Radiofrequency for skin tightening: everything you need to know

While many clients assume a surgical facelift is the only solution to skin laxity and ageing, there are actually several non-invasive treatments and technologies that can achieve comparable results with significantly less pain, downtime and cost. Chief among these technologies is radiofrequency...

“With surgery, you have one treatment and get instant results,” explains Dr Samantha Hills, clinical director at Lynton Lasers. “With non-invasive devices, you won’t get the same degree of tightening, but you can get very close.”

What is radiofrequency?

Dr Yannis Alexandrides - founder and head of surgical practice at 111 Harley Street in London, and founder of advanced anti-ageing product range 111SKIN and spa concept Spa/Clinic by 111Skin - says, "Radiofrequency (RF) is a popular treatment that uses oscillating electric currents through an antenna or electrode to generate electromagnetic waves. These wavelengths radiate through space at the speed of light and can range from less than a centimetre to 100 kilometres. Due to this level of frequency, radio waves do not interfere with the neuromuscular structure (unlike simple electrical current) and thus can be safely used for medical and aesthetic practices.

"When radiofrequency is conducted through the skin, it penetrates down to the subcutaneous layers, producing an exothermic reaction – meaning it is a catalyst for heat production within the body. In fact, the skin can heat up to 38–40 degrees during radiofrequency treatments."

Dr Alexandrides adds, "This has many physiological effects on the dermis, the primary being tightening, firming and brightening, and this is because the thermal reaction causes the contraction of collagen in the short term and collagen synthesis in the long term, tightening the underlying skin structures without damaging the top layer.

"It is particularly effective on areas that commonly suffer from skin laxity such as the brows, jowls, jaw and neck, ensuring skin looks lifted even after just one application."

How long does a radiofrequency treatment last?

"Radiofrequency sessions tend to last between 20 to 40 minutes and may require a topical anaesthetic cream," says Dr Alexandrides. "Many aestheticians favour a grid approach to application, which assures an even and more efficient treatment.

"Following radiofrequency, many clients will experience redness but this quickly dissipates, particularly with application of cooling gels and calming products, so there’s very little downtime with the treatment.

"The number of radiofrequency treatments needed in a course depends on the client’s skin laxity, but for truly visible results, I would suggest between three-to-five sessions over a period of three-to-five months. By using the technology consistently, it ensures maximum contraction and synthesis of collagen production, even affecting the more resistant cells."

Dr Ahmed El Muntasar, GP and award-winning aesthetician, says, "The results typically last for years, on average 18-24 months."

Who is radiofrequency treatment ideal for?

"The ideal client for radiofrequency is a middle-age man or woman who is beginning to see signs that denote a degradation in skin firmness. These clients would also benefit from combining radiofrequency with other advanced treatments such as photo-rejuvenation or chemical peels," says Dr Alexandrides.

Dr El Muntasar comments, “Patient selection for this treatment is very important; this treatment is not for someone who is aged 60+. It is more ideal for someone in their 40s or 50s who have a bit of 'give' to their skin, but still have good structure. I usually say that if you feel your skin and you have more than 2mm-4mm movement, this treatment probably isn't for you. So it is important to manage patient expectations and let them know what to expect in the first place.”

Dr Alexandrides adds, "While radiofrequency alone will help to remodel tissue to lift, firm and tone the face, it does not address any surface issues on the skin. That is why I often recommend radiofrequency to coincide with laser treatments and injectables; the first serves to resurface and reduce the appearance of pores, pigmentation and visible vascular lesions, while the latter helps to plump, volumise and hydrate areas that will no longer produce collagen."

Heat-based modalities like radiofrequency (RF), ultrasound, and laser treatments, are widely used to stimulate collagen production by inducing controlled thermal injury to the dermis and are becoming increasingly popular in younger clients in the name of collagen banking.

"This [heating] process activates fibroblasts and triggers the wound-healing response, leading to the deposition of new collagen fibres," says Dr Sabika Karim, founder of Skin Medical.

One key mechanism of heat-induced collagen stimulation is the activation of heat shock proteins (HSPs). When dermal temperatures reach approximately 42–45°C, HSPs, particularly HSP47, are upregulated. These proteins act as molecular chaperones, stabilising newly synthesised collagen and preventing its degradation. The remodelling of collagen occurs over several weeks to months, resulting in improved skin texture, firmness, and elasticity.

Radiofrequency or RF microneedling?

Radiofrequency in combination with microneedling is one of the innovations touted for the ultimate “non-surgical facelift.” Microneedling on its own entails pricking the skin with tiny sterilised needles. These small wounds cause the body to produce more collagen and elastin, which heals the skin and helps it look younger.

Radiofrequency microneedling (RFM) merges both technologies for maximum collagen-producing power. Microneedling encourages collagen production superficially by creating controlled trauma, while RF goes much deeper to boost this production, creating faster and more dramatic results that improve over time.

The marriage of these two technologies helps to lift, firm and tighten the skin, reduce wrinkles, shrink pores and even minimise acne scars and other blemishes and can be found in devices such as Lynton’s Focus Dual.

RFM can offer comparable results to ablative laser procedures but with significantly less discomfort and downtime. It can also be used as a preventative and to avoid even more invasive procedures such as surgery when laxity is not severe as well as to improve skin texture, colour and tone... something surgery could never achieve. 

“It’s all about prevention and remodelling that collagen so that its better quality,” says Dr Hills. “There are lots of technologies that can plump the skin and stimulate collagen such as RF and ablative lasers. But if you really want to tighten as you would with a facelift or threads, you need to target the SMAS [superficial musculoaponeurotic system] layer.”

High-intensity focused ultrasound (HIFU) - which is also found in the Focus Dual - can be added to cause reversible damage to the far deeper SMAS layer of the skin, which then helps tighten and pull, especially in the jowls and around the eyes. By combining HIFU with RFM, results can be maximised at every layer.

Are there any contraindications to radiofrequency?

Dr Alexandrides explains, "While radiofrequency is widely lauded, it is still limited in its effects. Contraindications include patients who suffer from significant amounts of redundant skin as they will not see the desired results, or patients who suffer from rosacea because they will see exacerbated symptoms due to the additional inflammation that occurs post-radiofrequency treatments. 

Excessive heating of the epidermis can also present risks of overheating and when combined with microneedling - this can cause fat loss...

"Overheating the epidermis can cause burns, erythema, and post-inflammatory hyperpigmentation (PIH), particularly in darker skin types," says Dr Karim. 

"To optimise treatment while minimising risks, it is crucial to target the dermis without affecting deeper subcutaneous fat layers," Dr Karim adds. "If heat reaches the subcutaneous fat, it may trigger adipocyte death, leading to loss of facial volume. This can make the skin appear lax rather than tightened. However, in areas such as the submentum (under the chin), targeting fat reduction may be desirable."

Dr Alexandrides agrees that this side-effect could become a target for fat. 

"The future of radiofrequency looks so promising, with so much development in the category having taken place in the past decade. There is still space to grow for the treatment to be used in fat-reduction and body-contouring by inducing temperature manipulation. I expect we will see advancement in that realm in the years to come, concludes Alexandrides." 

For more on combining radiofrequency with microneedling head to our article combining-radiofrequency-and-microneedling