1. Introduction

Aged skin displays various signs of aging, including increased wrinkles, skin laxity, and loss of elasticity [1]. In contrast to the typical wrinkles and rhytides observed on the aged face, aging of the neck is primarily characterized by horizontal wrinkles, manifesting as linear grooves or furrows on the anterolateral sides of the neck [2]. This appearance is often referred to as the telltale sign of aging, as rejuvenating the neck region presents unique challenges in achieving satisfactory cosmetic outcomes [3]. Therefore, the pursuit of noninvasive yet effective methods for neck rejuvenation has long been a focus within the field of esthetic medicine. While surgical interventions have historically been the primary approach for addressing neck laxity and skin aging, the emergence of minimally invasive technologies has revolutionized the landscape of esthetic procedures. Current noninvasive and minimally invasive treatments for neck laxity include laser therapy, chemical peeling, botulinum toxin, and fillers [4–6]. While effective, these approaches have limitations such as temporary results, uneven skin tightening, and potential adverse effects.

Among these innovations, microneedle radiofrequency (RF) devices have gained significant attention for their ability to deliver precise and controlled energy to targeted layers of the dermis [7]. By combining the principles of microneedling with RF energy, these devices offer a versatile solution for stimulating collagen production, tightening lax skin, and improving overall texture and tone. The use of insulated microneedles allows for selective heating of dermal tissue while minimizing damage to the epidermis, thereby enhancing safety profiles and reducing downtime compared to traditional ablative procedures.

Recently, a novel microblade RF device has been developed, featuring dual-length needles designed to intensify respective effects on the papillary and reticular dermis [8]. While microneedle RF technologies have demonstrated efficacy in skin rejuvenation, their penetration and energy distribution remain suboptimal for treating horizontal neck wrinkles. The variation in the shape of the microblade, resembling a hexagonal column, was specifically designed to enhance tissue regeneration and biostimulation, facilitate improved energy delivery and tissue penetration, and optimize outcomes by precisely targeting specific dermal layers, addressing the limitations of conventional microneedle RF treatments.

In this study, we performed a novel microblade RF procedure using the microblade RF device on aged neck skin. Our objective was to evaluate the outcomes of this device for nonsurgical neck rejuvenation.

2. Materials and Methods

3. Results

3.1. Subjects and Efficacy Outcomes

All 12 participants (11 female and 1 male) completed the study without dropouts and were included in the final analysis (Table 1). The mean age was 61 ± 9.19 years (range: 51.8–68.8 years). While confounders were not formally adjusted for, factors such as participant age, gender, and baseline skin condition were considered in the study design, recognizing that middle-aged and older women are primarily seeking demographic treatment for neck wrinkles. The mean HNWS score at baseline was 2.58 ± 0.49 (range: 2–3), indicating moderate to severe, deeply etched neck wrinkles. By Visit 2, which occurred 4 weeks after the initial treatment session, the HNWS score decreased to 1.58 ± 0.49. By Week 12, it further decreased to 1.33 ± 0.62.

Table 1. Baseline demographics.

Age (years)	61 (8.8)
Gender (female)	11 (91.7%)
Corneometer	68.3 (13.6)
TEWL	15.6 (7.5)
R2 value	63.2 (11.6)
Horizontal neck wrinkle scale
Grade 2	5
Grade 3	7
Fitzpatrick skin type
3	7
4	5

• Note: Data are means (SD) or numbers (%).

The regression coefficient, with 95% confidence intervals, for the time effect in the linear mixed-effect model on the HNWS score was −0.625 (−0.757 to −0.493) (Table 2). A coefficient > 0 indicates an increase over time for the respective variable, while a coefficient < 0 signifies a decrease. The p value was < 0.001, indicating a significant improvement in horizontal neck wrinkles over time. The representative case is shown in Figure 1.

Table 2. Changes in each repeated measurement.

Index	Coefficient (95% CI)	p value
Corneometer	9.047 (5.491∼12.603)	< 0.001
Tewameter	−3.498 (−4.528∼−2.467)	< 0.001
Cutometer R2	10.258 (6.872∼13.645)	< 0.001
Cutometer R5	14.100 (11.456∼16.744)	< 0.001
Cutometer R7	11.642 (9.657∼13.626)	< 0.001
Horizontal neck wrinkle scale	−0.625 (−0.757∼−0.493)	< 0.001

• Note: Coefficient (95% CI): regression coefficient and 95% confidence intervals for the time effect in the linear mixed effect model. A coefficient > 0 indicates an increase over sessions for the respective variable, while a coefficient < 0 signifies a decrease.

Both dermatologist-reported GAIS and patient-reported GAIS indicated better improvement at Visit 3 compared to Visit 2. For dermatologist-reported GAIS, the scores were 2.83 ± 0.37 at Visit 2 and 2.08 ± 0.64 at Visit 3, reported as improved to much improved. Similarly, for patient-reported GAIS, there was greater improvement at Visit 3 (2.67 ± 0.47) compared to Visit 2 (3 ± 0) (Figure 2).

Significant improvements were observed in the objective measurement of skin biophysical properties following the procedure, as obtained by the corneometer, tewameter, and Cutometer. Skin hydration increased at both Week 4 and Week 12, while TEWL decreased, indicating improved skin barrier function. Additionally, the skin elasticity indices, as determined by R2, R5, and R7 values measured by the Cutometer, showed consistent improvement at Week 4 and Week 12 (Table 3, Figure 3).

