Why has RF Microneedling suddenly fallen out of favor? What are the alternatives for non-surgical skin tightening?
Recently there has been a barrage of negative press about Radiofrequency (RF) microneedling. Once the darling of skin tightening, suddenly social media is on fire with warnings of bad outcomes. In October 2025, FDA issued a black box warning about RF microneedling potentially causing fat loss.
Does RF microneedling really cause fat loss?
RF microneedling releases focal radiofrequency heat at the depth of which the needles are programmed to penetrate underneath the skin. Whether or not fat is lost depends on the amount of heat and the depth of the needle penetration. With any aesthetic treatment option, there will be potential associated risk. But that does not mean the risk will occur with 100% of every treatment. A knowledgeable and experienced provider with a good quality RF microneedling device can certainly avoid fat loss, and instead boost collagen - leading to plumper, healthier skin.
At Rejuve Medspa, Dr. Kaplan uses Genius RF microneedling - a device developed in South Korea by a company called Lutronic which later merged with Cyanosure. The Genius RF microneedling device has the distinct advantage of having very tiny/fine needles (49 per stamp) that produces minimal skin surface damage. But the key benefit of Genius RF that makes it superior to other RF microneedling devices, is the level of control and feedback of the needle depth and energy. Feedback about the amount of Joules or heat energy produced with each stamp is provided. The level of hydration of the treated tissue is monitored and warnings are signaled if dehydration is detected. The depth of the needles can be manually programed and tightly controlled in increments of 0.1 mm. Whereas other devices only allow pre-programed depths of 1.5 mm, 3.0 mm, 4.5 mm, etc. Genius RF can be manually controlled at whatever depth desired - adjustable in increments of 0.1 mm to a maximum depth of 3.5 mm. This allows Dr. Kaplan to avoid fat reduction after clinically assessing each patient’s individual anatomy.
Examples of Genius RF Microneedling improving collagen and facial volume:
Examples of Genius RF microneedling for Acne scars with no loss of fat:
Fat reduction with RF microneedling can be intentional - And that’s a good thing:
There are certain circumstances where fat reduction is desired, in which case RF microneedling can be a useful tool. Areas such as the under chin (submental) region, abdomen, and triceps region of the upper arms are popular sites that patients often seek help for fat reduction. The advantage of using RF microneedling is that it can also help with skin tightening, so patients aren’t left with sagging skin after the fat has been removed. The key is to understand the patient’s anatomy and to be able to control the needle depth and energy levels to achieve successful fat reduction.
Examples of where fat reduction was desired with RF microneedling:
What are the alternative options to RF microneedling for skin tightening?
At Rejuve Medspa, XERF has essentially replaced RF microneedling as the most popular treatment for skin tightening. XERF has the advantage of integrating two different Radiofrequencies (6.78 MHz, 2 MHz) without using needles. XERF is able to target the shallow, middle, and deep depths below the skin to boost collagen production. Rather than the focal energy with RF microneedling, XERF relies on bulk heating which is both more efficient and more effective for targeting the retaining ligaments and SMAS (Superficial Musculoaponeurotic System) to promote structural skin tightening and lifting. Radiofrequency specifically targets water. Since fat has very little water content, the risk of melting fat is lower with XERF when used at safe temperatures.
There is no associated down time with XERF, and you can resume your daily activity immediately afterwards. With RF microneedling, patients will typically experience 5-7 days of redness and swelling (could be more or less depending on the patient, device, energy used, etc). There is a small risk of hyperpigmentation (higher risk with darker skin tones) and risk of prolonged increased redness with RF microneedling, but not with XERF.
About Dr. Kaplan at Rejuve Medspa
Dr. Kaplan has extensive experience with radiofrequency devices. She has personally performed hundreds of radiofrequency treatments since 2019, including Genius RF microneedling, Exilis Ultra 360, and her latest addition XERF. After graduating medical school, she completed a 4-year Emergency Medicine Residency training program and became board-certified as an Emergency Specialist with 20 years experience. Wanting to devote more time and attention to each patient, she transitioned to aesthetic and regenerative medicine in 2019. Dr. Kaplan operates Rejuve Medspa as a small, privately owned boutique practice focused on individualized care. She takes time to understand each patient’s goals and develops thoughtful, evidence-based treatment plans tailored to their specific needs and interests.