Your Ultimate Guide to Radiofrequency (RF) Treatment Guidance Manual

I Pre-Procedure Preparation

Abstract: This guide aims to provide medical aesthetic institutions with a standardized operational procedure, risk management, and quality control plan for Gold Radiofrequency Microneedling treatment to ensure the safety and efficacy of the treatment.

3D RF Micro Needle

1. Patient Assessment & Informed Consent

1.1 Medical History Collection

• Systemic Diseases: Strictly exclude autoimmune diseases, severe cardiovascular and cerebrovascular diseases, coagulation dysfunctions, etc.
• Medication History: Record recent medications in detail, paying special attention to isotretinoin (must be discontinued for at least 6 months), anticoagulant drugs (e.g., aspirin, warfarin, recommended to discontinue for 1-2 weeks, follow medical advice), photosensitive drugs, etc.
• Vaccination History: For vaccines such as COVID-19, it is recommended to have an interval of at least 2 weeks between vaccination and treatment, or follow the latest clinical guidelines.
• Allergy History: Specifically inquire about metal allergy history (especially nickel, chromium, etc., as trace amounts of underlying metals beneath the gold coating may still pose a sensitization risk), and anesthetic drug allergy history.
• Recent Treatment History: For treatments like lasers, chemical peels, etc., assess the skin repair status to ensure an adequate interval period.

1.2 Professional Skin Condition Assessment:

• VISIA Skin Detection System (or other professional skin imaging analyzers):
  • Quantitative Analysis: Erythema value to assess skin sensitivity and inflammation levels.
  • Pores & Sebaceous Glands: Assess pore blockage and sebaceous gland activity.
  • Pigmentation: Record basal layer pigmentation levels to evaluate potential risks of hyperpigmentation.
• Skin Barrier Function Assessment:
  • Objective measurement using a Transepidermal Water Loss (TEWL) meter.
  • If the TEWL value > 15-20 g/h·m² (the specific threshold can be adjusted based on the device and clinical experience), it indicates a compromised skin barrier. In such cases:
    • Recommend skin barrier repair treatment first.
    • If the patient insists on treatment, appropriately reduce the treatment energy (recommended to decrease by 10%-25%), and it may be necessary to shorten the single treatment duration or increase the treatment interval.

1.3 Informed Consent FormInformed Consent & Expectation Management:

• Detail the treatment principle, expected effects, and potential risks (e.g., temporary erythema, edema, pain, scabbing, infection, rare temporary or persistent post-inflammatory hyperpigmentation (PIH, incidence rate of about 5%-10%, slightly higher in Asian populations), scarring, etc.).
• Inform about the post-procedure recovery period (e.g., peak redness and swelling typically last 24-72 hours) and care instructions.
• Sign a detailed informed consent form to ensure the client fully understands and voluntarily accepts the treatment.

II. Device Parameters & Pre-Procedure Setup

2.1 Needle Model & Energy Settings

Needle Specification	Applicable Area	Recommended Puncture Depth	Energy Density (J/cm³)	Scanning Passes & Mode
24/25-pin	Large facial areas (forehead, cheeks)	1.5–3.0 mm	10–25	1 low-energy rapid pre-scan + 1–2 conventional vertical scans
36/49-pin	Delicate areas (periorbital, nasolabial folds)	0.5–1.5 mm	8–15	Multi-point stamping + fan-shaped lifting technique
8/16-pin	Body (abdomen, thighs, stretch marks)	4.0–7.0 mm	25–40	2 vertical scans, oblique puncture for special areas

Note: Specific depth and energy must be individualized based on the patient’s skin thickness, treatment goals (e.g., skin rejuvenation, scars, tightening), device model, and clinical experience.

