【】 Objective: To investigate the clinical efficacy of black obsidian dual-wave pulsed radiofrequency microneedles combined with collagenous dressings in improving sensitive skin. Methods: From August 2024 to June 2026, 80 patients with facial sensitive skin admitted to Nanjing Han Chen Beauty Hospital were selected and randomly divided into the radiofrequency group (40 cases, treated with black obsidian dual-wave pulsed radiofrequency microneedles) and the combined group (40 cases, treated with black obsidian dual-wave pulsed radiofrequency microneedles combined with recombinant collagen repair dressings). The treatment lasted for 16 weeks. The efficacy, skin physiological status, and safety indicators of the two groups were compared. Results: The overall distribution of efficacy in the combined group was better than that in the radiofrequency group (P < 0.05); after treatment, the transepidermal water loss (TEWL) and erythema index of both groups decreased, and the stratum corneum water content (SCH) and sebum content increased. Compared with the radiofrequency group, the TEWL and erythema index of the combined group decreased, and the SCH and sebum content were higher (P < 0.05). The total adverse reaction rate of the combined group was lower than that of the radiofrequency group (P < 0.05). Conclusion: The combined application of collagenous dressings can improve the efficacy of black obsidian dual-wave pulsed radiofrequency microneedles in improving sensitive skin, further improve the skin physiological status of patients, and enhance the treatment safety.