6th January 2023

Your Ultimate Guide to Radiofrequency Skin Tightening in 2023 and Beyond

Last Modified: January 9, 2023

What is Radiofrequency Skin Tightening?

While facial cosmetic surgeries are trending downward, minimally invasive treatments are steadily increasing in popularity. One of the rising stars benefiting from this trend is non-surgical skin tightening. And none of the available options is as popular as radiofrequency skin tightening.

So exactly what is radio frequency skin tightening?

A 2022 systematic review describes radiofrequency (RF) skin tightening as an aesthetic rejuvenation technique that uses resistance heating within the skin layers to convert radiofrequency energy into thermal energy. The heat then causes controlled injury to the skin to stimulate selective tissue repair. The result is tissue contraction and remodelling i.e. firmer and tighter skin.

In this article we will look at:

  • History of RF skin tightening 
  • How does RF work?
  • Different types of RF devices
  • People who should avoid RF skin tightening treatment
  • How to book your RF skin tightening treatment

Let’s get started!

The History of RF Skin Tightening 

In the 1980s and 90s, ablative and nonablative lasers were the primary mechanisms for nonsurgical improvement of skin sagging. In properly selected patients, lasers were able to produce excellent skin resurfacing and remodeling.

However, the energy required for significant skin tightening and the subsequent heat are associated with a tremendous risk of injury to the epidermis. this led to complications such as burns and irreversible hyperpigmentation. For this reason, lasers are limited to lighter Fitzpatrick skin types and exclude darker-skin tone patients.

Consequently, interest in low-risk, non-invasive skin tightening solutions grew. It was only a matter of time before someone figured out how to use radiofrequency (RF) for minimally invasive cosmetology.

After all, RF had been used in almost every medical specialty by then, including cardiology, urology, sleep medicine and oncology since the 1920s.

The breakthrough came in 2002 when the Food and Drug Administration (FDA) approved the first radiofrequency device.

Thermage Inc. from California launched its flagship ThermaCool(R) anti-wrinkle system. The device used radiofrequency energy to contract collagen fibers and tighten skin.

Since then, Thermage Inc, along with several other companies, has significantly improved RF technology. They have and continue to add a lot of new features that have increased the safety and effectiveness of this treatment.

How Does RF Work Exactly?

Radiofrequency skin tightening works based on (Ohm’s law) formula: 

Energy (J) = Current × Resistance × Time

The RF machine first generates an electric current within an electromagnetic field with a frequency of 3 kHz-300 mHz. This is then converted into thermal energy due to the inherent resistance of the target skin tissue.

The dermis and subcutaneous layers have a higher resistance or impedance than the epidermis. As a result, the deeper skin layers generate more heat while the epidermis remains unaffected.

In fact, these deeper skin layers can heat up to 38-40 degrees during radiofrequency treatments.

This thermal reaction has many physiological effects, especially tightening, firming, and brightening the skin.

This is due to the following:

short-term contraction of collagen - the splitting of hydrogen bonds in collagen fibers causes them to shorten and thicken
long-term collagen synthesis - stimulation of the wound healing response causes the formation of new collagen in the following 3-4 months.

There's also one significant benefit of radiofrequency skin tightening beyond helping your skin look tighter and firmerF.

It is safe to use in all Fitzpatrick skin types: something that can't be said about most other energy-based aesthetic treatments.
That's because there is no specific temperature when collagen contraction is activated.

Rather, as you saw with OHm’s law, the delivery of RF energy is a function of time and temperature. Not to forget various tissue impedances.

In simpler terms, by leveraging these factors one can generate desired heat and contraction safely on any skin type.

Types of Radio Frequency Devices

There are currently 2 major configurations of RF devices: monopolar and bipolar.


Radiofrequency (RF) was first used for aesthetic purposes as a monopolar RF. In the monopolar form, RF is applied to the target area with a special handpiece while a grounding pad is applied to the body at some distance.

The monopolar method uses a single electrode tip that delivers energy into the space between the electrode and the grounding pad. This allows it to penetrate up to 20 mm deep into the skin and affect both the dermis and the subcutaneous fat.

This makes the monopolar method the most effective type of radiofrequency treatment as it penetrates deeper into the skin layers and is able to dissolve subcutaneous fat. Most modern monopolar RF devices have a cooling system to reduce the risk of overheating.


A bipolar RF device consists of two electrodes without a grounding plate. The patient's skin is positioned appropriately between the two electrodes and a high-frequency electric current is passed precisely through the skin by a handpiece.

The penetration depth of the bipolar RF is about half the distance between the two parallel electrodes (about 2-8 mm). The biggest limitation of this configuration is the depth of penetration. But compared to the monopolar method, this option offers a more controlled or localised energy distribution and less discomfort. This technology has been advanced by multipolar RF devices.

These use three or more electrodes, one of which has a positive pole, while the remaining electrodes serve as negative poles. This is to further reduce the risk of overheating and tissue damage.

Fractional RF therapy

Minimally invasive fractional RF therapy uses a microneedle to deliver electromagnetic current directly into the dermis. This is still a relatively new method that is being tested as a replacement for the more invasive fractional laser treatment

Who Shouldn't Use Radio Frequency Skin Tightening

The ideal client for radiofrequency treatment is a middle-aged man or woman who is beginning to show signs of a decrease in skin firmness. These clients would also benefit from combining radiofrequency with other advanced treatments such as stem cell micro-needling.

However, there are some  contraindications:

  • Patients with implantable medical devices such as a pacemaker or defibrillator. 
  • Those with collagen vascular diseases or autoimmune diseases (anti-inflammatory drugs that can interfere with collagen remodeling )
  • Patients under radioactive treatment
  • Those with recurrent herpes infections
  • Elderly patients (60+) with very thin skin

Book Your RF Treatment With Dr Aesthetica

RF treatments have proven to be one of the most popular non-surgical aesthetic treatments for facial rejuvenation and skin tightening. At Dr. Aesthetica, we are proud to offer this treatment to our patients using the revolutionary NuEra™ Tight with FocalRF technology. This advanced and highly customisable skin tightening device from Lumenis allows precise heat application for the perfect results.

With an initial treatment therapy of 4-6 treatments spread over several months, your skin will undergo an incredible transformation.

Why multiple treatments?

In the early 2000s, applying a higher amount of energy concentrated in a single session was very popular. The biggest problem with this approach was the pain and risk of tissue burns it caused. Further studies found that applying a lower amount of energy over a number of sessions was more helpful in stimulating new collagen and improving of skin elasticity.

Are you ready to take the next step and book your RF treatment? Maybe you need to have a few more questions answered. Either way, feel free to get in touch with our friendly and knowledgable staff today via email ([email protected]) or phone ( 0121 769 0242)

Post Reviewed by: Dr Baldeep Farmah
Medically Reviewed on: 6th January 2023
Dr Baldeep Farmah is the Medical Director and lead Doctor of Dr Aesthetica, a Medical Aesthetic Clinic.

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