Guide to Thermage

What is Thermage® used for?

It is used to non-surgically tighten lift and rejuvenate the skin. It works best on these areas:

  1. the face - especially around the jawline
  2. the eyelids
  3. the backs of the hands
  4. the neck and chest (not as effective here but okay)
  5. the body

On the face, the whole face and jaw line are treated to tighten the cheeks, reduce the nasolabial fold (between the nose and the mouth), and to tighten and lift skin along the jaw line. Most centers including ours do the area under the chin as part of the face. You shouldn't need to schedule a neck treatment for that.

Thermage can also be performed on the forehead to lift the eyebrows and make the eyes look more open. Used with the Total Tip 3.0 Thermage treatment, you can get quite impressive result with mild to moderate problems here. It can also be helpful on the neck if there isn't too much loose skin.

How does Thermage work?

The Thermage procedure uses radiofrequency energy to create a uniform heating effect in the deep dermis. This gentle heating tightens existing collagen and stimulates the production of new collagen. It reduces wrinkles and achieves brow lifting, cheek lifting, and jaw line lifting.

The skin tissue lifting and tightening is caused by immediate collagen contraction followed by gradual collagen tightening. The result is a more youthful appearance to lax and sagging skin.

What kind of results can I expect with Thermage? When will I see results?

In a 2007 study, fifty-seven hundred patients were surveyed at multiple clinics. With the third-generation multi-pass Thermage, 87 percent observed some immediate tightening, 92 percent had tightening three months after treatment, and 94 percent found that treatment results met their expectations. All patients show an increase in collagen in biopsy studies, so even if you don't see a noticeable result, the procedure should help prevent more sagging.

Although a few patients show immediate improvement, response to treatment for most patients is gradual with progressive improvement over 1 to 6 months. 80-90% of patients show measurable and noticeable effects at 3 months. All patients show an increase in collagen in biopsy studies.

Why do some people not see results with Thermage?

We know from good research studies that everyone makes collagen after a Thermage treatment. To use a baseball analogy, I think it's realistic to expect a single, double, or triple from Thermage, but not a home run. So sometimes there is a perceived lack of results that is related to expectations that are too high. A good medical aesthetic center will let you know what is realistic for you. Thermage is for mild to moderate sagging, not for full fledged jowls.

Good research studies also show that about 90% of patients show a measurable and noticeable effect at 3 months. Many patients see some results immediately. For the 10% who do not see visible tighening, i still think there is a good result because it helps to prevent sagging over the next year or two. Preserving what you have is still a benefit.

How long will the effects of the Thermage procedure last?

While treatment results have been observed to last for at least 2 years, studies indicate that the beneficial changes to skin collagen can last over 2 years in some cases. As with virtually all skin restorative techniques, including surgical facelifts, the original aging symptoms may slowly return as the aging and sun damage process continues.

What does a Thermage treatment feel like?

You'll feel a brief sensation of heat each time the Thermage is pulsed. But the Thermage device monitors the surface temperature of your skin and applies a cooling cryogen spray, which is delivered before, during, and after the application of heat. If you do feel discomfort, ask your doctor to turn the energy down just a bit. The new Total 3.0 tips, through which the heat is delivered, are quite comfortable without sedation. Thermage treatments are less painful today.

Usually a treatment takes 1-2 hours depending upon the size of the target area. Here's how the procedure goes: First,we gently clean the face and apply numbing cream for 40 minutes. Then, a small rubber patch (grounding pad) is placed on your abdomen. Usually, your doctor will treat one side of your face at a time-pulse by pulse. Your doctor will do multiple passes, all over one side of your face, including extra pulses in your problem areas and always under the chin. After one side is done, you can sit up to see the difference already from the other side.

Some history on Thermage and the pain issue:

A little history is helpful here because the Thermage (fourth generation) that dermatologists now use is vastly different than the Thermage of 10 years ago.

