BACKGROUND Recently, it has been reported that a micro-insulated needle radiofrequency (RF) system is effective at achieving subcutaneous fat reduction; however, no study has yet applied this technique to reduce submental fat. OBJECTIVE To evaluate the efficacy and safety of a fractional RF device with a micro-insulated needle to reduce submental fat. MATERIALS AND METHODS In this prospective, single-blinded, pre-post comparative study, 24 adults with excess submental fat were treated once using a micro-insulated needle RF device. Outcomes included efficacy (submental fat rating by an independent investigator, fat volume quantified with a 3-dimensional camera, and patient satisfaction), assessed 1 and 2 months after the procedure, and safety (adverse events), assessed throughout the study. RESULTS The patients' Physician-Assisted Submental Fat Rating Scale score significantly decreased after 1 month and further decreased after 2 months. The average volume of submental fat was significantly decreased after 2 months (20.44 6 5.53 cc to 16.41 6 4.58 cc, p , .001). Patient satisfaction was high. Transient and mild local skin reactions without longterm sequelae were observed in 4 patients. CONCLUSION The micro-insulated needle RF device is beneficial for the reduction of submental fat and has tolerable safety profiles. Trial registration ClinicalTrials.gov Identifier: NCT05517824.