Combining radiofrequency microneedling with 1927 nm thulium laser treatment delivered superior results for hyperpigmentation reduction compared to microneedling alone in a 53-patient clinical trial. Both approaches achieved comparable submental volume reduction, but only the combination protocol produced measurable improvements in skin tone evenness using standardized color space analysis. The study involved patients averaging 50-55 years with photoaged lower face and neck skin, comparing combination therapy (1-3 microneedling sessions plus thulium laser, followed by three additional laser treatments) against microneedling monotherapy.
This finding reinforces the synergistic potential of multimodal aesthetic approaches for age-related skin changes. While radiofrequency microneedling effectively addresses structural concerns like skin tightening through controlled thermal injury to deeper layers, the addition of fractional thulium laser appears to target pigmentary irregularities more effectively through its specific wavelength absorption properties. The combination represents an evolution in photoaging treatment, moving beyond single-modality approaches. However, the study's relatively small cohort and single-center design limit generalizability. For practitioners, this suggests that patients with mixed photoaging concerns—both textural and pigmentary—may benefit from combination protocols, though treatment complexity and cost considerations require careful patient selection.