Fractional Radiofrequency (Gold Needle) — Scarlet X

What is fractional radiofrequency?

Fractional radiofrequency is a minimally invasive skin-rejuvenation method that combines controlled microneedling with radiofrequency energy.

While microneedles create very small, controlled channels in the skin, radiofrequency energy generates a controlled thermal effect in the deeper skin layer known as the dermis. This controlled stimulation activates the skin’s natural repair mechanisms and supports the production of new collagen and elastin.

The aim is not to peel or thin the skin from the surface, but to initiate a controlled renewal process in deeper skin layers.

What is Scarlet X?

Scarlet X is one of the skin-rejuvenation systems that uses microneedling fractional radiofrequency technology.

During the procedure, microneedles are advanced to a selected skin depth and radiofrequency energy is delivered to the tissue in a controlled manner. Needle depth, energy level and treatment passes are not the same for every patient. Treatment parameters are determined by the dermatologist according to:

• Skin thickness,
• The area being treated,
• The target concern, such as acne scars or enlarged pores,
• The degree of skin laxity,
• The patient’s skin type,
• Previously performed procedures.

Scarlet X should therefore be considered a personalized dermatologic procedure based on evaluation of the patient’s skin rather than a standardized beauty treatment.

Which concerns can Scarlet X be used for?

Fractional radiofrequency may commonly be considered for the following concerns:

Acne scars

It may help reduce the appearance of depressed atrophic acne scars. It can be included in treatment plans for rolling scars, boxcar scars and selected superficial ice-pick scars. However, not all acne scars have the same characteristics. Deep or tethered scars may require additional techniques such as subcision, TCA CROSS, fractional laser, filler or other dermatologic methods alongside fractional radiofrequency.

Scientific studies have shown that microneedling fractional radiofrequency may improve atrophic acne scars on the face. However, results may vary depending on scar type, treatment protocol and number of sessions.

Enlarged pores

Pores cannot be anatomically eliminated completely. However, their appearance may be reduced by supporting collagen, improving surface regularity and controlling excess oil production.

Fine lines

The treatment may help improve fine lines around the eyes, cheeks, forehead, mouth and neck. It may not be sufficient on its own for very deep expression lines or marked volume loss.

Skin laxity

By supporting collagen and elastin production, the treatment may help achieve a firmer and more supported appearance in mild to moderate skin laxity. Fractional radiofrequency is not an alternative to surgical face lifting. Expectations should be evaluated realistically in patients with advanced sagging.

Textural irregularities

It may contribute to a smoother, more even and more vibrant appearance in rough skin, dullness and superficial textural irregularities.

Surgical or traumatic scars

It may be used in the treatment of selected surgical and traumatic scars. The age of the scar, whether it is raised or depressed and its anatomical location influence treatment selection.

Stretch marks

It may help reduce the appearance of stretch marks on areas such as the abdomen, buttocks, legs or arms. Complete disappearance should not be expected.

Which areas can be treated with fractional radiofrequency?

Scarlet X is not limited to the face. In suitable patients, it may be applied to:

• Face,
• Eye area,
• Cheeks,
• Jawline,
• Neck,
• Décolletage,
• Backs of the hands,
• Abdomen,
• Buttocks,
• Arms and legs,
• Body areas with acne or surgical scars.

Because skin thickness differs by anatomical area, needle depth and energy settings are adjusted accordingly.

How is fractional radiofrequency performed?

Before treatment, the patient is evaluated by a dermatologist. Active infection, cold sores, acne flare-ups, medications and conditions that may affect wound healing are reviewed. The procedure generally includes the following steps:

1. The skin is cleansed.
2. A topical local anesthetic cream is applied to the treatment area.
3. Sufficient time is allowed for the anesthetic cream to take effect.
4. The skin is cleansed again and prepared with an antiseptic.
5. Treatment is performed using a single-use microneedle tip.
6. Appropriate soothing products are applied after the procedure.

Procedure time varies according to the size of the treatment area. Facial treatments are usually completed in approximately 20–45 minutes. The waiting time for topical anesthetic cream is not included in this duration.

Is Scarlet X painful?

Because topical local anesthetic cream is applied before the procedure, pain and discomfort are significantly reduced. Mild stinging, warmth, burning or pressure may still be felt during treatment. Areas such as the forehead, upper lip and jawline may be more sensitive.

The level of discomfort varies according to individual pain threshold, energy settings, treatment depth and the area being treated.

What does the skin look like after treatment?

The most common findings after treatment include:

• Redness,
• Mild swelling,
• Burning or warmth,
• Tenderness,
• Pinpoint crusting,
• Dryness and tightness,
• Temporary microneedle marks.

Redness usually decreases significantly within the first 24–72 hours. After more intensive treatment, redness, edema or pinpoint crusting may persist for several days. The duration of these reactions varies according to the settings used and the patient’s skin characteristics.

What should be considered after fractional radiofrequency?

The skin barrier is temporarily more sensitive after treatment. During this period, the care program recommended by the dermatologist should be followed. During the first days:

• Cleanse the skin gently.
• Use moisturizing and barrier-repair products.
• Apply sunscreen regularly.
• Do not rub the skin or pick at crusts.
• Pause retinoids, peels and acid-containing products.
• Avoid alcohol-containing or irritating cosmetics.
• Avoid sauna, Turkish bath and very hot showers.
• Limit intense exercise and excessive sweating.
• Wait the period recommended by the physician before using pools or swimming in the sea.
• Avoid direct and intense sun exposure during the first days.

The appropriate time to restart makeup depends on treatment intensity. Makeup can generally be used after the skin surface has calmed and in accordance with the physician’s recommendation.

Can fractional radiofrequency be performed during summer?

