Resumo

Objectives: To compare fractional radiofrequency (RF) microneedling alone (Group A) versus the same combined with platelet-derived exosomes (Group B) for under‐eye dark circles. Primary outcomes included changes in melanin index, dermal thickness, and vascular visibility. Secondary endpoints assessed safety, adverse events, and patient satisfaction, aiming to elucidate whether exosomes amplify RF‐induced periorbital skin improvements. Introduction: Under‐eye dark circles result from hyperpigmentation, thin dermis, and prominent vasculature. Fractional RF microneedling induces controlled dermal injury, triggering collagen remodeling and modest pigment reduction. Platelet‐derived exosomes are enriched with growth factors that enhance cellular regeneration and may further reduce melanin synthesis. Combining these modalities could offer synergistic correction of multifactorial infraorbital darkness. Materials / method: Twenty‐four adults (age 27–54) were randomized into two groups of 12. Each underwent three sessions of fractional RF microneedling (2 MHz, 40–50 mJ, 0.8–1.2 mm depth) at 4‐week intervals. Group B additionally received topical platelet‐derived exosomes post‐needling. Outcomes (melanin index by colorimetry, dermal thickness via OCT, vascular scores on dermoscopy) were measured at baseline and 12 weeks. Data were analyzed by repeated‐measures ANOVA (p<0.05). Results: Group A showed a 14.8% drop in melanin index vs. 21.3% for Group B (p=0.022). Dermal thickness rose by 7.3% in Group A and 12.9% in Group B (p=0.039). Vascular scores declined by 0.6 (A) and 1.2 (B, p=0.031). Patient satisfaction was higher with exosomes (8.1±1.2) than RF alone (7.0±1.4, p=0.045). Mild erythema and edema occurred in both groups, resolving within 48 hours without complications. Conclusion: Fractional RF microneedling significantly lessened under‐eye dark circles, and platelet‐derived exosomes enhanced clinical efficacy by further reducing pigmentation, boosting dermal thickness, and lowering vascular prominence. Higher patient satisfaction and negligible adverse events support the synergy of biologic augmentation with RF for periorbital rejuvenation.