Device Impedance Real-Time Monitoring & Calibration:

• Pre-treatment Calibration: Each time a new treatment tip is replaced or when the device is turned on for the first time daily, perform an impedance matching test using the manufacturer-recommended testing medium (e.g., standard testing gel).
• Normal Range Reference: Typically between 200-400Ω (refer to the device manual for specifics).
• Deviation Handling: If the impedance value consistently deviates from the normal range by more than ±10%, suspend use and contact the device supplier for professional calibration or repair.

2.2 Pre-Procedure Skin Cleansing & Anesthesia

2.2.1 Degreasing & Disinfection Wipe the treatment area with a 75% medical alcohol cotton pad (avoiding eyelids), then remove excess alcohol with normal saline. Begin the procedure after the skin is dry.

2.2.2 Topical Anesthesia Protocol:

• Standard Clients: Apply a compound lidocaine cream or other topical anesthetic evenly and thickly to ensure complete coverage of the treatment area. Occlude (e.g., with medical plastic wrap) for 30-60 minutes (specific time adjusted based on product instructions and clinical experience). Thoroughly remove the anesthetic before the procedure.
• Highly Sensitive or Special Area Clients: Consider local nerve block anesthesia or local infiltration anesthesia (e.g., 0.5% lidocaine with low-concentration epinephrine, to be performed by qualified physicians) to maximize treatment comfort.

III. Intra-Procedure Technique

3.1 Scanning Strategy & Advanced Techniques

Layered Treatment & Progressive Energy Principle:

• First Pass (Optional, adaptive operation): Use lower energy (e.g., 50%- 70% of target energy) for rapid, full coverage to preheat the tissue, assess immediate skin response, and open skin channels for subsequent treatment.
• Second Pass (Main treatment pass): Use the target energy, ensuring the treatment tip is perpendicular to the skin (90° angle) with even pressure to ensure full needle insertion. RF emission time per spot is typically controlled at 0.2-0.5 seconds (adjusted based on device settings and treatment goals). Avoid excessive stacking in the same area.
• Third Pass (Specific situations, e.g., deep treatment on body areas): Consider increasing the energy by 10%-20% (discretionarily), or adjusting the needle insertion angle (e.g., 45° oblique puncture) to enhance the thermal effect on specific tissue layers (e.g., fat layer or deep dermis). This operation requires extreme caution and is based on sufficient anatomical knowledge and clinical experience.

3.2 Standardized Operation for Key Areas

• Periorbital: Maintain a distance of ≥3 mm from the eyelid margin. Use a point-lifting stamping technique, with a depth not exceeding 1.0 mm.
• Nasolabial Folds: Insert needles at a 45° angle along the wrinkle direction, supplemented by a fan-shaped lifting technique. Post-procedure, an immediate lifting effect of 15% %- 20% can be achieved.
• Stretch Marks: For white striae (striae alba), set depth to 4.0–5.0 mm, using a cross-hatch pattern. For red striae (striae rubrae), set depth to 2.0–3.0 mm, which can be combined with a 585 nm pulsed dye laser treatment.

3.3 Real-Time Monitoring & Pain Control

3.3.1 Real-Time Treatment Feedback & Dynamic Risk Monitoring:

• Device Parameter Instant Feedback:
  • Real-time Impedance Monitoring: Pay attention to the tissue impedance value displayed on the device screen.
    • Sudden Drop in Impedance (e.g., <100-150Ω): May indicate tissue adhesion to the needle tip, carbonization, or poor contact. Stop operation immediately, clean the needle tip (e.g., wipe with sterile gauze moistened with normal saline), and check connections.
    • Sustained Increase in Impedance (e.g., >450-500Ω): May indicate tissue dehydration, poor needle contact, or relatively high energy settings. Assess whether energy adjustment or supplemental cooling/hydration is needed.
• Clinical Endpoint Observation:
  • Immediate Response: The ideal clinical endpoint is typically uniform mild to moderate erythema, slight edema in the treatment area, and fine pinpoint bleeding spots visible in some areas.
  • Avoid Overtreatment: Avoid obvious epidermal stripping, blisters, eschar, or purpura.