Table 3. Paired comparison of repeated measurements.

Variable	Reference	Comparison	Comparison—reference	p value
Corneometer	0 week	4 weeks	8.65 (1.49∼20.02)	0.064
	0 week	12 weeks	19.02 (10.38∼27.89)	0.003
Tewameter	0 week	4 weeks	−3.20 (−5.05∼−1.25)	0.007
	0 week	12 weeks	−5.10 (−9.05∼−3.88)	< 0.001
Cutometer R2	0 week	4 weeks	8.20 (2.07∼21.27)	0.001
	0 week	12 weeks	21.55 (9.72∼31.60)	< 0.001
Cutometer R5	0 week	4 weeks	13.45 (6.53∼27.65)	< 0.001
	0 week	12 weeks	27.65 (17.97∼36.98)	< 0.001
Cutometer R7	0 week	4 weeks	13.45 (6.37∼21.75)	0.003
	0 week	12 weeks	26.50 (15.75∼29.42)	< 0.001

• Note: Variables are expressed as median (interquartile range). p values are computed using the Wilcoxon signed-rank test and adjusted for multiple comparison using the Bonferroni method.

4. Safety Outcomes

Treatment-related local adverse effects such as mild-to-moderate edema and erythema occurred in all patients. The symptoms subsided in a few days after treatment. All the patients completed the study. No serious side effects were reported.

5. Discussion

The pursuit of effective neck rejuvenation methods has been a longstanding challenge in esthetic medicine due to the unique characteristics of aging observed in the neck region [13]. Traditional surgical interventions have historically been the primary approach for addressing neck laxity and skin aging [14, 15]. Surgical treatment for neck wrinkles, such as neck lifts, can lead to complications including bleeding, infection, scarring, changes in skin sensation, and dissatisfaction with results, which may sometimes necessitate revision surgery [14, 16]. However, the emergence of minimally invasive technologies, such as microneedle RF devices [17], has provided alternative options with potentially improved safety profiles and reduced downtime—chemical peeling, laser resurfacing, dermal fillers, botulinum toxin, and RF therapy. These treatments are generally well-tolerated and can provide clinical improvements with minimal downtime compared to more invasive procedures.

In this study, we evaluated the efficacy of a novel microblade RF device for nonsurgical neck rejuvenation. Our results demonstrate significant improvements in horizontal neck wrinkles, as HNWS scores improved by an average of 35%, while skin elasticity increased by 22%. The observed improvement in the HNWS score aligns with previous findings that microneedle RF devices stimulate collagen production and tighten lax skin, resulting in overall improvement in skin texture and elasticity.

Unlike laser therapy, which primarily targets superficial layers, the microblade RF device delivers controlled energy to deeper tissue, enhancing long-term collagen remodeling. While botulinum toxin and fillers provide immediate results, their effects are temporary, typically diminishing within 3–6 months without significant preventative benefits against further wrinkle formation. In contrast, microblade RF stimulates collagen remodeling, offering longer-lasting improvements in skin elasticity and structure. Additionally, by strengthening the skin’s internal support system, this technology helps to prevent further wrinkle development over time.

Recent insights have revealed that the well-known process of dermal remodeling and rejuvenation following RF stimulation [18, 19] is attributed to the removal of accumulated senescent fibroblasts, which are more susceptible to heat compared to younger cells [20]. The buildup of these dysfunctional yet living fibroblasts disrupts the synthesis of the dermal matrix and the integrity of the epidermal structure, leading to the characteristic aging of skin tissues [21]. Various RF-based devices designed to transfer heat to the dermal layer have been suggested to induce skin rejuvenation by eliminating these heat-sensitive senescent fibroblasts. In particular, the precise delineation of targets using dual-length blades, specifically targeting the papillary and reticular dermis, proves to be a successful approach for achieving comprehensive rejuvenation across all skin layers [22, 23].

The thermal injury induced by RF energy promotes the synthesis of collagen and elastin, critical components of the extracellular matrix (ECM) [24]. Increased ECM production enhances skin structural integrity and supports barrier function by reinforcing the dermal-epidermal junction [25]. The procedure also influences the expression and organization of tight junction proteins in the epidermis, such as occludin and claudins. Improved tight junctions strengthen the skin barrier, reducing TEWL and increasing skin hydration [26]. Additionally, the hydration provided by HA supports the newly formed collagen and elastin, enhancing their functionality and integration into the skin matrix. HA’s volumizing and hydrating effects can provide immediate smoothing of fine lines and wrinkles, while its support of skin hydration sustains improvements in conjunction with the RF-induced structural changes [27].

The results of this study should be interpreted in acknowledgment of some limitations. First, the sample size was small, limiting the generalizability of the results. We could not determine the possible difference according to skin types. Also, limitations of this study include the absence of a control group, potential observer bias, and a short 12-week follow-up, preventing assessment of long-term effects. Future studies should include larger sample sizes, longer follow-up durations, and direct comparisons with other minimally invasive treatments.

In conclusion, our study demonstrates the efficacy and safety of the microblade RF device for nonsurgical neck rejuvenation. Data indicated low to no downtime and high patient satisfaction. The significant improvements in horizontal neck wrinkles, as well as objective measurements of skin biophysical properties, underscore the potential of this technology as a valuable tool in the armamentarium of esthetic procedures for neck rejuvenation.

Conflicts of Interest

The authors declare no conflicts of interest.

Funding

No funding was received for this research.