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Hey all.
As a fellow acne scars sufferer and patient who has been doing research on the best treatments and also having done treatments personally, I came across many interesting things regarding RF Microneedling which obviously is a major popular treatment for acne scars that I wanted to discuss and get people's thoughts on and also help others as well because it leaves me with a lot of questions and confusion which I hope to clear up for myself and others.
First, some facts:
The skin has 3 main/major layers: the epidermis (top, surface, superficial), the dermis (middle, underneath epidermis, deeper), the hypodermis/subcutaneous fat (bottom, underneath dermis, deepest).
RF Microneedling's goal is to deliver heat/energy at various depths in the dermis to create slight damages and promote growth of newer and more collagen.
RF microneedling ideally for acne scars (especially for deeper acne scars) needs to avoid the epidermis (to avoid superficial damage since we are targeting the collagen in the dermis) and also avoid the hypodermis/subcutaneous fat (to avoid fat melting/loss in the face).
Second, with that being said:
RF Microneedling would/should be done at depths that align with the dermis and avoid the epidermis and hypodermis/subcutaneous fat.
Thirdly, let's look at what is generally recommended (by doctors, estheticians, clinics, product manufacturers, etc.) for RF Microneedling depth and also studies on the skin and it's thickness/depth and also the effectiveness of RF microneelding at certain depths and compare these all:
1. Generally we see that it is recommended that the max depth should be around 2.5mm or sometimes 3mm on the first pass and the following passes lowered incrementally from that max depth. For example, 2.5, 2.0, 1.5, or 3.0, 2.5, 1.5, etc. I'm not posting specific links and references which clearly show doctors or estheticians or clinics or product manufacturers or people online who have had procedures done share the depths that they themselves said to do or had done on them as they are all all over the internet and very easy to find but if needed or requested I'd be happy to go find and share but long story short, the general consensus is to go 2.5mm to 3mm max and no deeper to avoid the hypodermis/subcutaneous fat layer. I have seen folks go even deeper but this is just the general guidelines.
2. I am now going to link here several studies, first on the depths and thickness of the skin and it's different layers and then on the effectiveness of RF microneedling from experiments at different depths.
- https://www.selcukmedj.org/uploads/publications/2022-102-13168603.pdf
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10370326/
- https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-022-00839-w/tables/3
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4509584/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4134659/
Lastly, let's analyze/discuss the studies presented above:
I am not going to go in detail about every single study but rather give a summary of them all together and anyone interested can check them out with more detail themselves. Let's start, I am focusing obviously on the skin on the face and not other body parts/areas and speaking generally not breaking down each area of the face but if you want to do that you can check the studies out yourself as it's detailed in them. So what we see from these studies is that first, typically males have thicker skin (epidermis and dermis). Second, the epidermis is generally very thin and is under .1mm and going mostly to a maximum of .05mm except for one study showing up to .08mm. Third, the dermis is clearly thicker than the epidermis but is generally around 1.0mm to 1.5mm with one study going up to almost 2mm but most show a range of 1.0mm-1.5mm. Lastly, the RF microneedling depths and effectiveness, the studies show samples where RF microneedling was done with a range of minimum 1.5mm and maximum 3.5mm with increases effectiveness at deeper depths. I am not talking about energy here, only depths. It is shown that there is much more effectiveness at deeper lengths and there was significant improvement at the 2.5mm+ depths relative to lesser than that. One study did three passes total one at 3.5mm, one at 2.5mm and one at 1.5mm and it was noted that their scarring went from Grade 4 to Grade 2 which is a significant reduction and strong progress (See the study (last link) to see what each grade is defined as). I did not see any points regarding losing any subcutaneous fat in any of these studies.
So now that we've covered all this, let's talk and discuss on this.
- We are seeing that the total skin thickness in different areas of the face (epidermis + dermis but not accounting for the hypodermis/subcutaneous fat) generally is between 1.02 to 1.55 with the dermis being most/almost all of that measurement.
- We are also seeing that RF microneedling is typically done much deeper than the measurements/depths of the dermis shared in the studies and most people also actually recommend and/or have done much deeper than the dermis range shared above and seen results, with better results at deeper depths with a max of 3.5mm.
- I personally had even gotten by skin thickness measured by a doctor (and told I have pretty thick skin) and the depth settings (3 passes) I got for my RF Microneedling treatments were 2.2 max, then 1.8 and then 1.6 for the cheeks and jaw and 1.6 and 1.4 for the nose, temples and between the eyebrows area. I had done around 4 treatments or so and noticed little to no improvement. I had done the Genius RF treatment with 60,50,40 energy settings for cheeks and jaw and 26 for nose, temples and between the eyebrows area.
- Recently I switched to a different clinic as it's way closer to me, way cheaper, and also because I want to do different settings/depths and I just had my first treatment where I did 5 passes on the cheeks/jaw at 2.5 (60), 2.2 (60), 2.0 (50), 1.8 (50), and 1.5 (40) and 3 passes on the forehead, temples and nose at 1.6 (40), 1.4 (40), and 1.2 (30). I will also note though that the clinic actually recommended me to do deeper depths and stronger/higher energy but I opted out for now due to concerns over going too deep and hitting the hypodermis/subcutaneous fat and not sure of implications/effectiveness of higher energy. Also because I generally saw online to never go past 2.5 or 3mm by doctors, etc. and this was also before I did any of this research.
- So something isn't right here, something isn't adding up, something has to give. How is that studies show a much smaller skin thickness but somehow doctors and studies are showing, recommending, and/or doing much deeper depths for RF microneedling? By these measurements shouldn't all these treatments be going past the dermis and into the hypodermis/subcutaneous fat? How is that doctors and studies/trials are doing and recommending such deep depths, how is nobody losing or damaging their hypodermis/subcutaneous fat, and how are studies actually showing much better results at deeper depths that seem to be clearly past the dermis (at least based on and relative to the studies) and even myself and my own experience showing almost no results at depths of max 2.2mm and my clinic suggesting deeper and stronger for better results? Something is clearly not right here right? In theory all of these depths should not be done and would be going past the dermis and damaging the layer yet they are being recommended and even shown to have much better results. The only answer/solution I can think of is that these needles aren't actually going as deep as the settings that are being told/done and the machines have a flaw in which there must be a significant reduction is where the needles are actually going so they are not actually going as deep as told and they're not actually going into the fat and are instead going into the deep dermis and so producing great results at depths which really don't make sense.
I would like to hear others thoughts on this as I'm very curious and want to know what the deal is. In my personal interest, I am also looking for the optimal depth and energy settings for my genius rf treatments to get the best results.
I hope this was insightful and helpful and we can discuss and help each other, thank you!