By Dr Scott J Turner, Specialist Plastic Surgeon | Sydney & Brisbane
Radiofrequency (RF) microneedling has emerged as one of the most sought-after non-surgical skin treatments in aesthetic medicine today. When administered correctly by appropriately trained practitioners, this technology may provide notable improvements for specific skin concerns. However, as with all medical procedures, patients should understand the associated risks—particularly those contemplating facelift surgery at some point in the future.
This article presents an objective overview of RF microneedling, encompassing its potential benefits, recent FDA safety communications, and essential considerations for patients weighing their long-term facial treatment options.
Table of contents
What Is RF Microneedling?
RF microneedling integrates two distinct treatment modalities into a single procedure. Ultra-fine needles generate microscopic channels within the skin whilst concurrently delivering radiofrequency energy to deeper tissue layers. The treatment focuses on the dermis—the skin’s middle layer—where collagen and elastin fibres establish structural integrity and support. By creating controlled micro-injuries whilst simultaneously applying thermal energy, the procedure aims to prompt the skin to generate new collagen over the subsequent months.
Potential Benefits and Clinical Applications
When performed correctly by suitably qualified practitioners employing appropriate technique and device settings, RF microneedling may assist in addressing various skin concerns:
Skin Texture and Tone: The collagen-stimulating properties may enhance overall skin texture, potentially diminishing the visibility of surface irregularities and unevenness.
Fine Lines: Certain patients observe softening of superficial lines, particularly in the perioral and periorbital regions, as collagen development progresses in the months following treatment.
Acne Scarring: RF microneedling has shown promising results for specific acne scar types, particularly rolling and boxcar variants. The combination of mechanical and thermal tissue stimulation may facilitate scar tissue remodelling.
Pore Visibility: Some patients report that dilated pores appear less conspicuous following a treatment course.
Mild Skin Laxity: For patients presenting with early or minimal skin looseness, RF microneedling may deliver modest firming effects. However, maintaining realistic expectations is essential—outcomes are characteristically subtle rather than striking.
Stretch Marks: Certain practitioners utilise RF microneedling to address the appearance of stretch marks, though outcomes vary considerably between individuals.
Outcomes typically emerge progressively over three to six months as new collagen forms. Most treatment protocols comprise a series of three to four sessions scheduled several weeks apart, with maintenance treatments advised to preserve results.
Understanding the Limitations
Whilst RF microneedling can prove effective for suitable candidates, comprehending its limitations is crucial:
4RF microneedling cannot substitute for surgical procedures. Patients with significant skin laxity, pronounced jowling, or substantial neck concerns will find that non-surgical treatments alone cannot achieve the structural modifications that facial surgery can deliver. Procedures, including deep plane facelift, neck lift, or brow lift, physically reposition tissues and establish structural support that energy-based devices cannot replicate.
Outcomes from RF microneedling remain temporary and necessitate ongoing maintenance. Unlike surgical procedures, which deliver enduring structural changes, the collagen stimulation from RF treatments gradually diminishes, typically requiring repeat sessions every 6 to 12 months.
FDA Safety Communication: Key Concerns
In October 2025, the U.S. Food and Drug Administration (FDA) released a safety communication alerting healthcare providers and patients to severe complications documented with RF microneedling devices. This advisory highlighted several significant issues that patients should consider.
Documented Complications
Thermal Burns: The FDA documented instances of burns ranging from superficial to deep tissue injuries. RF devices generate substantial heat—typically between 60 and 70 degrees Celsius—and improper technique may cause thermal damage to skin and underlying structures.
Scarring: Both raised (hypertrophic) and depressed (atrophic) scarring have been documented. For a treatment designed to enhance skin appearance, the development of permanent scarring is a particularly troubling outcome.
Facial Fat Atrophy: This complication, medically termed lipoatrophy, occurs when thermal energy damages subcutaneous fat cells. The periorbital region (surrounding the eyes) and the cheeks are particularly susceptible due to thinner skin and reduced protective fat padding. Fat loss in these regions may create a hollowed, gaunt appearance—directly contrary to what most patients seek to achieve.
Nerve Injury: Reports encompass numbness, abnormal sensations (dysesthesia), and other neurological complications. Such issues are more likely when treatment is performed in anatomical regions where nerves course superficially.
Disfigurement: In certain instances, the cumulative effects of scarring, fat atrophy, and pigmentation alterations have resulted in visible disfigurement necessitating additional corrective procedures.
