Beyond Lifting: Superficial-Targeted Monopolar Radiofrequency for Erythematotelangiectatic Rosacea

Noninvasive monopolar radiofrequency (NMRF) is an established modality for skin tightening, but its role in inflammatory dermatoses such as rosacea remains poorly defined. We report a man in his forties with an erythematotelangiectatic rosacea (ETR) phenotype, characterized by persistent centrofacial erythema, flushing, and xerosis, who underwent two sessions of multifrequency NMRF (XERF; Cynosure Lutronic, Goyang, Korea) at 4-week intervals using an off-label, superficial-targeted protocol (shallow setting, intensity level 5; 6.78 MHz; approximately 250 pulses; approximately 23,000 J cumulative energy per session; fragmented-pulse mode with controlled off-time). One month after the second session, facial erythema was visibly reduced and skin tone appeared more uniform. Antera 3D (Miravex, Dublin, Ireland) multispectral imaging showed a 24.3% decrease in average hemoglobin level (2.016 to 1.525) and a 36.9% decrease in hemoglobin variation (0.255 to 0.161). Surface scaling and xerosis also improved clinically. This single case suggests that superficial-targeted NMRF may reduce erythema and improve barrier-related symptoms in ETR through combined vascular, anti-inflammatory, and epidermal barrier mechanisms, beyond its established tissue-tightening effect, although these findings are exploratory and controlled studies incorporating standardized imaging, transepidermal water loss, histology, and inflammatory mediator assessment are needed to test this hypothesis.