Compared with certain laser procedures that fully resurface the skin, fractional radiofrequency can be used more cautiously during summer. However, this does not mean that sun protection is unimportant. Sun exposure after treatment may increase the risk of post-inflammatory pigmentation, particularly in people prone to developing dark marks. If treatment is planned during summer:

• Use a high-protection-factor sunscreen,
• Reapply sunscreen during the day,
• Use physical protection such as a hat,
• Avoid tanning beds,
• Avoid tanning before the procedure.

How many Scarlet X sessions are needed?

The number of sessions varies according to the concern being treated and the skin’s response. In general, the following may be planned:

• 1–3 sessions to support overall skin quality,
• 3–6 sessions for acne scars,
• 3–4 sessions for enlarged pores and textural irregularities,
• Longer treatment series for stretch marks and body scars.

These numbers are general estimates. Some patients may need fewer or more sessions. Treatments are often performed at intervals of approximately 4–6 weeks. The dermatologist determines the interval according to the energy used and the skin’s recovery process.

When do Scarlet X results begin?

During the first days after treatment, temporary brightness or fullness may be seen because of edema and increased water retention in the skin. However, the main effect develops as collagen remodeling begins. In general:

• Early changes may be noticed within a few weeks.
• Improvement in skin texture may become more noticeable within 1–3 months.
• Collagen production and remodeling may continue for several months.

Results are not immediate. Improvement in acne scars and more pronounced textural irregularities is usually gradual.

Are Scarlet X results permanent?

The effects of collagen remodeling produced by treatment may continue for a long time. However, natural skin aging, sun exposure, smoking, weight changes and genetic factors continue. To help maintain results, the following may be recommended:

• Regular sun protection,
• An appropriate home-care routine,
• Smoking cessation,
• Healthy nutrition,
• Maintenance sessions when needed.

Structural improvement in acne scars may be long-lasting. However, if new active acne continues, new scars may form. Active acne should therefore also be treated at the same time.

Who should not undergo fractional radiofrequency?

Scarlet X is not suitable for every patient. Treatment may be postponed or avoided in the following situations:

• Pregnancy,
• Active bacterial, viral or fungal infection in the treatment area,
• Active cold sores,
• Uncontrolled inflammatory skin disease,
• Open wounds or active eczema,
• Significant medical conditions that impair wound healing,
• Bleeding disorders,
• Use of blood-thinning medication,
• Pacemakers or certain electronic implants,
• Metal implants incompatible with the device being used,
• Ongoing active cancer treatment,
• Marked tendency to develop keloids or excessive scarring,
• A recent procedure that significantly affects the skin.

The procedure can be safely performed during breastfeeding. Some of the conditions listed above are relative risk factors rather than absolute contraindications. Suitability should be determined after dermatologic examination. Medications should not be discontinued without medical advice.

Does fractional radiofrequency have side effects?

Fractional radiofrequency is a medical procedure and is not completely risk-free. Common, usually temporary effects may include:

• Redness,
• Swelling,
• Tenderness,
• Burning sensation,
• Dryness,
• Pinpoint crusting,
• Temporary acne flare-up,
• Itching,
• Mild bruising.

Less common complications may include:

• Infection,
• Reactivation of cold sores,
• Prolonged redness,
• Delayed healing,
• Darkening or lightening of skin color,
• Scarring,
• Allergic or irritant reactions.

Serious complications such as burns, permanent scarring, fat loss or nerve injury have been reported in situations including inappropriate patient selection, incorrect treatment depth or excessively high energy. In a safety communication dated October 15, 2025, the FDA emphasized that radiofrequency microneedling is a medical procedure and warned patients and healthcare professionals about reports of serious adverse effects. For this reason, treatment should be performed after dermatologic evaluation, using an appropriate device and individualized parameters.

Can Scarlet X be used for pigmentation?

Fractional radiofrequency may help improve skin texture and reduce the appearance of uneven tone in some patients. However, it is not suitable for every type of pigmentation.

In recurrent pigment conditions such as melasma, uncontrolled heat and inflammation may darken the pigmentation in some patients. Treatment should therefore not be performed before the type of pigmentation is identified. Patients with pigmentation concerns should first receive a dermatologic diagnosis, after which sun protection, medical treatments and possible procedures can be planned together.

What is the difference between Scarlet X and conventional microneedling?

Conventional microneedling primarily aims to support skin renewal through controlled microchannels created by needles.

In fractional radiofrequency, radiofrequency energy is delivered to selected skin depths in addition to microneedling. This adds controlled thermal stimulation to the mechanical microneedling effect. Both procedures may support collagen production. The choice depends on skin structure, scar depth and treatment goals.

What is the difference between Scarlet X and fractional laser?

Fractional lasers deliver energy into the skin through laser light. Fractional radiofrequency uses microneedles to deliver electrical radiofrequency energy to selected skin layers.

Fractional lasers may be particularly useful for the skin surface, pigmentation and certain scar types, while fractional radiofrequency may be preferred for dermal collagen remodeling, acne scars, enlarged pores and mild laxity. The methods are not absolute substitutes for each other. In some patients, one technique is sufficient; in others, a combined treatment plan may be more appropriate.

Can Scarlet X be combined with other procedures?

Depending on the patient’s needs, fractional radiofrequency may be combined with:

• Subcision,
• TCA CROSS,
• Fractional lasers,
• Chemical peels,
• PRP,
• Mesotherapy,
• Botulinum toxin treatments,
• Filler treatments,
• Pigmentation treatments,
• Medical acne treatments.

The dermatologist should determine whether combinations can be performed during the same session and how much time should be left between procedures. Combining every treatment in one session does not necessarily produce a better result. The skin’s healing capacity and risk of side effects must be considered.

Frequently Asked Questions About Scarlet X