Radiofrequency-Based Treatments for Facial Rejuvenation: A Systematic Review of Efficacy, Safety, and Patient-Centered Outcomes

Abstract

Background

Radiofrequency (RF) devices are widely used for noninvasive facial rejuvenation, but evidence on patient-centered outcomes remains heterogeneous and variably reported.

Objectives

To synthesize evidence on the aesthetic, safety, tolerability, and psychological outcomes of RF treatments for facial rejuvenation.

Methods

A systematic review was conducted in accordance with PRISMA and JBI guidelines. Databases (PubMed, Embase, CENTRAL, and LILACS) were searched for studies published between 2015 and 2025. Risk of bias was assessed using a JBI tool. A thematic synthesis was performed for aesthetic outcomes, patient satisfaction, and safety. The confidence of findings was evaluated using the GRADE-CERQual approach.

Results

Fifteen studies were included, comprising a total of 1230 participants. RF treatments consistently improved aesthetic outcomes. Skin texture improved in 71% to 100% of patients (4 studies), and skin firmness improved in 52.9% to 100% (2 studies). High patient satisfaction was demonstrated, with rates ranging from 82% to 100% (13 studies). The safety profile was favorable; adverse events were mild and transient (erythema: 17.6%-100%; edema: 5.3%-26.5%), and no serious complications were reported. Mean pain scores were low (1.94/10 VAS). GRADE-CERQual assessment showed moderate confidence in these findings. A key limitation was the universal underreporting of downtime.

Conclusions

Evidence indicates RF treatments for facial rejuvenation yield meaningful aesthetic improvements, high patient satisfaction, and an excellent safety profile. However, these conclusions are tempered by methodological limitations in the primary literature. Future research should employ rigorous designs, standardized outcome measures, and report on downtime to strengthen the evidence base.

Level of Evidence: 4

Radiofrequency (RF) has gained significant traction as a minimally invasive aesthetic modality for skin rejuvenation, particularly in facial and neck applications. Unlike ablative techniques, nonablative RF delivers heat energy to the dermis while sparing the epidermis, thereby stimulating collagen remodeling and neocollagenesis without surface damage or significant downtime.^1,2 This mechanism has made RF devices increasingly popular for addressing common signs of cutaneous ageing, including laxity, fine lines, and loss of skin firmness.³

Early studies highlighted the ability of RF technologies to achieve visible tissue tightening through subdermal heating, and newer approaches have continued to refine treatment protocols by incorporating fractional modes or microneedling to enhance depth control and collagen induction.^4,5 As a result, RF devices have become a mainstay in aesthetic dermatology, favored for their balance between efficacy, tolerability, and safety in diverse skin types.

Nevertheless, much of the existing literature focuses predominantly on technical parameters and objective efficacy measures. In contrast, subjective outcomes, such as patient-reported satisfaction, tolerability, perceived improvement, and expectations, remain underexplored and inconsistently reported. Given the inherently perceptual and satisfaction-driven nature of cosmetic interventions, a comprehensive understanding of the patient's experience is essential.

This systematic review aims to bridge that gap by synthesizing evidence on the experiential, subjective, and qualitative outcomes associated with nonablative RF treatments for facial and neck rejuvenation in adults. In doing so, it complements the existing clinical literature by foregrounding patient perspectives, safety experiences, and satisfaction, all of which are critical elements to informed decision-making and patient-centered care in aesthetic practice.

METHODS

The protocol for this systematic review was prospectively registered in PROSPERO (CRD420251081170). The review followed PRISMA 2020 guidelines for reporting systematic reviews.

Information Sources and Strategy

A systematic search was conducted in PubMed, Embase, Cochrane CENTRAL, and LILACS for studies published between January 1, 2015, and March 15, 2025. The search strategy combined MeSH/Emtree terms and free-text keywords related to radiofrequency and facial rejuvenation (see Appendix A, available online at https://doi.org/10.1093/asjof/ojaf159, for the complete strategy). The search was limited to English-language publications.

Study Selection and Screening

Two reviewers (N.K. and D.H.S.) independently screened titles and abstracts. The lead reviewer (N.K.) then assessed the full text of all potentially eligible studies against our eligibility criteria and documented all reasons for exclusion. We employed this single-reviewer approach for the full-text stage due to resource constraints. To safeguard against error, a second reviewer (D.H.S.) verified the exclusion decisions for a randomly selected 20% of the studies. No discrepancies were identified during this verification process.

