Abstract
BACKGROUND: Sequential monopolar-bipolar radiofrequency (RF) systems aim to provide multi-layer dermal heating for skin tightening and rejuvenation. Real-world outcome data for these devices remain limited. OBJECTIVES: To evaluate the clinical efficacy, safety, and patient-reported outcomes of the DENSITY NOIR sequential RF device for aesthetic facial indications. METHODS: A retrospective multicentre case series was conducted across dermatology clinics in the United States. Consecutive patients who underwent DENSITY NOIR RF treatment and had standardized pre-and post-treatment photographs, along with follow-up surveys completed ≥ 30 days after treatment, were included in the study. Provider-rated improvement (4-point scale) and patient-reported outcomes, including visible improvement, satisfaction, pain, downtime, and likelihood to recommend, were summarized descriptively. Age-stratified subgroup analyses and correlation assessments were also performed. RESULTS: Twenty-five patients (88% female; age range 26-55 years) met the inclusion criteria. All demonstrated improvement from baseline; 56% showed moderate improvement, while 24% showed marked improvement. Patient satisfaction was high (100%), with 48% "very satisfied." Likelihood-to-recommend scores were strong (median 10/10). Downtime was minimal; 92% reported none. Age-subgroup analyses showed greater proportions of marked improvement and "very satisfied" responses among patients > 55 years. Pain scores were low, and no adverse events were recorded. CONCLUSIONS: Sequential RF treatment demonstrated meaningful aesthetic improvement with excellent tolerability, high satisfaction, and negligible downtime. Findings support its value as a minimally invasive skin-rejuvenation option.