Pin-Based Fractional Radiofrequency: 2024 International Consensus Recommendations for Aesthetic Skin Indications

August 2025 | Volume 24 | Issue 8 | 817 | Copyright © August 2025


Published online July 31, 2025

Heidi A. Waldorf MDa, Victor Ross MDb, Maurice Adatto MDc, Ofir Artzi MDd, Stephen W. Eubanks MDe, Kai O. Kaye MDf, Woraphong Manuskiatti MDg, Neil Sadick MDh, Sonja Sattler MDi, Atchima Suwanchinda MDj,k

aNew York, NY
bScripps Clinic, San Diego, CA
cSkinpulse Dermatology and Laser Centre, Geneva, Switzerland
dDepartment of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
eAmeriderm Research, Leavitt Medical Associates of Florida, Port Orange, FL
fOcean Clinic, Marbella, Spain
gDepartment of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
hWeill Cornell College of Medicine, New York, NY
iRosenparkklinik, Darmstadt, Germany
jDivision of Dermatology, Chulabhorn International College of Medicine, Thammasat University
kDermatologic Surgery and Laser Unit, Division of Dermatology, Ramathibodi Hospital, Mahidol University 

Abstract
Background and Objective: Fractional radiofrequency was developed as a potentially lower-risk and downtime alternative to traditional fractional ablative and nonablative lasers for skin resurfacing. Pin-based FRF (pFRF) delivers radiofrequency heat in focal, high-energy density columns within intact skin, without microneedle insertion. The main objective of this publication was to get an expert consensus on best-in-practice protocols for treating common aesthetic indications for resurfacing using a novel pFRF device.
Methods: An international panel of 10 dermatologists and plastic and reconstructive surgeons from 6 countries and a variety of practice settings was assembled to develop updated consensus recommendations for using pFRF. A modified Delphi method included: a preliminary questionnaire, video conference roundtable discussion, individual review of initial data, a secondary questionnaire, and multiple rounds of email discussion until a group consensus was reached.
Results: The panel developed standardized pFRF protocols for the treatment of acne scars, enlarged pores, skin texture, rhytides, and striae. For each diagnosis, device parameters and techniques are outlined. General requirements for patient preparation, anesthesia, and post-treatment care are described. Special consideration was given to device settings for condition severity and Fitzpatrick skin type. These guidelines are meant to provide new practitioners with a starting point for safe and effective patient treatment.
Conclusions: pFRF without microneedles is a useful alternative to fractional laser technology and radiofrequency microneedling for resurfacing patients’ skin texture irregularities. Patients tolerate the procedure and recovery well. Here, protocols for the treatment of 5 common aesthetic skin complaints with a novel pFRF device are provided.

INTRODUCTION

The concept of fractionated photothermolysis, using laser energy to create microscopic treatment zones of thermal heating, was first described in 2004 and has since become a standard way to deliver ablative and nonablative heat energy.1 Fractionated lasers have proven effective for photodamage, rhytides, scars, and striae. This approach allows for rapid re-epithelialization and neocollagenesis, resulting in reduced downtime and lower risk of complications than traditional continuous wave or ultra-pulsed ablative lasers.2,3 Nonablative lasers reduce downtime and risk relative to ablative lasers; however, results may be less impressive.4 Impediments to ablative fractional laser use are prolonged downtime and increased risk of infection, pigmentary changes, and scarring, especially after more aggressive treatment off the face and in darker-skinned patients. Fractional radiofrequency (FRF) addresses these limitations associated with other 'ablative' resurfacing methods. Like fractional lasers, FRF treatment induces controlled damage in both the epidermis and dermis, creating damaged foci that are surrounded by untreated dermis. FRF creates multiple tiny foci of ablation and coagulation, ranging in spot size diameters from 100 to 400 μm, and can create wounds up to 400 μm deep.5,6 Since FRF is not absorbed by chromophores like melanin, it may offer a safer alternative

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