Data Extraction

The lead reviewer (N.K.) performed the initial data extraction into a standardized template. To ensure accuracy, a second reviewer (D.H.S.) then cross-checked the extracted data from all studies. The two reviewers discussed any instances of disagreement until they reached a consensus.

Quality Appraisal (Risk of Bias)

The methodological quality of included studies was assessed by a single reviewer (NK) using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research, adapted for this review. Due to resource constraints, a second independent reviewer was not utilized for this specific task. To ensure consistency and minimize potential for bias, the reviewer applied the checklist in a standardized, pre-piloted manner, and all appraisal decisions were subsequently reviewed and confirmed by a second reviewer (D.H.S.). This approach is acknowledged as a limitation of the review.

Data Synthesis

A thematic synthesis was performed. Findings were analyzed across three pre-specified domains: (1) Aesthetic Outcomes, (2) Satisfaction and Psychological Impact, and (3) Safety and Tolerability. Due to significant heterogeneity, a narrative synthesis was conducted. The confidence in findings was evaluated using the GRADE-CERQual approach. A detailed summary of the CERQual assessments for each key finding is available in Appendix B, available online at https://doi.org/10.1093/asjof/ojaf159.

Assessment of Heterogeneity

Heterogeneity among included studies was assessed qualitatively, considering variability in RF technologies, treatment parameters, outcome measures, and participant characteristics. This high degree of heterogeneity informed the decision to perform a narrative synthesis, as a meta-analysis was not feasible. The overall confidence in the synthesized findings was evaluated using the GRADE-CERQual approach.

RESULTS

Study Selection

A total of 1445 articles were identified through database searching and additional sources. After removing duplicates and applying inclusion criteria, 15 articles were included in the final synthesis (see PRISMA diagram, Figure 1).

Figure 1.

PRISMA 2020 flowchart illustrates the identification, screening, eligibility, and inclusion of studies. Numbers correspond to records at each phase (n = 1445 initial records; n = 15 included).

Characteristics of Included Studies

The 15 included studies comprised one randomized controlled trial,⁶ 3 prospective cohort series,^7-9 and 11 case series.^10-20 Studies were conducted in North America (n = 2),^8,11 Europe (n = 2),^14,17 and Asia (n = 9),^{9,10,12,13,15,16,18-20} with two studies not reporting its location.^6,7 A total of 1230 participants were enrolled across all studies. The cohort was predominantly female (n = 1048), with 137 male participants; one study (n = 45) did not report gender distribution.⁸ Interventions included monopolar (n = 7),^{6,7,9,12,13,15,20} bipolar (n = 4),^10,11,14,17 fractional (n = 2),^16,18 multipolar (n = 2)^8,19 RF systems. The key characteristics of the included studies are summarized in Table 1. Detailed data extracted from each of the 15 selected studies, including intervention type, study design, population characteristics, outcome domains, and experiential findings, are provided in Appendix D, available online at https://doi.org/10.1093/asjof/ojaf159.

Table 1.

Characteristics of Included Studies

First author, year	Country	Study design	Participants (n, F/M)	RF modality	Key outcomes measured
Alhaddad, 20199	Not Reported	RCT	20 (20/0)	Monopolar	GAIS, Patient Satisfaction
Bai, 20251	China	Case Series	46 (43/3)	Bipolar	GAIS, ACGS, Satisfaction
Cook, 20218	USA	Case Series	745 (639/106)	Bipolar	Satisfaction, Adverse Events
Hwang, 20246	Korea	Case Series	50 (50/0)	Monopolar	Satisfaction, VAS Pain
Menayo, 202212	Spain, Portugal	Case Series	65 (65/0)	Fractional Bipolar	Satisfaction, Wrinkle Severity
Seungwon, 20242	Republic of Korea	Case Series	21 (18/3)	Monopolar	GAIS, WSRS, Satisfaction
Thanasarnaksorn, 20173	Thailand	Case Series	55 (33/22)	Fractional	GAIS, Satisfaction
Yang, 202510	South Korea	Case Series	13 (13/0)	Monopolar	GAIS, Satisfaction
Palmieri, 202314	Italy	Case Series	62 (62/0)	Bipolar	Satisfaction, Skin Hydration/Elasticity
Kim, 20177	Korea	Case Series	10 (10/0)	Monopolar	Improvement Scale, Patient-Reported Improvement
Park, 201611	South Korea	Prospective Study	17 (15/2)	Monopolar	Satisfaction, Physician Assessment, VAS Pain
Angra, 20215	Not Reported	Prospective Study	40 (39/1)	Monopolar	GAIS, Satisfaction
Ai, 20234	China	Case Series	22 (22/0)	Multipolar	GAIS, VAS Satisfaction
Sadick, 201613	USA	Prospective Study	45 (not reported)	Multisource	Elasticity, Collagen Content, Satisfaction
Baek, 202315	South Korea	Case Series	19 (19/0)	Multifrequency	GAIS

