Vivace: microneedling with fractional radiofrequency

If you are looking for a technology that is buzzy, buzzy – look no further than microneedling with fractional radiofrequency (MFR). Microneedling is a minimally-invasive treatment for facial rejuvenation, acne vulgaris, scars, dyspigmentation, alopecia, and transdermal drug delivery. The technology boasts minimal to no discomfort, dramatic results, almost no downtime, and a safely profile for all skin types. This article discusses the bridge between talking points and what the research is saying. Maybe it IS as good as people say.

Microneedling originated in 1995 with Orentreich and Orentreich who coined the term “subcision”, manual needling to treat scars, followed by Camirand and Doucet who used a tattoo gun without ink.1,2 Modern microneedling utilizes a set of fine needles delivered into the epidermis and papillary dermis. Microneedling with fractional radiofrequency is the latest version of this concept, in which needle depth, power level, and pulse duration can be adjusted to control the injury. The needle delivery system of Vivace is quite advanced – the same robotic delivery system as the DaVinci Surgical Robotic systems. Insulated needles release radiofrequency currents from the needle tips producing thermal zones in the dermis without damaging the epidermis, creating a safe treatment for Fitzpatrick Skin Type VI. The platform also incorporates LED diode pulses.

Microneedling with fractional radiofrequency creates micro-wounds that trigger an inflammatory cascade and the release of growth factors in the dermis.3 Histologically, clinical studies have demonstrated significant rejuvenation effects on the aged skin by the activation of fibroblasts and increased dermal collagen and elastin production.3,4 In 2011, Lee et al. reported MFR (INFINITM, Lutronic Co., Goyang-si, Korea) on young and aged hairless mice. The treatment increased hyaluronic acid in the epidermis of young and aged mice as well as reversed age-related epidermal dysfunction.4

Microneedling has been extensively studied for acne scar treatment. Chandrashekar et al. treated 31 patients (skin types III-V) with Grade 3 to 4 atrophic acne scars with 4 MFR treatments. After 3 months, 80.6% of patients showed improvement by 2 grades, and 19.4% showed improvement by 1 grade.5 Microneedling with fractional radiofrequency has also been studied in the treatment of acne vulgaris. In 2014, a prospective case series by Kim et al. examined 25 patients with moderate to severe acne treated with 3 sessions of MFR. Inflammatory acne decreased significantly after every treatment and was reduced by 90.11% at 3-month follow up. A 36.9% decrease in sebum production was also noted.6

Microneedling has been studied in androgenic alopecia and alopecia areata. It is hypothesized that microneedling induces growth factors essential in the expression of hair growth related genes.7 A prospective study by Dhurat et al. included 100 men with androgenetic alopecia and randomized the patients to either microneedling with 5% minoxidil lotion or only minoxidil twice daily.7 After 12 weeks of treatment, the hair count was significantly greater in 80% of patients treated with both microneedling and minoxidil, compared to no significant change in the minoxidil only group.7

Microneedling with radiofrequency is well tolerated with topical anesthesia. For results beyond a pre-Met Gala luminosity, a series of at least 3 treatments is required. Histologic examination at 24 hours demonstrates an intact epidermis and no change in melanocyte number, resulting in limited downtime and minimal risk of dyspigmentation. Transient erythema is the most common adverse event, but transient post-inflammatory hyperpigmentation and tram-track markings have been reported.

The voracious popularity of these treatments shows no sign of slowing down thanks to social media and celebrity endorsement. A single treatment is designed to create a red carpet glow and velvety texture and can be a comfortable way for your male patients to enter the complicated world of aesthetics. According to a recently released report by RealSelf on 2019 male cosmetic treatment trends, microneedling saw the highest year-over-year growth of all cosmetic treatments.8 Further, male interest in non-surgical cosmetic procedures outpaced interest in surgical procedures in the first three months of 2019, up 6% compared to 2018.8

Microneedling is an effective and safe option for numerous dermatologic conditions. However, the majority of studies have been case series or small RCTs, and the treatment is not without reported adverse effects. There is a paucity of research comparing MFR to traditional resurfacing modalities. Microneedling stands apart from chemical peels and laser resurfacing by the minimal to no downtime, safety profile on Fitzpatrick Skin Type VI, as a treatment for acne vulgaris, as a transdermal drug delivery system, and with indications for alopecia. This disruptive diversity has led it to become a standard part of skin care and self-care routines for both Gen Z and Baby Boomers.   

Disclosures: This article was not sponsored.


  1. Orentreich DS, Orentreich N. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg 1995;21:543–9.
  2. Camirand A, Doucet J. Needle dermabrasion. Aesthet Plast Surg 1997; 21:48–51.
  3. Hou A, Cohen B, Haimovic A, Albuluk N. Microneedling: a comprehensive review. Dermatol Surg. 2017;43(3):321-339.
  4. Lee HS, Lee DH, Won CH et al. Fractional rejuvenation using a novel bipolar radiofrequency system in Asian skin. Dermatol Surg. 2011;37(11):1611–1619.
  5. Chandrashekar BS, Sriram R, Mysore R, Bhaskar S, Shetty A. Evaluation of microneedling fractional radiofrequency device for treatment of acne scars. J Cutan Aesthet Surg. 2014;7(2):93–97.
  6. Kim ST, Lee KH, Sim HJ, Suh KS, et al. Treatment of acne vulgaris with fractional radiofrequency microneedling. J Dermatol 2014;41:586–91.
  7. Dhurat R, Sukesh M, Avhad G, Dandale A, et al. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. Int J Trichology 2013;5:6–11.
  8. RealSelf data, Jan. 2019-March 2019 and Jan. 2018-March 2018, U.S. only. Accessed 7/23/2019.


Kaete Archer, MD Facial Plastic Surgeon

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