Fractora – fractional radiofrequency for skin tightening by: Dr Serena Cardoso DipPEC (SA), BHSc, MB BCh (WITS)

Fractora (aka Microneedling Radiofrequency) is a new and exciting high tech treatment that works
through tiny laser-emitting needles, combining the antiaging power of controlled wound healing and
the physics of deep tightening, thermal energy. It shows great promise for the treatment of active
acne; acne scars; dull and uneven skin tone; wrinkles; loose skin and neck aging with manageable,
medium to low downtime depending on what you’re targeting and is safe in skins of darker colour.

The mechanics or physiology behind how the face ages is an important science to understand when
you want to choose the best treatments to correct those problems. There will never be single
treatment that does it all but this new technology comes close.

Aging of the face and neck involves:

sagging due to gravity,
atrophy with loss of collagen and elastin,
fat loss and redistribution i.e. hollowness in some places like the temples but noticeable
fatty prominences under the eyes (malar bags), adjacent to the nose (nasolabial folds) and
under the chin,
loss of bony volume,
a change from a positive to a negative facial expression (a relaxed happy face to a sad or
angry expression),
zones of distension in the face where skin is weaker.

In the neck we see loss of jaw definition, jowls, platysma bands, wrinkles, loose skin
Fractora is a new treatment modality that is used for acne scars, wrinkles and skin tightening with a
very exciting place in neck aging – one of the allusive areas in antiaging rejuvenation. It combines
microneedling (MN) with deeper fractional radiofrequency (RF) technology both previously used
independently.

Fractora is different to regular microneedling in that each needle also releases a radiofrequency
current from its tip producing changes in the structure of various dermal (skin) components. You
could see it as ten micro-needling treatments in one and as I like to call it, “botox laser”, for the face.
Where botulinum toxin softens deep lines caused by muscle contractions for a period of three
months, fractora smooths fine lines that can’t be softened with injectables, tightens skin and shows
improvements in collagen production even 6 months to a year after a single treatment.
Let us break down the two processes: Microneedling and radiofrequency, then we will discuss the
utility of their combination.

Miconeedling, is a dermatological treatment where we gently penetrate the skin with fine needles to
create small wounds and induce their healing without causing too much damage to the epidermis.
Healing is a beautiful biological cascade where little platelets and neutrophils make their way to the
wound to get the mending started, they release growth factors to stimulate collagen deposition by
fibroblasts and also result in elastin production. This why microneedling is also known as Collagen
Induction Therapy. As one gets older fibroblasts stop functioning as well as they once did and even
go to sleep. So it’s important to keep them stimulated and working not only for collagen induction
but for ongoing healing of UV damage. Skin biopsies after MN show a statistically significant increase
in collagen type i, iii and vii and acne scars become more shallow. The small holes created by the
needles also allow for the penetration of topical treatments and to get across the statum corneum.
Your skin is a barrier specifically designed to be a shield and not allow anything to get in too deep.
That’s why classical facials and creams can only go so far and provide temporary results.

It is also important that needling is done in a very sterile, controlled fashion and with careful consideration to
infection control and exactly what topical therapies are applied with it. If you needle in non-
sterilized drugs you could cause infection. In a medical setting with the supervision of doctors it is
safe and works very well.
Radiofrequency is a type of highly controlled energy that heats tissues at a lower frequency than
traditional lasers. Laser uses light energy at high frequencies on the skin’s surface and RF works
through a much lower frequency inducing thermal energy that reaches deeper into the collagenous
tissues of the dermis and subcutaneous fat which is where we want to target to tighten and lift. CO2
laser’s high frequency ablation is a wonderful treatment for face wrinkles and evening out skin tone
but it’s physics limit its use to the face and is only safe for those with a pale complexion. We can’t
use it on the neck as it would it would burn the superficial layer of the thin neck skin too much and
damage it.

This is why RF is a safe treatment for necks and patients with different skin tones where there is less
risk permanent discolouration because it isn’t aimed at the superficial epidermis where pigment or
melanin lies. Thermage is an example of an older unipolar RF technology. Fractional RF is the new
kid on the block and unlike previous versions where the entire area of skin treated was heated
throughout, fractional RF heats the skin in tiny little fractions or thermal columns with areas of
normal skin in-between to help heal the mini wounds we’ve created. We find this causes less
damage and better results. RF energy also stimulates fibroblasts to synthesize new collagen, existing
collagen to contract and tighten and fat to breakdown (lipolysis). Basically tighten and tone.

The combination:
It’s long been a question in developing anti-aging treatments – how do you tighten skin? Well you
need a mechanism that passes through the epidermis and reaches down into the dermis where we
naturally find lots of collagen, once you get there you want to stimulate new collagen to form and
the old, decrepit collagen that’s there to get into gear, tighten up and strengthen. That’s what the
radiofrequency needle beams of fractora are doing. The needles pass through the epidermis
inducing a gentle wound healing response on the superficial skin for glow but also get our
radiofrequency beams down to the right areas and shine through, gently heating the tissue and
stimulating a healing cascade. If you apply RF just on top of the skin you get a little bit of tightening
but not as much as you would when you get down to the collagen factory of the reticlodermis! It is
here that we want to target our radiofrequency needle beams to induce collagenous tissue in the
dermis.

Microneedling RF is a lovely treatment to tighten the lower face and neck prior to a facelift or if you
are in the years before a facelift and need some extra tightening of the jowls and neck. It reduces
the depth of wrinkles in places we can’t botox like the cheek, décolletage or places resistant to
botox like to periorbital area and forehead. It plumps out skin with collagen induction giving a
gorgeous glow through a gentle resurfacing and can be strategically used to melt fat in small areas
like the nasolabial (cheek) and marionette (mouth corner) folds. Acne scars are made more smooth
and shallow and uneven skin texture and tone is brightened with fractora.
It’s multiple indications require various energy settings and depths so there isn’t a one fits all
approach with microneedling RF. Your face and neck has to be medically analysed by one of our
doctors in a skin consult so we can assess the safest, most effective way forward to improve your
skin’s requirements.