Why Do These Complications Occur?
Medical specialists largely concur that numerous RF microneedling complications arise from procedural execution rather than fundamental technological deficiencies. Comprehending these risk factors clarifies why practitioner selection proves so critical.
Operator-Related Factors
Inadequate Training: RF microneedling demands specific knowledge and proficiency. Practitioners require a thorough understanding of facial anatomy, appropriate energy parameters for different anatomical zones, and the capability to recognise and manage complications. Regrettably, the rapid expansion of medical spas and aesthetic clinics has resulted in many procedures being performed by inadequately trained personnel.
Inappropriate Device Settings: Different facial regions require distinct treatment parameters. Settings safe for thicker skin along the jawline may cause injury when applied to delicate tissue surrounding the eyelids. Practitioners lacking proper training may utilise excessively aggressive settings for specific treatment zones or individual skin types.
Excessive Treatment: Performing excessive passes over identical areas, treating too frequently, or employing inappropriately high energy levels can induce cumulative thermal damage. Skin requires adequate cooling intervals between passes, and complete healing must occur before subsequent treatment sessions.
Depth Errors: Utilising needles penetrating too deeply—particularly in regions with thin skin or minimal subcutaneous fat—elevates the risk of fat atrophy and nerve injury. Appropriate depth selection requires understanding the thickness of skin and subcutaneous tissue in each facial zone.
Device-Related Factors
The aesthetic industry has also witnessed concerning reports of counterfeit RF microneedling devices. These fraudulent devices may lack proper calibration, use inferior materials, and fail to meet safety standards—all factors that may increase the risk of complications.
Implications for Future Facelift Surgery
For patients who may eventually consider surgical facial procedures, understanding how prior RF microneedling treatments may influence future surgery is particularly important. Research and clinical observations have identified several potential concerns.
Alterations to Tissue Planes
Facelift surgery—whether a deep plane facelift, short scar facelift, or Face+ Signature Facelift—involves meticulously separating and repositioning tissue layers, particularly the SMAS (superficial musculoaponeurotic system)—a tissue layer providing structural facial support. Surgeons depend on these tissue planes remaining distinct and separable.
Extensive or aggressive RF treatments may induce fibrosis—scar tissue formation—in the subcutaneous layer, where surgical dissection typically occurs. When this develops, usually distinct tissue planes may become adherent or ‘fused,’ rendering surgical dissection more technically demanding.
Surgeons have observed that patients with extensive prior energy-based treatments present with tissue that proves more challenging to work with. Rather than cleanly separating along natural anatomical planes, the tissue may be scarred, requiring more meticulous dissection.
Nerve Considerations
The facial nerve and its branches control facial expression. Surgeons utilise anatomical landmarks to identify and protect these nerves during surgical procedures. If previous treatments have induced scarring or altered normal tissue relationships, these landmarks may prove less reliable, potentially increasing the technical complexity of the procedure.
Vascular Supply and Healing
Successful healing following facelift surgery depends upon adequate blood supply to the repositioned skin. If prior RF treatments have caused scarring or altered the microvasculature, this could influence healing outcomes, particularly at incision sites where tissue is under greater tension.
Volume Alterations
If RF microneedling has caused localised fat atrophy, patients may present with uneven fat distribution—areas of normal volume adjacent to regions of heat-induced fat loss. Addressing these volume irregularities may necessitate additional procedures, such as facial fat grafting, to restore facial harmony.
Surgical Planning Considerations
Due to these potential factors, patients with a history of extensive RF treatments may require a more comprehensive preoperative assessment and planning. Some surgeons approach such cases similarly to revision facelift procedures, anticipating that surgery may prove more technically demanding than a primary facelift in patients without prior energy-based treatments.
This does not mean excellent outcomes cannot be achieved—they can. However, it underscores the importance of transparent communication regarding treatment history during surgical consultations.
Book a Consultation in Sydney or Brisbane
If you are considering facelift surgery, Dr Scott J Turner provides comprehensive assessments at his Sydney and Brisbane clinics. As a Specialist Plastic Surgeon (FRACS) with extensive experience in facial aesthetic surgery, Dr Turner can evaluate your individual concerns and recommend the most appropriate surgical approach.
To arrange your consultation, please contact us or telephone 1300 00 FACE (1300 00 3223).