3.3.2 Visual Analogue Scale (VAS): Intermittently ask the client for a pain score (0 for no pain, 10 for severe pain) during the treatment.

• 1-3 points (Mild discomfort): Normal range, can continue operation.
• 4-6 points (Moderate pain): Consider appropriately lowering energy parameters (by about 10%-20%), increasing the speed of movement, or enhancing communication with the client to distract them.
• ≥7 points (Significant pain/unbearable): Immediately pause the operation, check the anesthetic effect, whether device parameters are too high, or if other abnormalities exist.

IV. Post-Procedure Care & Complication Management

4.1 Phased & Refined Care Plan:

• Immediate to 24 hours (Acute Inflammatory Phase):
  • Main Goals: Soothe, cool down, reduce redness, prevent infection.
  • Care Measures:
    • Immediately after treatment, apply medical-grade sterile cold compresses or ice packs intermittently (15-20 minutes each time, every 1-2 hours, being careful to avoid frostbite).
    • Apply medical-grade repair products (e.g., sterile repair gels or serums containing growth factors, hyaluronic acid, ceramides).
    • Strictly keep the treatment area clean and dry; avoid contact with water within 24 hours. Do not scratch, rub, or directly touch the treatment area with your hands.
• 24 hours to 7 days (Tissue Repair Phase):
  • Main Goals: Promote repair, moisturize, and strict sun protection.
  • Care Measures:
    • Can begin gentle cleansing (using medical-grade or sensitive skin-specific cleansers, rinse with clean water).
    • Continue using repair products, such as serums or creams containing copper peptides (GHK-Cu), Centella Asiatica extract, vitamin B5, etc., morning and evening.
    • Strict physical and chemical sun protection: Use wide-brimmed hats, masks, sunglasses, and other physical barriers, and apply broad-spectrum sunscreen with SPF≥30, PA+++. Avoid sun exposure as much as possible.
    • Avoid using irritating skincare products (e.g., fruit acids, retinoids, scrubs).
• 7 days to 14 days (Stabilization & Recovery Phase):
  • Main Goals: Consolidate repair, prevent hyperpigmentation, and gradually resume normal skincare.
  • Care Measures:
    • After the skin has basically returned to normal, gradually introduce low-concentration (e.g., 5%-10%) L-ascorbic acid (Vitamin C) and other antioxidant products to prevent and improve post-inflammatory hyperpigmentation.
    • Based on skin recovery, adjunctive gentle phototherapy repair treatments (e.g., 630 nm- 660 nm LED red light irradiation to promote repair and reduce inflammation) can be performed.
    • Continue to strengthen moisturization and sun protection.

4.2 Complication Prevention & Management

• Persistent Erythema/Edema (not significantly subsided after 7 days):
  • Management: Apply topical non-steroidal anti-inflammatory creams (e.g., 0.03%-0.1% tacrolimus ointment, 1-2 times daily, short-term use). If necessary, consider using vascular-targeting lasers (e.g., 595nm pulsed dye laser or intense pulsed light) for intervention after 3-4 weeks.
• Post-Inflammatory Hyperpigmentation (PIH):
  • Management: Strengthen sun protection, apply topical hydroquinone cream (requires doctor’s guidance), azelaic acid, arbutin, tranexamic acid, and other whitening/lightening ingredients. Can be combined with chemical peels or pico/nanosecond laser treatments.
• Acneiform Eruptions:
  • Management: Apply benzoyl peroxide gel or clindamycin gel topically. Can be combined with blue light (415nm) irradiation for antibacterial and anti-inflammatory treatment. Avoid using oily skincare products.
• Infection:
  • Management: If signs of infection, such as pustules, increased redness, swelling, heat, and pain, appear, seek medical attention immediately. Follow medical advice for oral or topical antibiotics based on bacterial culture and drug sensitivity test results.
• (Rare) Fat Atrophy/Depression:
  • Management: This is a serious adverse event, usually related to excessively deep operation, excessively high energy, or risks in specific anatomical areas. Immediately stop all subsequent treatments. After assessment, consider using autologous fat grafting, PLLA (Poly-L-Lactic Acid), or CaHA (Calcium Hydroxylapatite) and other collagen-stimulating agents for filling and repair. It must be handled by an experienced physician.

