Clinical Effects and Safety of Radiofrequency Microneedling for the Management of Melasma: A Retrospective Study.

BACKGROUND: Melasma is a chronic hyperpigmentary disorder that is difficult to treat in patients with Fitzpatrick phototypes III to VI because of the risk of postinflammatory hyperpigmentation. Radiofrequency microneedling (RFMN) is an emerging modality that targets dermal photoaging while minimizing epidermal injury. OBJECTIVES: The aim of this study was to evaluate the clinical effectiveness and safety of POTENZA RFMN in patients with melasma in a real-world retrospective cohort. METHODS: The authors conducted a retrospective pre-post observational study of adults with clinically diagnosed melasma treated with POTENZA (Jeisys Medical Inc., Seoul, Republic of Korea) at a tertiary dermatology center in Seoul, Republic of Korea, between May 2022 and May 2025. All treatments were delivered in bipolar mode at 1 MHz with an insulated microneedle tip (I-25 or I-49). The primary outcome was the change in modified Melasma Area and Severity Index (mMASI) from baseline to posttreatment. Secondary outcomes included physician-rated improvement, patient satisfaction, changes in texture and brightness, and adverse events. Sensitivity analyses were performed to assess the robustness of the findings after excluding patients who received concurrent topical depigmenting agents. RESULTS: Fifty patients (mean age 40.7 years; 60% female; Fitzpatrick type III in 80%) were included. Median (interquartile range) mMASI decreased from 6.15 (4.90-8.62) to 3.75 (2.18-5.92) (median ΔmMASI -1.80; median percentage reduction 32.3%; P < .001). A responder analysis using a ≥30% mMASI reduction threshold identified 27/50 patients (54%) as responders. No significant differences in ΔmMASI were observed by melasma pattern or Fitzpatrick phototype; however, male patients showed greater median improvement than female patients (-2.70 vs -1.65; P = .039). In the sunscreen-only subgroup (n = 31, functional monotherapy), the median percentage mMASI reduction was 42.3%, consistent with the overall cohort. Independent reviewers rated clinical improvement in 98% of patients (36% marked, 36% moderate, and 26% slight), and 90% of patients reported satisfaction. Procedure-related adverse events occurred in 12% of cases; all were mild, transient, and resolved without intervention. CONCLUSIONS: POTENZA RFMN produced clinically meaningful mMASI reductions, high physician-rated improvement, high patient satisfaction, and a favorable safety profile in this predominantly Fitzpatrick type III cohort of patients with mild-to-moderate melasma. These findings support RFMN as a promising adjunctive option and warrant confirmation in prospective controlled trials. LEVEL OF EVIDENCE 4 RISK: For image description, please refer to the figure legend and surrounding text.