A Masterclass in Microneedling: Powerful Tools for Customizable Solutions

Advances in microneedling technology offer an unprecedented ability to tailor medical microneedling therapy to each patient’s unique age, skin, and cosmetic goals. But the devices themselves can have limitations. With the goal of sharing advanced radiofrequency (RF) medical techniques and technology, Candela recently hosted a Microneedling Masterclass with an expert faculty panel to review three of its multi-modality microneedling devices: the Exceed medical microneedling pen; the Matrix multiapplication short-pulse RF device; and the Profound long-pulse RF microneedling device.

For providers seeking clinically proven, minimally invasive solutions to help patients rejuvenate skin naturally, these state-of-the-art tools target a range of concerns—from acne scars to wrinkles to cellulite—while offering deeply customizable treatments.

Candela Microneedling Masterclass Expert Panel

The panel was moderated by Candela’s SVP of Global Clinical Operations and Medical Director Konika Patel Schallen, MD, and included board-certified dermatologists and trainers Stacy Chimento, MD, Scott Gerrish, DO, James Newman, MD, and Scott Paviol, MD. (The panel’s treatment considerations are under the discretion of the qualified licensed healthcare professional. Individual healing times, discomfort, treatment results, and satisfaction can vary.)

Here’s what they covered:

• The principles of mechanical, short-pulse RF, and long-pulse RF microneedling and the clinical applications of each technique.
• Practical tips for combining microneedling and RF devices.
• Case studies showing how practitioners can use these technologies in day-to-day clinical practice.

52-year-old female before and after Exceed treatment of the periocular area. The patient received a total of 3 treatments approximately 1 month apart, targeting a depth of 0.8 mm.
(Courtesy of Stacy Chimento, MD.)

A Pen Device With Proven Results

The first dual-indicated medical microneedling treatment with FDA clearance to address facial acne scars and wrinkles, the Exceed medical mechanical microneedling pen is a handheld that relies solely on the creation of small wounds to stimulate collagen production. Instead of RF energy, the Exceed device uses a patented, 6-needle (32-gauge) cartridge with a tilting surface to create punctures in the skin at a speed of 100-150 cycles per second, making it easy to adjust treatment depth based on the patient’s clinical characteristics.¹

26-year-old female with forehead rhytids who wished to avoid neurotoxin injection. She received 3 treatments of Exceed microneedling spaced one month apart.
(Courtesy of Stacy Chimento, MD.)

According to Dr. Chimento, the Exceed device is the best option for patients who have little or no experience with cosmetic skin treatments, because it’s minimally invasive and has a low risk for post-inflammatory hyperpigmentation. “For people who have never had any sort of invasive treatments before, I would say this is the one that I would start them out with. People who are in their twenties, thirties, or forties,” she said.

And they should like what they see. In a clinical study examining the effects of the Exceed device on signs of skin aging, more than 85% of subjects had clinically meaningful improvements in glabella frown lines, periorbital lines, and cheek folds.²

For Dr. Chimento, a significant feature of the Exceed device is that it works well as part of a combination procedure. Combining treatments to target different concerns is an important part of the treatment plans for many of her patients, especially those with melasma. Chimento explained how the Exceed device’s microneedling action creates microchannels in the skin, which may increase the absorption of a variety of topical agents.

“I’ve been using a lot of topical tranexamic acid and topical vitamin C—a lot of infusions—after making those small channels,” she explained. “So anywhere from 0.3 to 0.8 depth with Exceed, and then following that with those infusions, I’m seeing a lot of great results for patients.”

In addition to topicals, the Exceed device can easily be combined with another RF device. For example, Dr. Chimento explained how she uses a light treatment with the Candela Matrix Sublative™ RF applicator (described in more detail, below) followed by the Exceed pen. “You’re not only getting that radiofrequency, that deep bulk heating for collagen, you’re also doing mechanical microneedling,” she said.

Dr. Chimento said that she’d successfully applied this technique on her patients at a variety of sites, including the face, chest, hands, and body, and says large areas can be treated quickly, with completion of a full-face treatment in 15 to 20 minutes.

Patient was treated with a combination of Sublative RF and Matrix Pro, 2 treatments 5 weeks apart.
(Courtesy of Scott Gerrish, DO.)

