Objective To explore the efficacy of multi-channel radiofrequency (MCRF) combined with vacuum system (VS) under intelligent evaluation and personalized parameter optimization in the treatment of sensitive skin. Methods A total of 90 patients with sensitive skin admitted to Jiangyin Hospital of TCM from March 2023 to March 2025 were selected as the research subjects, and they were divided into the control group (n =30), the combination group (n =30) and the intelligent combination group (n =30) by the random number table method. The control group was treated with MCRF with fixed parameters, the combination group was treated with combined MCRF and VS with fixed parameters, and the intelligent combination group was given intelligent evaluation based on patients' skin sensitivity, barrier function and inflammatory factor levels, and optimized MCRF's energy power, application time, and VS's suction pressure and pulse mode accordingly. The sensitive skin symptom score (SSS), skin barrier function indicators (TEWL, SC hydration), skin inflammatory factor (IL-1α, TNF-α) levels, dermoscopic vascular distribution density, satisfaction and adverse reactions were compared among the three groups. Results The SSS scores of the intelligent combination group after the second treatment, the fourth treatment and at 1 month after treatment were lower than those of the control group and the combination group (P <0.05). The TEWL level of the intelligent combination group after the second treatment, the fourth treatment and at 1 month after treatment was lower than that of the control group and the combination group, and the SC hydration was higher than that of the control group and the combination group (P <0.05). The levels of IL-1α and TNF-α in the intelligent combination group after the second treatment, the fourth treatment and at 1 month after treatment were lower than those in the control group and the combination group (P <0.05). The vascular distribution density of the intelligent combination group after the second treatment, the fourth treatment and at 1 month after treatment was lower than that of the control group and the combination group (P<0.05). The satisfaction score of the intelligent combination group at 1 month after treatment was (4.48±0.50)points, which was higher than (3.15±0.75)points of the control group and (3.82±0.65)points of the combination group (P<0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P>0.05). Conclusion Multi-channel radiofrequency combined with vacuum system has a good effect in the treatment of sensitive skin. Personalized parameter optimization through intelligent evaluation can improve the therapeutic effect, enhance skin barrier function and alleviate inflammatory state, with high safety and patient satisfaction.