Thermage Demonstration

View this video to see Dr. Irwin demonstrate a Thermage treatment for facial skin tightening.

Thermage uses radiofrequency to stimulate collagen growth and thereby tighten sagging skin along the jaw line, in the cheeks area, and above the eyes.

Note that this demonstration is edited and does not attempt to convey all aspects of a treatment, such as consultation, informed consent, pre-treatment processes, and post-treatment care and communication. We have posted this subject to our Terms of Use.

Link to Guide to Thermage Skin Tightening Treatment

Video Transcription:

Dr. Irwin: Hi, I am Dr. Brandith Irwin. I’m a board certified dermatologist in Seattle at Madison skin and laser center and we’re doing these videos today for our website S-K-I-N-T-O-U-R.COM. And today we’re demonstrating the thermage treatment. We’re doing this because we really want you to be able to see what these treatments look like because many times we see mysterious or a little scary and you might be a little afraid that they might be a little bit painful and I think it’s really nice to just see what happens and then that way it takes a lot of the fear of the unknown out of it.

Dr. Irwin: So I have with me today – this is Sally. Sally, tell me when you’re hoping to accomplish with your thermage. What is it you’re hoping it will do for you?

Sally: I am just hoping it will do some tightening of my lower – my lower face area. Umm, my upper – I’m happy with my upper face; I just need some tightening of my jowls and uh, around my mouth area. Just gradual tightening, I’m hoping for.

Dr. Irwin: And the first thing I want to do is just get her comfortable so because thermage is – it can be – a fairly long procedure. Our thermages often take between two and three hours to do. And so, you know, you want to be comfortable. You really want to make sure that your – you know- that the person that you’re with, is feeling good for that period of time. So, I’m just going to get her adjusted.

Dr. Irwin (To Sally): Are you comfy now?

Sally: Yes.

Dr. Irwin: When Sally came in today, we had her take off all of her jewelry, because the sound waves in this equipment get confused if there’s metal around. So we’re actually putting a grounding pad on Sally’s abdomen, and she’s taken off all her jewelry. So that’s what I’m doing next.

So Sally, I’m just reaching up under here if, I may. Sorry, I kinda have cold hands today. Can, I sneak this up under your arm, here? Perfect.

The next thing I’m doing is, I’m going to put a template pattern on Sally’s face. This will help me do the thermage. And I won’t do her whole face today because we’re just demonstrating what the procedure is like, not actually doing her whole face today.

The grid is really just a map of where we’re going. And it helps us to make sure that the pulses are all in the right place. The first thing I’m going to do is, just do a tuning pulse. That tuning pulse calibrates the tip to Sally’s skin thickness.

Dr. Irwin: Sally, are you comfortable?

Sally: Yeah

Dr. Irwin: Are you ready?

Sally: Yep.

Dr. Irwin: Ok. Let me get started.

Dr. Irwin: How’s that, comfort-wise?

Sally: It feels ok.

Dr. Irwin: Can you feel a little bit of heat, there?

Sally: Little bit of heat Uh-huh

Dr. Irwin: So on a scale of one to four, on the…

Sally: the comfort?

Dr. Irwin: Yeah

Sally: Uh… I’m pretty comfortable. It’s uh…

Dr. Irwin: Maybe a one or a two?

Sally: Yeah.

Dr. Irwin: Ok, I might wanna go just a little bit – and generally you’d like people to be – we do use the comfort level as a gauge…for the treatments partially. The only people that about two to three.

That one was a little Zingy.

Sally: That one was a little Zingy.

Dr. Irwin: I’m going to kind of pull your forehead up a little bit as I do this side.

Sally: Ok.

Dr. Irwin: So it’s a little sensitive right around the eyebrow.

Sally: Uh-huh

Dr. Irwin: You ok there?

Sally: Yeah

Dr. Irwin: Now, you tell me if it gets a little too warm and I’ll adjust it down.

Sally: Okay.

Dr. Irwin: If you get it more towards a three-four, let me know so I can adjust it for you so that you’re comfortable.

Sally: Okay.

Dr. Irwin: So the first thing we do, is go over in the squares all over the full face. Then we come back for a second pass and go in the circles. So that we’re covering the entire face, including underneath the jawline twice. Then we come back and we do what’s called a “vector-method”, where we go over areas that are problem areas several times. Sometimes, five six times with the tip. So for example, on Sally, for her vector, I mean, clearly there’s a little area right here, clearly around the jawline, so we pay special attention and do extra pulses here. But I’ll just kinda demonstrate the vector, where we pull up this way, hard, and really try to – and really try to pull this up. Ok, I’m going to adjust you down just a little, cause I think, it looks like you’re a little sensitive right there.

So this would be one vector this way. For Sally, I’d probably really pull this up this direction and pull up and out as much as I could. And when I went to doing the vector passes. And again this takes several hours usually. But you can see, she’s pretty comfortable and again, if you’re uncomfortable, it should be adjusted so that, you know, you feel it, but it’s not painful.

It’s really best for women or men in their 40s or 50s. In other words it works best if there’s just a little bit of mild to moderate safety and that goal of it is to do in general the whole face and give a subtle lifting everywhere. It can be done on the four head and around the eyes as well to give a little bit of lifting on the forehead. You know, I don’t know if you can see this, but if you lifted even a millimeter here, it gives an effect. If you lift three four millimeters all of a sudden you start to look chronically surprised. We’ve all seen that look, and it’s not good. So, what we’re going for in most people is a little bit of lift through this area and ideally a little bit of lift through the midface, a little bit of lift through the jaw line, and under the chin. And so when we do full face, we go ahead and wrap the treatment all the way under. When we do neck, this is the neck. The full face, in our office at least, includes this whole area underneath here, cause we’re trying to get a lift there.

It’s not for everyone. It’s not a facelift. And again, if you’re 65 years old with jowls, you know, surgery maybe your best option. I mean, no one who does this procedure would ever pretend that it’s for everyone, it’s not. And as long as your expectations are realistic, I think it’s excellent. The other thing I think it does really well is, it’s great for prevention of sagging and I think particularly after a facelift to preserve that tightening that you’ve gotten. Or if you’re younger, and you know, you just need a little bit, and you’re trying to prevent sagging, I think it’s excellent for that.

Generally we know that the collagen building after thermage lasts approximately 2 years. You know, for my younger patients who are, I generally say, who are in their late 30s maybe into their 40s, I usually say, think about doing it every other year. For my patients who are a little older, maybe 50, 60, 70s, I think, I’m saying, think about doing once a year. Also I think, if you’re really dead set against surgery, and you want some tightening, if you’re over 50, 60 years old, and have, you know, moderate laxity here or moderate sagging here, you need to think about doing more than one initially and in that case I might tell someone, ok, you really don’t want surgery, I totally respect that but, you might need to do two or three thermages about six months apart to really see a nice result. I do think it is technique dependant, and if you only put 300 pulses in and don’t do it well, the results will not be the same as if you’re really truly doing, what we call, a vector-method, full-face passes, a vector-method and using six to nine hundred pulses. So there really is a difference, there can be a significant difference between clinics. But a good reputable clinic will use usually six to nine hundred now, and it takes a while.

This is Dr. Brandith Irwin at Madison skin and laser center in Seattle. We’re just finishing up a thermage demonstration. The idea is just to give you an idea of what it looks like, what it feels like and this is for our website,, S-K-I-N-T-O-U-R.COM.

Dr. Brandith Irwin, MD

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