The plain-language read
Across 12 included studies, RFMN consistently improved Melasma Area and Severity Index (MASI) or modified MASI scores and melanin indices, with effects maintained up to 6 months. Histological evidence demonstrated reductions in dermal senescence markers and partial restoration of basement-membrane integrity. RFMN also showed a favorable safety profile, with a low incidence of PIH in darker phototypes.
- Across 12 included studies, RFMN consistently improved Melasma Area and Severity Index (MASI) or modified MASI scores and melanin indices, with effects maintained up to 6 months.
- Histological evidence demonstrated reductions in dermal senescence markers and partial restoration of basement-membrane integrity.
- RFMN also showed a favorable safety profile, with a low incidence of PIH in darker phototypes.
- RFMN is an effective and safe modality for melasma, offering advantages over pigment-directed lasers by addressing dermal mechanisms and limiting PIH risk.
Relevant if you're working with salicylic acid for hyperpigmentation.
What this means for your routine
If you're targeting hyperpigmentation, this research supports adding salicylic_acid to your AM/PM routine. Timeline to expect: 6 months based on study duration.
Translated from this study's findings, not a personal prescription. Pair with your existing protocol and your practitioner's guidance.
Technical Summary, For Professional Reference
Clinical context
1. Aesthet Surg J Open Forum. 2026 Apr 25;8:ojag075. doi: 10.1093/asjof/ojag075. eCollection 2026. The Efficacy and Safety of Radiofrequency Microneedling for Melasma: A Systematic Review and Qualitative Evidence Synthesis. Kumar N, Lin S, Luthra A, Patel T, Bhatia AC.
Full abstract→
1. Aesthet Surg J Open Forum. 2026 Apr 25;8:ojag075. doi: 10.1093/asjof/ojag075. eCollection 2026. The Efficacy and Safety of Radiofrequency Microneedling for Melasma: A Systematic Review and Qualitative Evidence Synthesis. Kumar N, Lin S, Luthra A, Patel T, Bhatia AC. Melasma is a chronic, relapsing hyperpigmentation disorder that is difficult to treat, particularly in Fitzpatrick skin types III-V, where energy-based devices frequently induce postinflammatory hyperpigmentation (PIH). Radiofrequency microneedling (RFMN) has emerged as a promising alternative because it targets dermal pathology while minimizing epidermal injury. Systematically evaluate the efficacy, safety, and mechanistic rationale of RFMN for melasma. A PRISMA 2020 compliant search of PubMed, Embase, Cochrane CENTRAL, and LILACS (2014-2025) identified clinical studies evaluating RFMN alone or in combination therapies. Risk of bias was assessed using Joanna Briggs Institute tools. Owing to clinical and methodological heterogeneity, a qualitative synthesis was performed. Across 12 included studies, RFMN consistently improved Melasma Area and Severity Index (MASI) or modified MASI scores and melanin indices, with effects maintained up to 6 months. Histological evidence demonstrated reductions in dermal senescence markers and partial restoration of basement-membrane integrity. RFMN also showed a favorable safety profile, with a low incidence of PIH in darker phototypes. Combination treatment, particularly with low-fluence Q-switched Nd:YAG laser produced greater pigment reduction than monotherapy. RFMN is an effective and safe modality for melasma, offering advantages over pigment-directed lasers by addressing dermal mechanisms and limiting PIH risk. It may serve as a first-line energy-based therapy. Level of Evidence:3 (Therapeutic) For image description, please refer to the figure legend and surrounding text. © The Author(s) 2026. Published by Oxford University Press on behalf of The Aesthetic Society. DOI: 10.1093/asjof/ojag075 PMCID: PMC13240677 PMID: 42253423
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