*3.2.2.2 Transdermal RF treatment*

More notable improvements to skin quality, including reduced laxity, roughness, and improved hydration, can be achieved when RF energy can be delivered to deeper levels of the dermis and subdermal tissues. Fractional RF devices (Fractora or Morpheus8; InMode or Profound, Candela Medical, Mississauga, ON, Canada), utilize (micro)needles or electrodes to heat the dermal and subdermal levels in a nonablative fashion. Heating of the subdermal tissues results in a degree of fat emulsification and mild contouring [12]. Skin needle puncture has been shown to improve skin texture and mild rhytids. These results are amplified when coupled with RF energy. Histologic changes consistent with increased reticular dermal thickness, dermal collagen, hyaluronic acid, and elastin content are seen following RF microneedling [15, 18]. These results are clinically notable as well. A randomized, blinded, quantitative study of skin laxity demonstrated a 16% improvement in skin laxity from baseline with fractional RF treatment as opposed to 49% achieved with surgical facelifting, and an improvement of 37% of that of facelifting with a single fractional RF treatment [19]. Fractional RF via (micro)needling can be applied in a multitude of fashions to enhance appearance of the arms. Fractional RF can augment the tightening effects of subdermal RF treatment in cases of severe skin laxity or more moderate cases of skin laxity who also present with moderate to severe skin roughness and photoaging changes. Additionally, due to its less invasive nature, RF (micro)needling can be used to address difficult-to-treat areas such as fat pads just proximal to the elbow or at the axillary-arm junction. Untreated islands of skin expedite recovery with fractional RF treatments, similar to fractional laser resurfacing [12, 15].
