Microneedling and microneedle fractional RF in the attenuation of atrophic scars
Objectives: A multimodal approach integrating subcision, microneedling (Dermapen), microneedle radiofrequency fractional (MNRF), salicylic acid peels, and jet volumetric remodeling provides a comprehensive and practical strategy for the management of various scars, including acne, traumatic, and varicella (chickenpox) scars.
Introduction: Subcision effectively releases dermal fibrotic adhesions, particularly in rolling scars, improving scar elevation and enhancing outcomes of subsequent treatments (Alam et al., 2005). MNRF induces controlled dermal heating via radiofrequency, stimulating neocollagenesis and neoelastogenesis with minimal epidermal injury, and has demonstrated significant improvement in acne scar grading across multiple studies (Cho et al., 2012; Vejjabhinanta et al., 2014; Chandrashekar et al., 2014). Microneedling (Dermapen) complements deeper remodeling by improving superficial texture and collagen induction
Materials / method: Jet volumetric remodeling further augments outcomes by delivering bioactive substances (e.g., hyaluronic acid, PRP) into the dermis via high-velocity jet streams, enabling uniform volumization and improving depressed scars without needle trauma. This combination approach addresses multiple scar types: rolling scars respond best to subcision and MNRF; boxcar scars show improvement with combined resurfacing and volumization; ice-pick and varicella scars benefit from adjunctive targeted treatments; and traumatic scars demonstrate improved texture and pliability through layered remodeling
Results: A practical protocol involves 4–6 sessions at 3–4 week intervals, beginning with subcision and MNRF, followed by alternating MNRF and microneedling sessions, with jet volumetric remodeling and salicylic peels interspersed as needed. Overall, combination therapy targets different depths and mechanisms of scar formation, resulting in superior clinical outcomes, minimal downtime, and a low risk of post-inflammatory hyperpigmentation, making it especially suitable for diverse scar etiologies and darker skin types