V. Equipment Maintenance & Quality Control

5.1 Daily Pre/Post-Operation Checks & Records:

• Power-on Self-Test Procedure: Strictly follow the device’s power-on self-test procedure to confirm that all systems (e.g., cooling system, RF module) are working normally.
• Cooling System Check: Confirm the coolant level and cooling system pressure (if applicable, refer to the device manual for normal values, e.g., 2.5-3.0 Bar).
• Emergency Stop Function Test: Regularly (e.g., first power-on daily), test the response time and effectiveness of the emergency stop button (should be <0.5 seconds).
• Treatment Head Management & Traceability:
  • Single-Use Principle: Strictly enforce single-use of treatment heads; reuse is prohibited.
  • Recording & Disposal: Detail the serial number, activation date, and client information for each treatment head, and dispose of them according to medical waste disposal regulations. Retain relevant records for at least 2-3 years for inspection.

5.2 Periodic Professional Maintenance & Calibration:

• Monthly Maintenance:
  • Clean the device casing and operating interface.
  • Inspect and clean RF electrodes (if applicable) according to the device manual, and replace necessary consumables (e.g., RF electrode coupling gel, if not a single-use design, to prevent its oxidation from affecting energy conduction).
  • (If applicable) Use specialized tools (e.g., fiber optic endoscope) to check the integrity of the treatment head needles or guide wires, ensuring they are not bent (discard if bent >5° or visibly deformed), clogged, or damaged.
• Annual/Semi-Annual Professional Maintenance:
  • Comprehensive inspection and maintenance by an authorized engineer.
  • Includes but is not limited to: energy output calibration, main unit capacitor bank performance testing and necessary replacement, cooling system deep cleaning and maintenance, temperature control system firmware upgrades (to obtain the latest safety algorithms and performance optimizations).

VI. Outcome Evaluation & Patient Retention

6.1 Standardized Effect Evaluation System

• Assessment Time Points: Recommended at 7 days post-procedure (initial recovery), 1 month (early collagen regeneration), 3 months (stable effect period, can assess need for a second treatment), and 6 months (long-term effect) for standardized photography and skin testing.
• Assessment Content: Includes objective indicators (e.g., VISIA image comparison, changes in wrinkle depth/quantity, skin tightening instrument measurements) and subjective satisfaction questionnaires.

6.2 Personalized Follow-up & Repurchase Guidance Scripts

• Acne Scar/Scar Clients: “After X treatments, we can see significant improvement in both the depth and area of your atrophic scars (for example, with 3 sessions, the comprehensive improvement rate is expected to increase from 70% [improvement rate of a single session] to 90%). To achieve the best results, we recommend…”
• Skin Aging/Laxity Clients: “After this treatment, there is an initial improvement in skin firmness and radiance. Gold microneedling primarily targets the dermis. To achieve more comprehensive facial rejuvenation, consider 2-3 gold microneedling sessions annually. This can also be combined with treatments targeting the SMAS layer, such as focused ultrasound (e.g., Thermage, Ultherapy), or laser/photorejuvenation for the epidermis, to achieve multi-level anti-aging.”
• Establish Long-Term Management Files: Record treatment parameters, client feedback, and effect evaluations for each session to provide a basis for optimizing subsequent treatment plans.

Disclaimer: This guide is for professional reference only. Specific operations must strictly adhere to the equipment manufacturer’s instructions for use and be combined with individual circumstances and clinical experience. All medical aesthetic procedures carry risks; please ensure they are performed in a qualified medical institution by a qualified and licensed physician.