Exceed’s ability to penetrate deeply without damaging the outer layer of the epidermis is what makes it unique. According to Dr. Paviol, the goal of microneedling is to induce regenerative healing, not to produce damage. The scientific basis of microneedling, he explained, is the release of growth factors within the epidermis, such as TGF beta. “That stimulates a big kind of waterfall of cytokines that creates the healing process without creating a lot of inflammation,” Dr. Paviol said. “More inflammation isn’t always better. You want to get the right amount to create a positive healing environment.”

And the recovery time–even with treatments of acne scars at the device’s maximum 1.5mm depth–is fairly quick, too. “Patients who have been treated with Exceed should leave the office looking pink. There’s never a case when a patient should have significant downtime,” Dr. Chimento said.

A 3-in-1 Device for a Wide Range of Treatments

Matrix, Candela’s latest innovation in bipolar RF microneedling, incorporates three different treatment modalities into a single device: Sublime™ (which combines infrared light with bipolar RF), Sublative™ RF (which delivers RF to the skin surface via an array of multi-electrode pin tips), and Matrix Pro® (bipolar, nonablative RF energy applied through an array of microneedles). Together, the three handpieces on a single platform provide a variety of approaches to target different skin levels.³

Sublime™

The least invasive option, Sublime, uses a combination of an infrared light source and bipolar RF to produce a gradual bulk heating of the dermis, according to Dr. Schallen. This heating of the dermal collagen is intended to stimulate collagen production, shorten aged collagen fibers, and treat wrinkles non-invasively.⁴

And the results are both immediate and lasting. “You can get quite a beautiful flash effect, which starts right away and lasts for about 48 hours or so, where you get an instant brow lifting, opening, and loss of the nasal labial folds. It doesn’t leave any lasting redness at all,” Dr. Schallen explained. “You can also combine Sublime with RF microneedling on the same day.”

The image on the left shows Matrix Pro device settings and impedance values. The patient was treated at a depth of 3 mm with 2.0 J of RF energy. Needles were then autoretracted to 2 mm with 1.0 J RF. At the deeper depth of 3mm, starting impedance was 106 ohms and decreased to 79 ohms. The needles then autocycle to the subsequent depth of 2mm, where starting impedance was 112 ohms, then decreased to 88 ohms. These values show that the needles were correctly positioned in the middle of the deep dermis, and that the energy was delivered effectively. Using impedance to guide therapy can reduce pain and swelling.* The image on the right shows the patient 30 minutes after the procedure.
(Courtesy of James Newman, MD.)

Sublative™ RF

For wrinkles and dermatologic procedures that require ablation and resurfacing of the skin, the Sublative RF applicator provides exceptional results without the extended downtime of other skin resurfacing treatments. Its needle-less applicator delivers bipolar RF to heat and ablate the skin at contact points with the multi-electrode pins, stimulating collagen growth in the epidermal/dermal tissues.⁵

Matrix Pro®

With the thinnest needle array of any RF applicator available⁶—and real-time feedback for ultra-precise RF needle placement—the Matrix Pro can target up to three different depth zones with one short-pulse microneedling application, with a maximum depth of up to 3.5 mm. The semi-insulated super thin needles protect the epidermis and provide for effective and safe treatment across a variety of skin types—and can also improve patient comfort and recovery time,^* according to Dr. Schallen. The Matrix Pro can be used to produce a variety of coagulation zones and effects to correct, maintain, or restore skin.⁴

First treatment focused on the medial aspect of the arm and over the triceps using Matrix Pro. Consecutive follow-up treatments were performed circumferentially around the arm.
(Courtesy of James Newman, MD.)

Dr. Schallen noted that the Matrix Pro is similar to mechanical microneedling treatments, with the addition of RF. She explained that the thinner needles can reduce the amount of hematoma that is created in some delicate areas. “The thing that’s different about this treatment is that you can treat multiple layers in one single insertion. You can choose to treat one, two, or three layers, and you can choose to make larger areas of coagulation or smaller areas of coagulation, and you can even adjust their depths so that you’re creating one long zone of coagulation,” Dr. Schallen said.⁷

Matrix Pro’s medical-grade, 34-gauge insulated steel microneedles are Teflon-coated with an exposed needle length or thermal zone of 0.6 mm to 0.65 mm. Short pulses of RF (average <1 second) pass through the needles to create a small thermal zone at the needle tips. And, with the Matrix Pro’s built-in impedance monitoring, the operator can determine, with a high degree of precision, whether the needle is placed in the dermis, in the hypodermis, or out of the skin entirely.

