BACKGROUND: Radiofrequency microneedling (RFMN) utilizes RF energy delivered via needles to the dermis to enhance texture, reduce laxity, and improve dyschromia. However, evidence has been fragmented by indication/device heterogeneity. We evaluated clinical effectiveness, safety, and patient-reported outcomes (PROs) of RFMN across dermatological conditions. METHODS: Searches of PubMed, Google Scholar, and Semantic Scholar (January 2015-July 2025) (PROSPERO registration: CRD420251089393) were conducted, and English-language RCTs, cohort studies, case series, and reports of RFMN across skin indications were included (non-human studies excluded). A modified Critical Appraisal Skills Programme (CASP) checklist was used for quality analysis. Findings were narratively synthesized. RESULTS: Forty-one studies met the criteria (15 RCTs, 19 prospective non-randomized studies, 5 prospective cohorts, 2 case series) spanning diverse geographies and Fitzpatrick skin types. For atrophic acne scars, RFMN consistently reduced scar scores and demonstrated efficacy comparable to fractional lasers. For skin laxity/photoaging, RFMN improved wrinkle scales, dermal density, and submental volume, (histologically evidenced). Additional benefits were noted for rosacea, melasma, and striae, though effect sizes varied. In primary axillary hyperhidrosis, botulinum toxin A outperformed RFMN for symptom reduction/comfort. Safety was favorable; erythema, edema, and transient pain predominated; post-inflammatory hyperpigmentation was infrequent and self-limited. PROs indicated high satisfaction and minimal downtime. Reporting of technical parameters, especially temperature, pulse width, and cooling, was inconsistent. CONCLUSIONS: RFMN is safe, well-tolerated, with credible efficacy across multiple indications and skin types, and an attractive recovery profile. Standardized outcomes, longer follow-up periods, and rigorous reporting of device settings are necessary to refine protocols and facilitate head-to-head device comparisons. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Kumar et al. (Tue,) studied this question.