, the need for combination treatment is, itself, a demonstration that a single method is not able to get everything achieved alone.

The only big development that I have seen in recent years has been microneedle radiofrequency (RF). Excluding the surgical option, the lower third of the face and neck have always been a difficult area for me to treat. I was not able to offer effective alternatives to surgery that were able to deliver a real tightening to this anatomical region. Furthermore, my activity in the summer months decreased drastically, owing to the risk of adverse effects such as post-inflammatory hyperpigmentation (PIH), forcing myself and my patients to postpone the treatments until the winter months. Fortunately, this new technology has allowed me to remedy, at least in part, these two issues.

Isolated needles with small diameters are inserted into the skin to a depth decided by the operator. Energy and pulse duration can also be varied by the operator at any time. The energy is emitted only at the tip of the needles and this ensures that tissue damage is restricted to the desired depth and bypasses the surface altogether. The RF energy is conveyed deep in the dermis via a serial needle insertion, which not only mitigates tissue damage, but also improves patient comfort. Rather than emitting energy that affects the skin from the outside inwards, the tissue damage, contraction of the collagen fibres, and the production of new collagen begins from the depth of the dermis. The basal epidermal layer will present with very little inflammation and the risk of complications is much lower compared with other non-RF procedures. The operator keeps the freedom to choose where, how much, and how to create the tissue damage. This allows physicians to customise the treatment and obtain a definitive tightening of tissues. The downtime is a maximum of 2 days and a simple anaesthetic cream (better if auto-occlusive), used 1 hour prior to treatment, allows for the treatment to be performed in an almost painless way.

Improving skin laxity and quality, and being able to do this during summer months or on tanned patients has dramatically improved the quality of the treatments I can offer to my patients.