ACGS, Alexiades Comprehensive Grading Scale; GAIS, Global Aesthetic Improvement Scale; VAS, Visual Analog Scale; WSRS, Wrinkle Severity Rating Scale.

Methodological Quality and Risk of Bias of Included Studies

The quality assessment of the included studies showed consistent strengths and weaknesses. Most studies had clear goals and used appropriate methods. However, we identified common limitations. A majority of studies failed to describe their theoretical framework or consider researcher influence, as assessed by the JBI checklist. Furthermore, ethical approval was not consistently reported; an explicit statement of IRB or ethics committee approval was absent in 5 of the included studies.^{8,11,12,16,17} Other frequently noted limitations included small sample sizes and a lack of control groups. The checklist was independently applied to all 15 included studies. Full results of the risk of bias assessment are summarized in Appendix C, available online at https://doi.org/10.1093/asjof/ojaf159. Items related to philosophical positioning and researcher reflexivity (eg, whether researchers were theoretically located within the study or considered their influence on the findings) were frequently rated “No” or “Unclear.” This reflects common limitations in the reporting of clinical or observational studies that incorporate experiential outcomes, rather than fundamental methodological flaws. The checklist was applied independently to each of the 15 included studies.

Aesthetic Outcomes

Across the included studies, improvements in perceived aesthetic outcomes were widely reported, particularly in domains associated with skin quality, texture, firmness, and tone. A thematic synthesis of clinician- and patient-reported outcomes allowed the identification of five main subthemes (Table 2), which are described below.

Table 2.

Summary of Key Findings by Thematic Category

Theme	Key finding	Magnitude of effect (Range)	Supporting studies	Total patients (n)
Aesthetic Outcomes	Improvement in skin texture	71% to 100% of patients	4/15	1448,9,12,16
	Improvement in skin firmness	52.9% to 100% of patients	2/15	907,10
	Patient-perceived lifting effect	>50% improvement in 100% of patients	1/15	1011
Safety and tolerability	Incidence of transient erythema	17.6% to 100% (procedure-dependent)	9/15	9126-8,11-13,15-17
	Incidence of transient edema	5.3% to 26.5%	9/15	9126-8,11-13,15-17
	Mean pain score (0-10 VAS)	1.94 ± 0.66	4/15	1286,7,10,16
Satisfaction	Patient satisfaction rate	82% to 100%	13/15	11496-17,19
	Willingness to recommend procedure	93.2% of patients	1/15	74517

Data are presented as the range of results reported across the included studies. The denominator for supporting studies is the total number of included studies (n = 15).

Skin Texture

Improvements in skin texture were a key finding, specifically reported in 4 of the 15 included studies. The outcomes were consistently positive across these investigations. In a study of monopolar RF for submental rejuvenation,⁹ 82.3% (14/17) of patients exhibited short-term improvement in texture, with 52.9% (9/17) maintaining improvements at long-term follow-up. A prospective trial of monopolar RF for the face and neck⁷ demonstrated clinician-assessed improvements in texture in 100% (40/40) of participants at 12 weeks, as confirmed by blinded evaluators. Treatment with fractional RF¹⁶ resulted in >75% textural improvement in 71% of patients after three sessions. Furthermore, a study on home-based multipolar RF¹⁹ showed measurable improvement in perioral wrinkles via 3D imaging in all 22 patients by week 4. These improvements were corroborated by objective measures, including ultrasound, tape-based assessments, and the Fitzpatrick Wrinkle Classification Score. Evidence was appraised with moderate confidence under the GRADE-CERQual framework.

