Should I do radio frequency (RF) microneedling or Erbium laser first?

Radiofrequency Microneedling Should Be Performed First

When combining RF microneedling with Erbium laser treatments, perform the RF microneedling first, followed by the laser procedure. This sequencing is based on established principles for combining energy-based devices with regenerative therapies.

Treatment Sequencing Rationale

Why RF Microneedling First

• RF microneedling creates controlled microtrauma at depths of 0.25-2.5mm, triggering neocollagenesis and neovascularization without ablating the epidermis 1
• The non-ablative nature of RF microneedling preserves the stratum corneum barrier, allowing for subsequent laser treatment without compromising healing 2, 3
• RF microneedling is safe across all Fitzpatrick skin types (I-VI) with minimal risk of post-inflammatory hyperpigmentation, making it the safer initial intervention 1, 2

Why Erbium Laser Second

• Ablative laser procedures (including Erbium) should be performed after non-ablative treatments because laser ablation removes the stratum corneum and creates significant tissue damage 4
• When combining ablative lasers with regenerative therapies like platelet concentrates, the guideline explicitly states: "Laser treatment is therefore performed first when combining modalities, with APCs applied directly after treatment" - however, this refers to the sequence of laser-then-biologics, not laser-then-RF 4
• Erbium laser ablation of the stratum corneum can enhance penetration of subsequent topical treatments, but performing it first before RF microneedling would create unnecessary tissue damage that could impair the RF treatment's efficacy 4

Practical Treatment Protocol

RF Microneedling Session

• Perform 1-3 RF microneedling sessions at 4-12 week intervals 5
• Use appropriate depth settings (0.25-2.5mm) based on treatment area 1
• Apply topical anesthetic for minimum 30 minutes prior, completely removed before starting 1
• Expected downtime: 24-48 hours with slight swelling and redness 5

Timing Between Procedures

• Allow minimum 4-6 weeks between RF microneedling and Erbium laser treatment to permit complete healing and initial collagen remodeling 1
• This interval ensures the RF-induced neocollagenesis cascade is established before introducing ablative trauma 1

Erbium Laser Session

• Perform after RF microneedling effects have stabilized 4
• The Erbium laser can then address superficial textural concerns and enhance overall rejuvenation 4

Important Safety Considerations

• Never perform ablative laser treatment immediately before RF microneedling - the compromised barrier function and tissue damage from laser ablation would significantly increase infection risk and impair RF treatment outcomes 4
• RF microneedling has minimal downtime (24-48 hours) compared to ablative lasers, making it the logical first step in a staged approach 1, 5
• Both procedures can be safely combined in darker skin types when properly sequenced, but RF microneedling first minimizes cumulative pigmentation risk 2

Adjunctive Therapy Optimization

• Consider applying autologous platelet concentrates (PRF or PRP) immediately after RF microneedling to enhance results - the microchannels created allow superior growth factor delivery 4, 1
• If using biologics, apply them after the RF microneedling but before any laser treatment 4
• Post-treatment care: avoid sunlight for 24 hours, use gentle cleansers, and avoid heavily scented products 1