Why We Don't Use RF Microneedling on the Face (and What We Use Instead)
Medically reviewed by our GMC or NMC-registered medical professionals. Published September 2026.
Radiofrequency (RF) microneedling is one of the most heavily marketed skin treatments of the last few years. It promises tighter skin, smoother texture and "non-surgical lifting". It is also a treatment we have chosen not to offer on the face at Sebastian Rose, and in October 2025 the US Food and Drug Administration (FDA) issued a safety communication that goes a long way to explaining why.
The FDA warned that serious complications have been reported with certain uses of RF microneedling, including burns, scarring, fat loss, disfigurement and nerve damage, with some patients needing surgical repair [1]. Although this is a US warning, the same devices are widely used in UK clinics. Here is what RF microneedling actually does, why facial fat loss worries us, and what we use instead for acne scars, texture and skin quality.
What is the difference between RF microneedling and medical microneedling?
Medical microneedling uses fine needles to create controlled micro-channels in the skin. The body responds by producing new collagen and elastin. There is no heat involved; the effect comes entirely from the skin's own repair process.
RF microneedling adds radiofrequency energy to the needles. The needles penetrate the skin and then deliver heat at the tips, deep beneath the surface. That heat is intended to cause controlled thermal injury that tightens tissue and triggers remodelling. Some devices can deliver energy several millimetres deep, which on the face can reach the fat layer beneath the skin.
That difference, heat delivered below the skin, is the heart of the issue.
Why facial fat matters
Facial fat is not the enemy. It sits in distinct compartments that support the cheeks, the under-eye area, the temples and the area around the mouth, and those compartments are a large part of what makes a face look youthful, soft and rested.
As we age, we lose facial volume naturally. Hollow temples, deeper tear troughs and flattened cheeks are some of the most recognisable signs of ageing. That is why so much of modern aesthetic medicine focuses on supporting or replacing volume, not removing it.
Heat is one of the ways fat cells can be damaged. When RF energy is delivered too deeply, too intensely or repeatedly in thin areas of the face, there is a risk of reducing the very fat that holds the face up.
Reports discussed alongside the FDA communication highlighted subcutaneous fat loss around the eyes and cheeks, leading to contour irregularities [1, 2]. Once lost, facial fat does not simply grow back.
Correcting it can mean filler, fat grafting or other procedures, and the result may never be quite the same.
Who is most at risk?
The risk is not the same for everyone. It is likely to be higher for people who:
have a naturally slim face or thin skin
are having treatment around the eyes, temples or mid-cheeks, where fat compartments are thin
have already lost facial volume through ageing, illness or significant weight loss, including people losing weight with medical weight-loss treatment
have had repeated energy-based treatments in the same area
are being treated at aggressive depths or energy settings
Rapid weight loss is currently changing many faces, and people already losing facial volume have the least to spare. For them in particular, a treatment that carries any risk of further fat loss deserves very careful thought.
Doesn't RF microneedling work?
In fairness, it can. RF microneedling is a legitimate medical technology, and there is published evidence for its use in acne scarring and skin laxity. The complications described by the FDA are associated with particular uses, settings and levels of operator experience, and the FDA itself stresses that RF microneedling is a medical procedure, not a simple cosmetic treatment [1].
Our position is about the balance of benefit and risk. On the body, where reducing some fat can even be desirable, RF microneedling may be entirely appropriate. On the face, we believe the same results for texture, scarring and skin quality can be achieved without putting facial fat at risk, and that is the standard we want to work to.
What we use instead
For acne scars, fine lines, texture and skin quality, we use medical microneedling combined, where appropriate, with regenerative add-ons such as platelet-rich plasma (PRP), exosomes and polynucleotides.
The evidence for this approach is strong and growing:
Systematic reviews of clinical trials support microneedling as an effective treatment for acne scarring with a favourable safety profile [3, 4].
A 2026 meta-analysis found that combining microneedling with PRP produced significantly greater improvement in acne scars than microneedling alone, with patients around three times more likely to achieve an excellent result [5].
A systematic review of microneedling safety found that complications are generally mild and short-lived, such as temporary redness and swelling [6].
Because medical microneedling works without heat, it stimulates collagen in the skin without targeting the fat beneath it. It is also well suited to darker skin tones, which can be more prone to pigmentation after heat-based treatments [7].
Questions to ask before any RF microneedling treatment
If you are considering RF microneedling anywhere, these questions will help you make a safer decision:
Is the person treating me a registered medical professional, and how many of these treatments have they performed?
What depth and energy settings will be used on each area of my face, and why?
Will you avoid or reduce treatment around my eyes, temples and cheeks?
Have you assessed my facial volume, and am I a good candidate if I am already losing volume?
What happens, and who treats me, if I develop burns, scarring or volume loss?
Is there a non-heat alternative that could achieve my goals?
A good clinician will welcome these questions. If they cannot answer them clearly, that tells you something.
Medical microneedling in Cardiff
At Sebastian Rose Medical Aesthetics, all microneedling is performed by GMC or NMC-registered medical professionals holding Level 7 in Aesthetic Medicine, with 24 years of healthcare experience including emergency medicine and over a decade in full-time medical aesthetics. Every treatment begins with a medical consultation, including an assessment of your facial volume, so your plan improves your skin without compromising the structure beneath it.
Our clinic is at 39 Charles Street in Cardiff city centre, and we see patients from across Cardiff and South Wales. Read more about medical microneedling in Cardiff, or explore our acne and acne scar treatments.
References
U.S. Food and Drug Administration. Potential Risks with Certain Uses of Radiofrequency (RF) Microneedling: FDA Safety Communication. 15 October 2025.
Dermatology Times. FDA alerts clinicians to serious complications with radiofrequency microneedling devices. October 2025.
Mujahid N, Shareef F, Maymone MBC, Vashi NA. Microneedling as a treatment for acne scarring: a systematic review. Dermatologic Surgery. 2020;46(1):86–92.
Sitohang IBS, Sirait SAP, Suryanegara J. Microneedling in the treatment of atrophic scars: a systematic review of randomised controlled trials. International Wound Journal. 2021;18(5):577–585.
Afreen S, Shenod S, Thirumushi Sairaj R, et al. Combined microneedling and platelet-rich plasma for atrophic acne scars: a systematic review, meta-analysis and trial sequential analysis. Archives of Dermatological Research. 2026;318:155. doi:10.1007/s00403-026-04547-1
Chu S, Foulad DP, Atanaskova Mesinkovska N. Safety profile for microneedling: a systematic review. Dermatologic Surgery. 2021;47(9):1249–1254.
Alster TS, Graham PM. Microneedling: a review and practical guide. Dermatologic Surgery. 2018;44(3):397–404.
