Abstract
BACKGROUND: Melasma is a common facial pigmentary disorder that markedly impairs quality of life, yet current treatments often yield incomplete clearance and frequent relapse. Microneedle fractional radiofrequency (MFR) can remodel the dermis and enhance transdermal delivery, whereas platelet-rich plasma (PRP) provides growth factors that may modulate melanogenesis and inflammation. AIMS: To compare the efficacy and safety of MFR combined with PRP versus MFR alone in the treatment of facial melasma. METHODS: In this prospective, randomized, evaluator-blinded, split-face trial, 30 patients with stable, symmetrical facial melasma received two sessions of MFR. One facial side was randomly assigned to receive adjunctive PRP and the contralateral side received saline. Outcomes included modified Melasma Area and Severity Index (mMASI) and hemi-mMASI scores, VISIA skin analysis, patient-reported satisfaction, and adverse events. Ultrasound was used to measure epidermal and dermal thickness at predefined facial landmarks. RESULTS: Twenty-nine patients completed the study. Overall mMASI and hemi-mMASI scores decreased on both sides at the 3-month follow-up after the last treatment. VISIA analysis showed significant reductions in red area and brown spot scores on the combination side, whereas changes on the MFR-alone side did not reach statistical significance. Ultrasound demonstrated increased dermal thickness at selected landmarks on each side, but the magnitude of change did not differ between sides. CONCLUSIONS: MFR is an effective and safe option for melasma in patients with Fitzpatrick skin types III-IV. Adjunctive PRP did not further improve global clinical pigment scores or ultrasound-detected structural changes, but may offer added benefit for erythematous and pigmentary features detected by VISIA.