Rethinking RF Microneedling for Rosacea and Melasma

By Rachel Medlock, Guest Editor

When most of us think of radiofrequency microneedling, we think of firming, tightening, texture, and remodelling. It’s a treatment traditionally reserved for skin that’s ready to be pushed, but what if this technology had the potential to serve as a reparative treatment?

According to Lainie Porter, Account Manager and Clinical Trainer at Laseraid, it’s time to rethink the way we position RF microneedling, particularly when treating inflammatory conditions such as rosacea and melasma.

“It does take a paradigm shift to look at RF microneedling as a reparative treatment,” she says. “But that’s essentially what it is when we use the pulse wave mode. We reduce inflammation, modulate and stabilise the skin with cellular communication, rather than the wound-to-rebuild approach that’s so typical of aesthetics.”

It’s a shift that not only expands the reach of this treatment but also brings a layer of nuance to how we understand and support complex conditions.

Not every red face is rosacea

Before discussing treatment, Lainie urges therapists to revisit their diagnostic process. A surprising number of rosacea and melasma cases are misdiagnosed in clinic settings, often leading to poor outcomes, inflammation, or recurrence.

“Melasma is a pigmentary condition with hormonal, vascular, and inflammatory influences. It’s symmetrical and presents on sun-exposed areas like the cheeks, forehead, and upper lip, but I still see it incorrectly diagnosed more often than you’d expect,” she explains.

Rosacea, Lainie adds, is even more commonly misunderstood. “It’s a word that gets thrown around a lot. A red face might be an impaired barrier, a transient sensitivity, or actual rosacea. And rosacea itself has four subtypes. Most of what we see in-clinic is either erythematotelangiectatic rosacea, which presents with redness and visible vessels, or papulopustular rosacea, which includes small pustules. These need to be treated very differently.”

One of the biggest mistakes? Treating what you see, rather than what’s causing it.

“It’s easy to forget that these conditions are deeply individual. Asking more questions in consultation is vital. There’s never a one-size-fits-all approach.”

The rise of pulse wave RF

Historically, RF microneedling was avoided in these cases due to caution. The fear of exacerbating redness, triggering pigmentation, or fueling already inflamed skin meant the treatment was reserved for robust skin types; however, technology has since evolved.

“With older devices, you’re using a continuous wave (bulk heating) to induce inflammation and stimulate neocollagenesis,” Lainie shares. “That’s great for collagen induction. It’s not what you want for melasma or rosacea.”

Newer technologies now offer the ability to toggle between continuous and pulsed wave RF. The difference is subtle in execution but profound in outcome. Rather than flooding the skin with heat,

pulse wave RF delivers short, targeted bursts of energy designed to regulate cell behaviour without excessive thermal damage.

“With the pulse wave mode, we’re communicating with the skin, not wounding it. That means we can safely treat inflammatory conditions that would’ve previously been off-limits.”

Shallower isn’t less effective

Depth is another consideration that Lainie believes requires rethinking. The traditional instinct to treat pigment deep in the dermis is being challenged by emerging research and clinical experience.

“In the past, we were working at depths of 0.8 to 1.5mm to target the melanocyte at the basement membrane,” she says. “Now, we’re seeing better outcomes by targeting the papillary dermis at around 300 microns. That’s where key aspects of melanogenesis are happening.”

By staying more superficial, therapists can avoid unnecessary trauma, reduce pain and downtime, and still achieve meaningful changes in pigment and vascular conditions. The goal isn’t destruction, it’s regulation.

“Strengthening the basement membrane improves skin health overall. It also helps prevent melanin from leaking into the dermis, which is part of what makes conditions like melasma so difficult to treat long-term.”

More options, less compromise

This refined approach is not only safer for inflamed skin, but it also makes the treatment more versatile. With newer RF Microneedling devices, such as Sylfirm X, therapists can customise parameters on a single device using a single needle tip across multiple areas of the face or body.

“You might have a client with melasma on the upper cheeks and laxity through the lower face,” Lainie explains. “In the past, you’d have to turn them away or separate the treatments. Now, we can use pulse wave for the melasma and continuous wave for the laxity, all in the one session. It’s not about compromise. It’s about precision.”

This adaptability allows therapists to support clients holistically, rather than limiting their approach based on device capabilities.

Stop rushing in

One of the most common mistakes Lainie sees in clinic training is the urge to do too much, too soon.

“Therapists often want to go in hard; peel it away, laser it off, break it up with a Q-switch or IPL. That’s not necessarily wrong, but it’s not always necessary either.”

Instead, she advocates for a “low and slow” approach, giving the skin a chance to regulate before jumping into more aggressive modalities.

“If you can reduce the inflammatory load and strengthen the skin first, you might not need to use other modalities at all. Or, if you do, the skin will be much better prepared to receive that trauma and less likely to relapse.”

Inflammation first, always

Whether it’s acne, melasma, rosacea, or something else entirely, Lainie says that inflammation should always be the first thing therapists address, even if it’s not the first thing the client sees in the mirror.

“Inflammation is usually what’s driving the condition. If you jump ahead and treat the visible symptoms without calming what’s happening underneath, you’re going to find yourself chasing it around the face.”

That means understanding how treatments like pulsed RF can be used to modulate that inflammation in a strategic, controlled way. Not to wound or suppress, but to repair.

“Barrier health plays into this, too. If your client’s skin is impaired, it’s going to respond unpredictably to any modality you throw at it. Even the best technology can’t outwork a compromised barrier.”

What to look for in a device

For clinics considering expanding their offerings to better support vascular and pigment concerns, Lainie encourages looking beyond the brochure.

“Start with the science. Is it backed by evidence? What does the safety profile look like? Can it treat all phototypes, and if so, how?”

She also stresses the importance of sales representatives who understand more than just settings.

“Your rep should be able to explain how the technology interacts with skin. Not just the device, but the skin. What happens with different conditions, different phototypes, different healing trajectories.”

Versatility is crucial, especially in a modern clinical environment where multimodality approaches are prevalent. Therapists should also consider how easily a device integrates with their current treatment menu and philosophy.

And lastly, education.

“Ongoing training is essential, but don’t wait to be spoon-fed either. There’s so much power in self-directed learning. Stay curious.”

A call to rethink what results look like

RF microneedling will always have a place in skin tightening or scar revision treatment plans, but if there’s one thing Lainie hopes therapists take away from her work, it’s this: don’t overlook inflammation.

“We have an incredible opportunity with this technology to support skin that would normally be excluded. When you use it wisely, with intent, and a strong understanding of the inflammatory process, it becomes one of the most reparative tools in your clinic.”

You just have to be willing to slow down long enough to see it that way.