Patient is shown before and after treatment with Matrix Pro applicator.
(Courtesy of Scott Gerrish, DO.)

In addition, the ability to adjust the amount of energy delivered avoids excessive denaturation of collagen and over-coagulation of the skin. Dr. Schallen also emphasized that the treatment preserves the dermal/epidermal junction. “This is especially important for people with darker skin,” she said.⁸

Before and after photographs of a patient treated with Profound. The patient was a 61-year-old female with a history of sun damage, who wished to avoid plastic surgery.
(Courtesy of Scott Paviol, MD.)

Combination Treatments Using Matrix

The panel also discussed how Sublative RF, Sublime, and Matrix Pro treatments can be combined to deeply customize each patient’s treatment plan. For example, Dr. Gerrish explained that, as with the Exceed device, the microneedling procedure opens the epidermis and creates channels through which topical agents can be applied.

Patient shown before and after treatment with Profound.
(Courtesy of Scott Gerrish, DO.)

“We take lidocaine with epinephrine, put it in a syringe with a 30-gauge needle, and mist it on the skin.^** The lidocaine penetrates these ablative holes. This creates some skin blanching, which indicates that good penetration has been achieved, and adds some numbing for the patient. Also, it adds skin tension, which improves the penetration of the needle into the skin. Using Sublative RF first can also add tension to the skin by creating micro swelling, which improves penetration of microneedling,” Dr. Gerrish said.

Patient shown before and after treatment with Profound.
(Courtesy of Stacy Chimento, MD.)

Another benefit is that the combination of Sublative RF with Matrix Pro provides two treatments in which healing takes place over different time courses. Patients may be more satisfied when they begin to see cosmetic improvements in weeks rather than months, and with the Sublative RF treatment, microscopic swelling resolves over the first few weeks, while the collagen remodeling process induced by Matrix Pro can continue for several months.

42-year-old female with submental laxity and loss of jawline definition. Patient shown before and after treatment with Profound (1 treatment, dermal applicator/cartridge only, 550 total pulses).
(Courtesy of Stacy Chimento, MD.)

“The most common thing we see when we combine treatments is patients who come back a week to two weeks out, saying, ‘I am getting more compliments on my skin,’ which would not be usual if you were using one modality by itself,” said Dr. Gerrish.

Treating Skin in Other Areas of the Body

Dr. Gerrish described how the impedance values can be especially helpful when using Matrix Pro at sites other than the face. High impedance values at deeper levels can indicate that the tip is positioned into fatty tissues; whereas high impedance values for more superficial positioning may indicate that needles are not inserted completely, and coagulation is being produced at the surface of the skin.

“The stomach and arms are tough because you don’t have bone or a firm backing to help with the needle penetration,” he explained. “Pushing harder doesn’t get you to where you want to be. You have to put some traction on the skin but having that feedback of your impedances does help to let you know where you’re at.”

Dr. Paviol noted that the Matrix Pro’s applicator settings can be customized for different sites. For example, the typical parameters he uses in his practice are 1.2 to 1.5mm depth, with RF energy of 0.5 or 1.0 J. When he treats skin along the jawline, he says it might require insertions of 1.5 to 2 mm, with RF energy of 1.5 to 2.0 J. Dr. Paviol also noted that the Matrix Pro can be combined with the Frax 1940 non-ablative fractional diode laser treatment for a combined short-term and long-term recovery effect.

54-year-old female with jowling and skin laxity in the lower face. Patient shown before and after treatment with Profound (1 treatment, dermal applicator/cartridge only, 500 total pulses) and Sublative RF (3 treatments of the neck).
(Courtesy of Stacy Chimento, MD.)

For some areas that require more substantial improvement, Dr. Chimento described how in her practice, she applies Sublative RF, typically performing two to three passes at high energies. “There is a longer recovery time, but it produces substantial tissue shrinkage,” she said.

