What does this research mean for the field?

A novel monopolar radiofrequency system with continuous water cooling (RF-CWC) safely improves facial contouring and promotes superior extracellular matrix remodeling with reduced inflammation compared to traditional cryogen-cooled systems. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate the efficacy and safety of a monopolar radiofrequency device with continuous water cooling for facial contouring.

June 10, 2026Open Access

Innovative Facial Contouring Using a Monopolar Radiofrequency Device with Continuous Water Cooling: An Integrated Clinical and Preclinical Study

Key Points

This study aims to evaluate the efficacy and safety of a monopolar radiofrequency device with continuous water cooling for facial contouring.
Prospective, single-arm clinical trial with 22 female participants.
Treatment involved a single session of radiofrequency with static and sliding modes.
Evaluation included ex vivo human skin and in vivo porcine models for mechanistic insights.
Significant improvements in jawline lifting and midface volume increase were noted (p < 0.001).
RF-CWC enhanced collagen types I and III without thermal damage, promoting extracellular matrix remodeling.
Superior ECM restoration and reduced inflammation were observed compared to traditional cooling methods.

Abstract

Monopolar radiofrequency (MRF) is a well-established modality for non-invasive facial rejuvenation; however, its clinical utility is frequently constrained by patient discomfort and inconsistent thermal delivery. This study evaluated the efficacy, safety, and mechanistic profile of a novel MRF system incorporating continuous water cooling (RF-CWC) designed to optimize thermal distribution and enhance patient tolerance. In a prospective, single-arm clinical trial involving 22 female participants, a single RF-CWC treatment utilizing region-specific static and sliding delivery modes yielded statistically significant improvements in jawline lifting, alongside a volumetric increase in the midface and a concomitant volumetric reduction in the lower face (p < 0.001) over an 8-week follow-up period, with no adverse events reported. To elucidate the underlying cellular mechanisms, the system was further evaluated using an ultraviolet B (UVB)-induced ex vivo human skin model and an in vivo porcine model. Histological, immunohistochemical, and ELISA analyses revealed that RF-CWC effectively mitigated UVB-induced dermal degradation ex vivo by significantly up-regulating elastin, insulin-like growth factor, and hyaluronic acid, while down-regulating matrix metalloproteinase-1, interleukin-1α, and heat shock protein 72 (p < 0.05). Furthermore, the in vivo model demonstrated time-dependent increases in collagen types I and III and elastin without thermal tissue damage, with the sliding mode and higher shot counts correlating with enhanced extracellular matrix (ECM) remodeling. Comparative analyses demonstrated that RF-CWC achieved superior ECM restoration and reduced inflammatory cell infiltration relative to traditional cryogen spray-cooled RF systems. Taken together, these findings suggest that the RF-CWC system may promote robust ECM remodeling and significant facial neocollagenesis while minimizing inflammatory responses, potentially presenting an optimized, highly effective, and patient-friendly advancement in MRF technology.

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