Skin Firmness

Improvements in skin firmness and laxity were evaluated in 2 of the 15 included studies. Patient-reported data from a study of 50 patients undergoing monopolar RF treatment¹² found that 52.9% (26/50) of participants explicitly reported an improvement in skin laxity. Clinician-reported outcomes from a separate prospective clinical trial⁷ substantiated these perceptions; a blinded assessment of 40 patients using the Global Aesthetic Improvement Scale (GAIS) demonstrated visible improvements in skin firmness in 100% (40/40) of participants at the 12-week follow-up. The confidence in this finding (improvement in skin firmness) was assessed as low to moderate using the GRADE-CERQual approach, due to the small number of studies.

Lifting Effect

The lifting effect of RF-based treatments was directly evaluated in 1 of the 15 included studies. In a pilot investigation using a monopolar ultrahigh-frequency device (40.68 MHz) for facial contouring,¹³ clinician evaluation of standardized photographs indicated that 100% (10/10) of participants achieved more than 50% improvement in jawline and jowl contour immediately after a single treatment. These results were sustained at the 8-week follow-up assessment. The evidence supporting a subjective lifting effect was considered less robust; our confidence in this specific outcome was rated as low on the GRADE-CERQual scale because it currently rests on the findings of a single pilot investigation.

Rejuvenation and Youthful Appearance

Improvements in overall facial rejuvenation and youthful appearance were reported in 5 of the 15 included studies, encompassing clinical and home-use devices. In clinical settings, the outcomes were notable. One trial using bipolar RF found clinician-assessed GAIS scores showed partial to significant improvement in all patients (100%, 46/46), a result reinforced by independent evaluators who observed clear enhancement in periocular wrinkles.¹⁰ Similarly, a study on monopolar RF demonstrated significant improvement in periorbital wrinkles and overall rejuvenation in 100% of patients (13/13) at the 16-week follow-up.²⁰ Patient-reported data from one study (n = 50) confirmed visible effects within one month that were sustained for three months.¹² For home-use devices, clinician assessment of multipolar RF confirmed improvement in perioral wrinkles in 100% (22/22) of participants by week 4, as assessed by 3D imaging.¹⁹ Furthermore, a consumer perception study of a multisource RF device found that over 50% of users (23/45 patients) reported perceived improvements in tightness, freshness, smoothness, and wrinkle reduction.⁸ According to the GRADE-CERQual evaluation, the certainty of this evidence was judged to be moderate.

Tone and Brightness

Improvements in skin tone and brightness were specifically quantified in 2 of the 15 included studies. In a study of fractional RF for skin resurfacing,¹⁶ clinician-assessed improvements in tone were progressive. After the third treatment session, 71% (39/55) of the participants demonstrated more than 75% improvement in tone, 26% (14/55) achieved 51%-75% improvement, and 3% (2/55) showed 25%-50% improvement. No patients (0/55) experienced less than 25% improvement. These findings on tone were part of broader improvements in skin quality that also included texture. A study on submental rejuvenation with monopolar RF⁹ also reported improvements in tone for 82.3% (14/17) of patients short-term, which was sustained for 52.9% (9/17) at long-term follow-up. This study used instrumental assessments, including ultrasound, to objectively corroborate the clinical findings of improved skin quality. The confidence in this finding (improvement in tone) was assessed as low to moderate using the GRADE-CERQual approach, due to the small number of studies.

Safety, Pain, and Tolerability

Adverse Effects

Adverse events (AEs) were systematically reported in 9 of the 15 included studies, encompassing a total of 980 patients. Most reported side effects were minor and short-lived, with no serious complications. No serious or permanent complications were reported.

