Efficacy and Safety of Microneedle Fractional Radiofrequency Combined with Botulinum Toxin Type A for Periorbital Aging: A Retrospective Cohort Study.

Abstract

Purpose: To compare botulinum toxin type A (BoNT/A) alone with a single session of microneedle fractional radiofrequency (MFRF) followed by BoNT/A for periorbital aging.

Patients and methods: This retrospective cohort study included 35 patients treated between May 2022 and May 2025. Patients received BoNT/A alone (n=20) or one MFRF session followed by BoNT/A 1 week later (n=15). Dynamic crow's feet, static crow's feet, static infraorbital fine lines, the Global Aesthetic Improvement Scale (GAIS), skin biophysical parameters, and adverse events were evaluated through week 24; patient satisfaction was assessed at week 12.

Results: Dynamic crow's feet improved from baseline through week 16 in the BoNT/A group and through week 24 in the MFRF + BoNT/A group. Static crow's feet improved through week 12 and week 24, respectively. No individual follow-up comparison for static infraorbital fine lines remained significant after exact Wilcoxon testing and Holm adjustment. No between-group difference in wrinkle scores remained significant after Holm adjustment. GAIS was higher with combination treatment at week 16 (adjusted p=0.004). Compared with BoNT/A alone, the combination group showed a greater change in hydration at week 24 (adjusted p=0.021), greater improvement in elasticity at weeks 12, 16, and 24 (adjusted p≤0.002), and a transient increase in transepidermal water loss at week 2 (adjusted p<0.001). Procedural adverse events were transient, and no serious adverse events were documented.

Conclusion: Both regimens improved dynamic and static crow's feet during early and intermediate follow-up. In exact multiplicity-adjusted within-group analyses, late improvement was not consistently maintained in the BoNT/A-alone group, whereas the combination group remained improved through week 24; however, no between-group wrinkle-score difference was statistically significant. In this small, predominantly female cohort, the combination regimen was associated with greater improvement in selected skin-quality outcomes. Larger prospective studies using standardized multi-session MFRF protocols are needed.