The original (first-generation) Thermage was overhyped by the media and some doctors with promotions like a "lunchtime lift" or before-and-after photos that weren't representative of the average treatment result. The treatments were painful without sedation and the results were inconsistent. Even worse, some doctors didn't follow the published protocols and turned the energy up too high, causing an occasional depression in the skin.

Then came the second-generation Thermage. This was still painful. But it worked more consistently because the handpiece used on the skin was equipped with a larger tip size (the tip is the part that delivers sound energy to the skin) and delivered more pulses per tip.

With the third and fourth generation of tips now in use, the treatments have vastly improved. Thermage doubled the tip size, gave doctors many options for numbers of pulses in the tips (we usually use 600, 900 to 1200 pulses for the full face), and added a cooling element to the tip so there is less pain.

The treatment is now comfortable without sedation. What's more, our patients now get Thermage treatments without any medication whatsoever and are able to go back to their jobs and lives right away.

What will I look like right after the treatment? What will the healing time be?

You may return to your normal activities immediately after the Thermage treatment, as there is no down time. Makeup can be applied immediately after the treatment session. Minimal redness is seen in some patients after treatment, but it generally disappears within several hours. Bruising and discomfort are rare after the Thermage procedure. Occasionally mild swelling is noticed after the treatment but disappears in two or three days.

How many treatments will I need?

If you are 30-50, one is usually enough depending on skin condition. If you're over fifty and depending on skin condition, plan on two treatments six months apart for optimal results, then maintenance every one to two years.

When can I have another treatment?

It's hard to find studies on this but we usually advise waiting at least 2-3 months before repeating it.

Do I need to come for maintenance treatments?

Most people repeat their Thermage treatments every 2 years or so. if you are over 50, if may be best to repeat the treatment yearly and some people looking for optimal results repeat the treatment every 6 months.

Is Thermage compatible with fillers?

Yes, with some reservations. You should observe the wait times below since there isn't much data on these. There have been some reports of problems with Sculptra bumps if Thermage is done too soon after Sculptra.

  1. Restylane/Juvederm/Perfectha/Revanesse: Wait 1 month to have the Thermage treatment
  2. Sculptra: Wait 6 months after your last treatment before you have a Thermage
  3. Permanent Fillers: If you have permanent fillers like silicone or Artecoll, i would not recommend Thermage over or near the filler.

Is there any special preparation or follow-up regime?

No. Unlike plastic surgery, there is no bruising. There is no need to interrupt any medications or to do any fasting the day before Thermage treatment. You can return to normal activities the day after the procedure. Some patients exhibit a temporary redness for a few hours after treatment but there is usually no swelling or bruising. Rarely, a superficial blister may occur.

How safe is Thermage?

Radiofrequency energy has been used in operating rooms in USA for more than 30 years. The Thermage device was cleared by the FDA for cosmetic indications. Studies showed a very small incidence of minor and temporary side effects. Small, possibly permanent indentations were reported with the original tips at offices where the energy used for the treatment was very high.

Are there any medical or cosmetic side effects of the Thermage treatment?

Generally, anyone who has a pacemaker or internal cardiac defibrillator, active skin infections in the treated area, or is pregnant should not have this procedure.

Here are some of the possible other side effects:

  1. Redness. Thermage treatment may cause a transient reddening of the skin. Redness will usually dissipate in 1 to 2 hours after treatment.
  2. Healing. There is always a slight possibility of developing a crust, scab or blister. This is superficial and generally does not result in any scarring and is treated like a sunburn or any other superficial skin blister.
  3. Swelling (mild to moderate) usually occurs immediately after treatment, especially on the face. This is temporary and usually dissipates within 2 to 5 days.
  4. Indentation. Rarely small indentations have been observed with Thermage first and second generations. These were usually temporary but in very rare cases permanent. Minor surface irregularities were also reported at a rate of 0.14% which is less than 1.0%.
  5. Altered Sensation. There may be a temporary altered sensation or transient tingling at the treatment site. This rare occurrence has been reported to resolve within a week.
  6. Bruising rarely occurs.

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