The most common AEs were erythema and edema. Their incidence varied: erythema was reported in 17.6% of patients (9 of 51 patients),¹² was a universal finding in some studies (n = 20 patients⁶; n = 55 patients¹⁶ and was observed to resolve within one day (n = 13 patients).²⁰ Edema was reported with incidences from 5.3% to 26.5% (13 of 51 patients).¹² Other transient events included bruising and minor contour irregularities (n = 20 patients)⁶ and (n = 40 patients).⁷ Reassuringly, a study with 21 participants¹⁵ reported no adverse events whatsoever. The largest study, with 745 patients,¹¹ and another with 19 patients,¹⁸ documented only transient erythema and edema. Longer-term evaluations over 6 months confirmed the transient nature of all AEs, including isolated vesicles, in a study of 17 patients.⁹ The strength of this finding was rated moderate when assessed through GRADE-CERQual.

Downtime

A critical gap emerged from our analysis: not a single study among the 15 included quantitatively measured or reported patient downtime. Although adverse events were consistently noted as mild and short-lived (typically resolving within 24 to 72 hours), the literature entirely lacked data on functional recovery, such as the time required to return to work or normal daily activities. This absence of structured reporting on downtime prevents firm conclusions about recovery periods and highlights a major evidence gap in the field.

Pain During Treatment

Pain during treatment was evaluated in 4 of the 15 included studies. Both quantitative and qualitative results consistently showed minimal discomfort. In one study with 50 patients treated with monopolar RF, the average pain score was 1.94 ± 0.66 on a 0-10 VAS scale.¹² Another study involving a monopolar device with integrated water-cooling (n = 21 patients) found that over 85% of participants reported being “comfortable” or “very comfortable” during the procedure.¹⁵ Qualitative data from a study on bipolar RF (n = 46 patients) indicated that patients described the sensation as only “warm and tolerable”.¹⁰ Results from home-use devices echoed these findings; a study of a multisource RF device (n = 45 patients) reported that most users found the procedure “painless” and “more pleasant compared to other aesthetic technologies”.⁸

Satisfaction and Psychological Impact

Patient satisfaction was reported in 13 of the 15 included studies, with a consistent finding across both clinical and home-use settings. Quantifiable satisfaction rates were consistently high. The most extensive study (n = 745) showed that 93.2% of patients were satisfied and would recommend the treatment,¹¹ and another found 90.8% of patients maintained satisfaction at one year (n = 65).¹⁴ Both quantitative and qualitative data substantiated the high satisfaction rates for monopolar RF. One study reported 100% satisfaction at 12 weeks (n = 40),⁷ another 82% after a single session (n = 50) 10, and a third found all patients (17/17) felt “slightly above satisfied”.⁹ This data was corroborated by patient feedback 13, citing improved skin tone, elasticity, and rejuvenation.²⁰

Satisfaction with home-use devices and fractional RF treatments was similarly high. Studies on fractional RF (n = 55 patients) showed 100% of participants reported being “satisfied” or “very satisfied” after three treatments.¹⁶ For consumer devices, more than 90% of users (n = 45) reported their skin looked and felt rejuvenated,⁸ and 63.6% of participants (n = 22) noted significant improvement over 8 weeks.¹⁹ The remaining studies^6,10,13,17 consistently reported high satisfaction through various metrics, including visible skin tightening and smoothness. The convergence of these high satisfaction rates across the 13 studies is a central finding of this review. According to GRADE-CERQual, the certainty of this evidence was judged moderate (Supplementary file 2).

DISCUSSION

This systematic review synthesizes evidence from 15 studies on the efficacy, safety, and patient experience of noninvasive radiofrequency (RF) treatments for facial rejuvenation. Across studies, RF treatments generally demonstrated positive aesthetic outcomes and high levels of patient satisfaction, despite variation in study design and quality,^{7-10,12,16,19,20} supported by a favorable safety profile dominated by mild, transient adverse events.^{6-11,15,16,18,19} While these results are broadly in line with other reviews,^21,22 the methodological limitations we identified suggest that the evidence should be interpreted with caution.

Clinical and Aesthetic Efficacy

The consistent reports of improvements in texture, firmness, rejuvenation, and tone suggest that the various RF modalities evaluated in this review^{7-10,16,19,20} effectively engage a common biological pathway. Patient-reported improvements align with clinician assessments and, in some studies, objective measures such as ultrasound or 3D imaging^7,9,19 suggesting that the perceived benefits correspond to observable clinical changes rather than placebo effects. This finding confirms the conclusions of prior reviews regarding RF's efficacy, which also identified significant improvements in skin laxity and elasticity as central outcomes of RF treatment.^21,22 Furthermore, as identified in this review, the two studies that specifically quantified firmness provide strong, quantifiable evidence supporting the efficacy of RF for this endpoint.