An Advanced Long-pulse RF Microneedling Device System

With a 25°-angle dermal handpiece and cartridge for wrinkles, and a 75°-angle SubQ handpiece and cartridge for cellulite, the Profound system delivers bipolar RF energy through microneedles into the dermal and subcutaneous layers beneath the surface of the skin. Temperature sensors in the microneedles ensure the optimal dose of energy for precisely the right time at precisely the right temperature to partially denature collagen and create new elastin.⁹

Though Profound is a single-treatment procedure, it requires more anesthesia and a longer recovery time than the Exceed device or Matrix system. But the results speak for themselves. Profound’s long-pulse RF energy delivery mechanism creates all three skin fundamentals, including up to five times the amount of elastin in the skin, twice the collagen, and increased hyaluronic acid.⁹ “Having that long RF pulse stimulates neoelastogenesis, which we don’t see with traditional CO2 laser or with Erbium laser devices, where you get a little bit more fibrosis or collagen,” said Dr. Newman. According to Dr. Newman, this method of RF microneedling results in increased skin elasticity and a greater self-rated and physician-rated appearance of the skin.¹⁰

As with the Exceed device and Matrix system, Profound can be combined with other treatments. For older patients, Dr. Newman noted that the Profound can be followed by Matrix Pro after a recovery period of 6 months (or until the treated area has healed). Dr. Newman also noted that adding Sublative RF, an ablative treatment for the skin surface, is another option for combination therapy with Profound. “We’re able to treat all the different levels of the skin, the elastin and the collagen, the epidermis, and the fine pigment.”

To set expectations post-procedure, the panel agreed that doctors should explain to patients that the swelling and inflammation produced by Profound are part of the wound healing response and contribute to its beneficial effects. “I try to discourage patients from using ice. No anti-inflammatories. If there’s any bruising, I will bring them in the next day to do my pulsed dye laser, which I think significantly improves healing time,” said Dr. Chimento.

A Lifelong Pathway for Healthy Skin

For doctors eager to provide diverse strategies for nonsurgical patients, Candela’s array of microneedling devices offers a lifelong pathway of customizable solutions. From Exceed’s motorized precision to Matrix’s versatile short-pulse RF technology to Profound’s long-pulse RF method, Candela continues to push the boundaries of minimally invasive skin revitalization. Combined, these techniques provide a variety of options to customize skin care and target multiple layers of tissue to improve skin elasticity and cosmetic appearance.

*Profound Matrix system FUFT2002 Clinical Study Report_DHF03167. Treatment considerations are under the discretion of the qualified licensed healthcare professional. Individual healing times, discomfort, treatment results and satisfaction can vary.

** Anesthetic agents have systemic as well as local effects. Medication calculations assume weight-based toxicity and vary depending on type of agent, concentration of agent, manufacturer, country recommendations, patient-specific, site-specific, and block-specific factors. Administration of medications should be individually assessed by the qualified healthcare professional. Treatment considerations are under the discretion of the qualified healthcare professional.

1. Exceed Microneedling Device 510(k) Clearance (K182407). July 2019.

2. Ablon G. Safety and Effectiveness of an Automated Microneedling Device in Improving the Signs of Aging Skin. J Clin Aesthet Dermatol. 2018 Aug;11(8):29-34. Epub 2018 Aug 1. PMID: 30214664; PMCID: PMC6122507.

3. Profound Matrix 510(k) Clearance (K211217). December 2021.

4. Schallen KP, Dest N, Friedman D. Novel RF Microneedling Applicator for Wrinkle Reduction and Scar Treatment. ePoster presented at ASLMS 2022, the 41st annual conference of the American Society for Laser Medicine and Surgery, Inc.

5. Huang J et al, Rejuvenation Res. 2018 Apr;21(2):117-122.

6. Based on publicly available specifications as of October 2022.

7. Weiner, SSF. Radiofrequency Microneedling: Overview of Technology, Advantages, Differences in Devices, Studies, and Indications. Facial Plast Surg Clin North Am. 2019 Aug;27(3):291-303

8. The Matrix Pro applicator is indicated for general dermatological procedures for electrocoagulation and hemostasis.

9. Hantash BM, Ubeid AA, Chang H, Kafi R, Renton B. Bipolar fractional radiofrequency treatment induces neoelastogenesis and neocollagenesis. Lasers Surg Med. 2009 Jan;41(1):1-9. doi: 10.1002/lsm.20731. PMID: 19143021.

10. Willey A, Kilmer S, Newman J, et al. Elastometry and clinical results after bipolar radiofrequency treatment of skin. Dermatol Surg. 2010;36(6):877-884.