Radiofrequency microneedling, also called RF microneedling, has become increasingly popular with patients seeking skin rejuvenation. The treatment uses a combination of technologies that have been used individually for many years. When used together they are intended to have synergistic effects to increase collagen production and improve skin tone and texture. While not as painful as some more invasive treatments, RF microneedling still requires a numbing cream to get the best results and ensure a comfortable experience. The most powerful numbing creams available are those that are made by compounding pharmacies with combinations of anesthetics.

What is RF Microneedling?

RF microneedling combines two proven techniques for improving the appearance of the skin. Radiofrequency uses heat to stimulate collagen production. Microneedling uses needles to make small perforations that lead to tightening of the skin as it heals. These “micro-injuries” encourage the body’s natural wound healing process to help repair the skin. New fibroblasts are also stimulated which results in increased collagen production.

Collagen is essential to maintaining healthy, youthful skin. It is a structural protein that helps keep skin firm and unwrinkled. Declining collagen production is associated with age and is one of the main reasons facial skin starts to look older. The combination of increased collagen production and stimulation of skin renewal makes RF microneedling ideal for treating scarring, wrinkles and fine lines, stretch marks, and sun-damaged skin.

Examples of RF microneedling devices include Vivace, Infini Lutronic, Intesif, Intracel, Fractora, Secret RF, Venus Viva, and more. Many different types of devices are available, both because the treatment is popular and because radiofrequency and microneedling are well-established technologies in dermatology.

Benefits of Treatment

Many patients will see some improvement after one RF microneedling treatment, but usually a series of 3 to 4 treatments is recommended to achieve the best results. The treatments are spaced 4 to 6 weeks apart. Collagen production will increase over the months following treatment, with the best results noticeable in about 3 months.

Benefits of RF microneedling compared to other treatments include that it has little downtime and can be used in areas of the body besides the face. CO2 lasers are effective at resurfacing the skin but require downtime for the skin to heal. These more abrasive lasers are only recommended to be used on the face. Devices used for RF microneedling often come with customization options to change the depth of needle penetration. The needle depth may range between 0.5mm to 3.5mm to target different layers of the skin. They also may come with both insulated and non-insulated needles, to change where the heat is being applied. These customizations make RF microneedling easier to use on other parts of the body.

RF Microneedling Numbing Cream

RF microneedling involves the use of small needles that are inserted into the skin. A microneedling pen often has between 25 to 64 individual needles on its tip. The needles combined with the radiofrequency heat can be uncomfortable for many patients. With the use of a numbing cream, however, the procedure is made much easier. Patients are more likely to return for the full 3 to 4 treatments when the first experience is made comfortable by the use of a topical numbing cream.

Commercially available numbing creams include lidocaine, benzocaine, and other anesthetics. Lidocaine can commonly be found in strengths of 2.5% to 10%. There are no commercially available formulations that include benzocaine, lidocaine, and tetracaine together in one cream. However this combination can be made by a compounding pharmacy from raw ingredients and is sometimes called BLT Cream. Some examples of benzocaine, lidocaine, tetracaine formulations that can be compounded include:

As you can see on the RealSelf website, which is a popular community for asking doctors questions about cosmetic procedures, most doctors choose to use a compounded numbing cream for deep microneedling.

Numbing Cream Tips for RF Microneedling

When using a numbing cream for RF microneedling, the cream should be applied about 30 minutes before the procedure. Before the procedure starts it is important to thoroughly remove the cream from the skin. Any cream that is left over can potentially be pushed deeper into the dermis by the needles. It is expected that a treatment will taken between 20 to 45 minutes, bringing the total time to between 1 to 2 hours when including the time to numb the skin.

Who Can Use BLT Cream?

Due to the high potency of the anesthetic ingredients, this cream should only be used by dermatologists. Benzocaine, lidocaine, tetracaine cream misuse can potentially lead to adverse effects. A prescription is always required to obtain BLT cream from a compounding pharmacy. The cream is for application only in a dermatologist’s office, not for at-home use by patients.

Occlusion and Numbing Creams

While many over-the-counter numbing creams are occluded to increase their anesthetic effects, this is generally not recommended with compounded topical anesthetics. The higher strengths make occlusion either unnecessary or potentially dangerous. Increasing serum concentrations of topical anesthetics, which can occur with occlusion, can potentially lead to adverse effects.

Surface Area for Application

Another important application tip is to apply compounded topical anesthetics to only the minimum area needed. Do not apply them to large areas like an entire leg. Applying anesthetic to a large area increases the surface where the anesthetic ingredients can absorb into the blood. This can potentially lead to adverse effects. If a large area is being treated, anesthetize the area in smaller sections or schedule the treatment to be completed in multiple sessions.  

Numbing is Essential for RF Microneedling

Reducing patient discomfort should not be considered just a luxury, but a necessity to get the best results. When the patient is stressed, this often transfers to the practitioner and can reduce the effectiveness of the treatment. A compounded topical numbing cream like BLT cream can ensure a positive patient experience and good treatment outcomes.