The pattern of gradual and sustained improvement over months is a clear sign that RF treatments likely stimulate the skin's natural healing process. The most robust evidence supports improvements in skin texture and firmness, with high rates of improvement (71%-100% of patients) documented across studies.^7,9,12,19 These results at longer-term follow-up offer promising evidence for medium-term durability, though long-term data remain scarce.^9,12 Notably, our results on the durability of texture improvement align with the histological evidence of neocollagenesis presented in a previous review,²² providing a clinical correlation to those mechanistic findings.

A key advancement of our review lies in extending the scope of prior syntheses. The most recent systematic reviews on this topic explicitly excluded home-use devices from their analyses.^21,22 Our analysis demonstrates that these consumer devices produce similarly high satisfaction rates (>90%) and observable efficacy,^8,19,20 thereby establishing their role as a viable and effective segment of the aesthetic market. This represents a novel and significant contribution, reflecting the evolving landscape of aesthetic treatments that were not captured in earlier reviews.^21,22

Furthermore, we provide a more granular quantification of outcomes that were previously reported in broader terms. For instance, while prior syntheses reported global improvement,²² our analysis documents high rates of successful outcomes on specific tools like the GAIS, with 100% of patients showing improvement in several studies.^7,10,20 The reproducibility of these findings across both clinical and home-use devices significantly broadens the potential applicability of RF technology.^8,19,20

However, our review also refines the understanding of efficacy for certain endpoints. Evidence for lifting and tone enhancement, while encouraging, remains preliminary.¹³ The dramatic results from a single pilot study (100% of patients showing >50% improvement) are promising but necessitate validation in larger, controlled trials.¹³ Similarly, while improvements in tone were reported, they were derived from a smaller subset of studies and should be considered secondary outcomes.^9,16 This nuanced finding adds a layer of specificity to the conclusions of a previous review, which noted improvements in “global aesthetic” without disaggregating the strength of evidence for specific subdomains like lifting.²¹

Safety and Tolerability

The evidence reviewed supports a favorable safety profile for noninvasive RF treatments, which is important for both clinical adoption and patient acceptance. This result aligns with recent systematic reviews.^21,22 The most significant finding is that no serious or permanent complications were reported across any of the 15 included studies, including a large cohort of 745 patients.¹¹ This finding, which extends the safety profile reported in prior syntheses by including newer-generation devices, further strengthens the evidence base for modern noninvasive RF protocols.^21,22

The adverse event profile was characterized by predictable, mild, and transient reactions, primarily erythema and edema. The incidence of these events was highly variable (erythema from 17.6% to 100%),^6,12,20 a finding that likely reflects differences in protocol intensity, device aggressiveness, and individual patient sensitivity rather than true variability in safety. Notably, erythema resolved within 24 hours in one study,²⁰ reinforcing its transient nature. The fact that some studies, even with rigorous protocols, reported no adverse events whatsoever¹⁵ further underscores the controllability and safety of modern RF devices.

Patient tolerability was another key finding of this review. The consistently low pain scores, exemplified by a mean VAS of 1.94/10¹² and reports of “comfortable” or “painless” experiences,^8,10,15 suggest that RF treatments are highly acceptable to patients. This high tolerability, coupled with minimal downtime (inferred from the rapid resolution of AEs), positions RF as a compelling “lunchtime” procedure with minimal disruption to daily life.

However, a major evidence gap identified was the universal lack of structured reporting on downtime. This omission, also noted in prior reviews,^21,22 represents a critical gap in the evidence base. While the absence of serious AEs suggests recovery is swift, the failure to quantitatively measure return to normal activities represents a missed opportunity for robust patient counseling. Future studies must therefore prioritize patient-centered outcomes to facilitate better clinical decision-making.

