Doctors and companies are constantly working on the development of new technology that allows us to treat diseases and rejuvenate patients in a less invasive way. After years of working as a general surgeon and having been head of a plastic and reconstructive surgery service, I began to work in facial rejuvenation based on the use of technology.

In 1994, together with dermatologists from Harvard University and plastic surgeons from the Mayo Clinic, Jacksonville, USA, we began working on facial rejuvenation with ablative carbon dioxide laser. Although the results we obtained on the tissues were extraordinary, it was not extraordinary regarding the recovery time, side effects, and the anguish it generated in the patients, which was justified and no less important.

In 1998 I presented my first scientific work related to the rejuvenation of the eyelids without skin resection, tightening and rejuvenating the tissues through the light energy of the carbon dioxide laser. It was Dr. Dieter Manstein who in 2004 developed the concept of the fractional use of the CO2 laser. This improved the clinical results obtained and, above all, the recovery time, given that re-epithelialization did not occur from the dermis and its pilosebaceous follicles, if not from the bridges of healthy tissue.

It was Dr. Jongju Na who in 2007 began working on the use of radiofrequency with microneedles for facial rejuvenation. Likewise, rejuvenation with CO2 laser is not for all patients, since they also have to go through a period of scabs, erythema and the possibility of hyperpigmentation. In 2009, Dr. Na create a company in Seoul and patented for the first time an RF system which delivers controllable RF energy through a matrix of microneedles. This RF system was based on the principle of localized RF radiated inside the dermis, producing localized and specific volumetric tightening.

It is a bipolar RF deep into the dermis up to a depth of 3.5 mm controlled by the surgeon. This energy is irradiated through a matrix of 25 microneedles which create microthermal zones. The energy is delivered in the tip of the needle at a temperature around 50 degrees. This treatment is well tolerated for the patients.

I began to work with this device and other microneedles, and performed hundreds of histopathological studies. All this clinical and histopathological research led me to understand that the effect on the tissues was not only produced by the coagulation of the tissues, but also by the vascular damage and blood lagoons that occurred in the dermis as a result of blood extravasation which were growth factors. The clinical results obtained were excellent for skin rejuvenation, improving its texture and luminosity, but the tightening effects could not come close to those obtained with the CO2 laser.

This RF technology greatly improves scarring acne due to the two aforementioned mechanisms, coagulation and growth factors. It also improves acute acne due to the damage it produces in the sebaceous gland. In 2013, the results of my research were published the ISAPS magazine. The objective of this presentation is to show my experience of 10 years using this technology and also to talk about the future of RF microneedles, looking for more skin tightening and rejuvenation using news devices which deliver more energy more deeply. Only the future and more clinical and histopathological studies could let us now, if we can get similar results as with the CO2 laser but without recovery time.