Monopolar Radiofrequency–Induced Fibroblast Stimulation for the Prevention and Improvement of Skin Laxity

BACKGROUND: Fibroblasts are the primary producers of dermal extracellular matrix (ECM) components including collagen, elastic fibers, and hyaluronic acid. Fibroblast activity diminishes with age, contributing to deterioration of the dermal ECM and worsening of skin laxity. Heat-induced fibroblast stimulation is a validated strategy for restoration of the dermal ECM and improvement of skin laxity. OBJECTIVE: To review evidence supporting the effect of the monopolar radiofrequency tissue tightening system (monoRF) on dermal fibroblasts, reflected in its mechanism of immediate and prolonged skin tightening. MATERIALS AND METHODS: Using a structured gap analysis framework, we selected relevant literature that focused on histological studies of noninvasive monopolar radiofrequency from the year 2000 to 2024. RESULTS: Dermal collagen content increases with monoRF treatment immediately and up to 6 months post-treatment, indicating early and prolonged monoRF-induced fibroblast stimulation. Changes in elastin content and increases in the thickness of the epidermis and dermis also occur. Collectively, these physiological changes indicate increased fibroblast activity, resulting in a revitalized dermal ECM and cutaneous hyperplasia that coincide with immediate and prolonged improvements in skin laxity. CONCLUSION: MonoRF promotes sustained dermal health through enhanced fibroblast function and ECM organization, validating its role in both skin rejuvenation and prejuvenation.