Patient Satisfaction and Psychological Impact

The most compelling finding of this review is the exceptionally high and consistent patient satisfaction reported across the entire spectrum of RF technologies and treatment settings. This finding significantly extends the analysis of prior reviews.^21,22 Satisfaction rates ranging from 82% to 100% in quantifiable studies^7,11,12,16 represent a powerful consensus on the perceived value of the treatment. This is further reinforced by the high willingness to recommend the procedure (93.2%), found in the largest cohort,¹¹ which serves as a strong behavioral indicator of satisfaction.

The convergence of high satisfaction across both in-office and home-use devices is particularly significant. It suggests that the positive patient experience is a fundamental characteristic of RF technology itself, rather than being solely dependent on a clinical setting. The durability of this satisfaction, with studies reporting maintained high rates at 6 months and even 1-year follow-up,^9,14 indicates that the perceived benefits are not transient but provide lasting value to patients.

An important observation is that patient satisfaction was often high even when objective clinical improvements were modest. This dissociation suggests that the value of RF treatments extends beyond measurable skin parameters to encompass significant psychosocial benefits, such as improved self-confidence and well-being, which are primary motivators for patients seeking aesthetic care. The qualitative reports of improved skin being “toned,” “defined,” and “rejuvenated”²⁰ provide direct patient voice supporting this conclusion.

The primary limitation in this domain is the methodological heterogeneity of satisfaction measures, which relied heavily on nonvalidated, custom scales. While this precluded meta-analysis, the consistent direction and strength of the positive findings across studies create a robust qualitative narrative. Future research must employ standardized, validated psychometric tools to precisely quantify the profound psychological impact that this review's findings strongly suggest. Despite these encouraging findings, the available literature is constrained by methodological limitations, including small sample sizes, lack of control groups, and inconsistent use of validated outcome measures. Furthermore, a significant evidence gap was identified, as no study quantitatively measured or reported patient downtime, leaving a critical void in understanding the recovery process. The absence of stratified analyses by skin type and variability in treatment parameters further limits generalizability. Future research should prioritize rigorous trial designs, standardized aesthetic and psychometric outcome measures, and long-term safety monitoring. Future studies should integrate patient-centered and multidomain assessments to capture the value of RF better. Such approaches would help clinicians choose the most appropriate modality for each patient.

Publication Bias and Selective Reporting

The interpretation of our findings must consider potential publication bias and significant study heterogeneity, which we addressed through qualitative assessment. The included studies were assessed for potential conflicts of interest and funding sources, which revealed that a subset was sponsored or supported by device manufacturers; this may introduce a potential source of bias in the reporting of outcomes. Furthermore, a targeted search of gray literature sources, including trial registries and conference abstracts, was conducted to identify unpublished or underreported trials. Although some unpublished studies were identified, they could not be included due to a lack of publicly available results. The overall predominance of studies reporting favorable outcomes, with limited documentation of null or negative results, indicates a likely influence of selective reporting and publication bias. This potential bias should be considered when interpreting the findings of this review.

Sensitivity Analysis

Given the small number of studies included (n = 15), a formal sensitivity analysis involving the exclusion of studies and re-synthesis was not feasible. Instead, the influence of study quality on the review's findings was assessed qualitatively throughout the thematic synthesis process. The methodological limitations identified during critical appraisal were actively considered during data interpretation. The principal thematic findings regarding high patient satisfaction, clinical efficacy, and a favorable safety profile were consistent across the body of evidence, suggesting that these conclusions are robust. However, more nuanced observations derived from single studies with methodological limitations have been interpreted with appropriate caution.

CONCLUSIONS

This systematic review demonstrates that noninvasive radiofrequency treatments for facial rejuvenation are associated with significant improvements in skin texture and firmness, high patient satisfaction, and a favorable safety profile. The consistency of these findings across devices and settings is notable. However, the strength of the evidence should be interpreted with caution due to limitations in the methodological quality of the primary studies. Further high-quality, controlled studies are needed to confirm these results and establish long-term efficacy.

Supplemental Material

This article contains supplemental material located online at https://doi.org/10.1093/asjof/ojaf159.

Disclosures

Dr Kumar is a consultant for Jeisys Medical Inc. (Seoul, Korea) and receives a fee from the company. Dr Suh is a consultant to Jeisys Medical Inc. and has received research and travel grants from the company. The remaining authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

Jeisys Med Inc., Seoul, Republic of South Korea, funded the Open Access publication of this manuscript.