Microneedling

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Both create controlled micro-injuries that prompt your skin to produce new collagen and elastin, and that healing response is the treatment. Radiofrequency microneedling with the SylfirmX adds heat, which is why we reach for it most often when the concern is pigment, redness or firmness. Traditional microneedling with the Dp4 uses the needling alone and can be paired with hyaluronic acid, accelerated serums or your own platelet-rich plasma.

Usually a series rather than a single session, because you are asking your skin to remodel and that happens over months rather than days. We space sessions four to six weeks apart. How many you need depends on what is being treated and how your skin responds, which is genuinely not knowable before we have seen you. Anyone promising a fixed number before assessing you is selling a package, not planning a treatment.

It depends which of the two we use, and the difference is bigger than people expect. Radiofrequency microneedling with the SylfirmX has essentially no downtime, and most people leave with some redness and warmth that settles within a few hours and go back to their day. Traditional microneedling with the Dp4 asks more of you, with redness like a mild sunburn for a day or two, sometimes mild swelling, and occasionally small pinpoint marks that settle within a few days. Either way you will need to be careful with sun exposure afterwards, and if you have an event coming up, tell us the date at your consultation so we can time the series around it rather than around our schedule.

Melasma is one of the main reasons the SylfirmX is in the clinic, and it comes down to how the device works. It runs in two modes, and the pulsed wave mode delivers repeated ultra-short bursts of energy rather than continuous heat, which is what allows it to be used on melasma and on the redness of rosacea, where broad heating would usually be the wrong idea. The continuous wave mode is the one used for laxity and texture. Which mode you need, and at what settings, is decided on your skin rather than from a protocol. What will not change is that melasma relapses. It is a condition to be managed rather than cured, the evidence supports ongoing maintenance rather than a course-and-done approach, and any honest plan includes daily sun protection and a realistic conversation about recurrence.

This is worth asking, and it is worth asking of anyone who treats you. Device settings, needle depth and energy all have to be chosen for your skin, and the risk being managed is post-inflammatory pigmentation. Bring it up at your assessment so the plan is built around it from the start.