Collagen remodeling and increased type I collagen density following non-ablative monopolar radiofrequency for vulvar...

Vulvar laxity is associated with alterations in dermal extracellular matrix structure, particularly collagen organization, resulting in reduced tissue firmness and elasticity. Energy-based technologies have been proposed as minimally invasive approaches for tissue remodeling. The aim of this study was to evaluate the clinical and histological effects of a single session of non-ablative monopolar radiofrequency on vulvar laxity, with emphasis on collagen remodeling.

This prospective study included nine women aged 30-60 years with vulvar laxity. Vulvar biopsies were obtained before treatment (T0) and at 90 days (T3). Participants underwent a single session of non-ablative monopolar radiofrequency (6 MHz, 60 % power), with dermal temperature maintained at 45-60 °C and epidermal cooling. Follow-up was performed immediately and at 30, 90 and 180 days. Collagen types I and III were quantified using Picro-Sirius Red under polarized light. Data were analyzed using the paired Wilcoxon test (p < 0.05).

Significant improvements were observed in all patient-reported outcomes at 90 days. Mean scores increased from 2.3 to 4.2 for perceived vulvar laxity, 2.7 to 4.3 for overall vulvar appearance, 2.1 to 4.2 for skin firmness, and 2.3 to 4.3 for comfort with genital appearance (all p < 0.05). Pinch Test measurements decreased significantly from baseline, indicating reduced skin fold thickness, with effects maintained throughout the 180-day follow-up (p < 0.05). Histologically, type I collagen increased from 8,986.65 ± 8,006.84 to 19,545.96 ± 4,570.01 µm² (p = 0.038), type III collagen decreased from 15,779.00 ± 3,980.40 to 8,626.27 ± 1,263.47 µm² (p = 0.017), and the collagen I/III ratio increased from 0.33 ± 0.50 to 1.77 ± 0.44 (p = 0.011), indicating collagen remodeling.

Non-ablative monopolar radiofrequency promoted clinical improvement and collagen remodeling in vulvar tissue, supporting its role as a minimally invasive option for vulvar laxity.