Comparative Analysis on the Efficacy of Monopolar Radiofrequency With Continuous Water Cooling and Conventional Cryogen Spray Cooling in Facial Rejuvenation

Abstract

Background: Monopolar radiofrequency (MRF) is widely used for non-invasive facial rejuvenation. Objective: In this study, we compared the clinical efficacy and patient-reported procedural pain of a novel MRF system with continuous water cooling (RF-CWC) versus conventional MRF with cryogen spray cooling (RF-CSC) in 22 Asian women. Methods: In this prospective, randomized, split-face, single-blind trial, 22 participants received a single session of both RF-CWC and RF-CSC. Clinical outcomes-including changes in pore size, elasticity, skin density, fine lines, and lifting-were assessed over 8 weeks using quantitative measurements and investigator-assessed global improvement scores. Procedural pain was also recorded. To support the clinical findings, an ex vivo model was used to evaluate collagen and elastin fiber density, collagen I and III concentrations, and dermal temperature profiles. Results: RF-CWC demonstrated clinical efficacy comparable to that of RF-CSC in terms of lifting, skin volume, and wrinkle reduction, while significantly reducing procedural pain. Ex vivo analysis confirmed enhanced collagen remodeling and efficient dermal heating with RF-CWC. Conclusion: RF-CWC offers a clinically effective and better-tolerated alternative to traditional cryogen-cooled MRF for facial rejuvenation.