eyelid thermage

Guide to Eyelid Thermage

What is the Eyelid Thermage used for?

Eyelid Thermage is used to nonsurgically tighten and lift the eyelid skin. It works best on these problems:

  • wrinkly eyelids – reduces fine wrinkles above and below the eye
  • “hooding” – reduces that loose skin on the upper eyelid if it’s mild to moderate
  • makes the eye look more “open”
  • helps to maintain the results of eyelid surgery

How does Eyelid 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 which is followed by gradual collagen tightening. The result is a more youthful appearance to loose and sagging skin.

Our Guide to Thermage has lots of information on the Thermage procedure in general.

What does Eyelid Thermage not do?

Eyelid Thermage does not improve “crow’s feet”  very much. These are caused by action of the smile muscles, and Botox is a better choice. Eyelid Thermage does not improve undereye fat pads; these need to be removed surgically. It also cannot remove significant hooding of the upper lid. This is a surgical problem. Mild to moderate hooding is fine for Thermage.

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

In a 2007 study, fifty-seven hundred patients (full face) were surveyed at multiple clinics. With the newer, third-generation multi-pass Thermage, 87 percent observed some immediate tightening, 92 percent had tightening six 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.

Why do some people not see results with Thermage?

We know from good research studies that everyone makes collagen after a Thermage treatment.  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 laser center will let you know what is realistic for you. Eyelid Thermage is for mild to moderate loose skin on the eyelid, not major sagging or hooding. For the 5-10% who do not see visible tightening, I still think there is good news 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.

How long does Eyelid Thermage take to work?

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 6 months. All patients show an increase in collagen in biopsy studies.

You’ll notice some immediate tightening of the skin and a bit of puffiness, usually unnoticeable to anyone else, immediately after the procedure. But there shouldn’t be bruising or redness of any kind. With Thermage, you can put on your makeup and go right back to work (I’ve done this myself).

How safe is Thermage?

The Thermage procedure is very safe with almost no significant adverse effects reported to date. Radiofrequency energy has been used in operating rooms all over the country for more than 25 years. The Thermage device was cleared by the FDA for cosmetic indications. Studies showed a very small incidence of minor and temporary side effects.

How much does Eyelid Thermage cost?

The cost for this procedure, depending on where you live, is usually somewhere from $1000 to $1,800. Again, this procedure is best for those with mild to moderate sagging. A fair number of patients have their foreheads done at the same time. This helps to lift the brows. Eyes plus forehead will cost $1,700 to $2,200.

What does an Eyelid Thermage treatment feel like?

Here’s how the procedure unfolds: First you remove any contact lenses and make-up. Then, a small rubber patch (grounding pad) will be placed on your abdomen. A small numbing drop is put in the eye itself (just like at the eye doctor) and a special contact lens shield is placed in the eye. The contact lens shield has a cushion of special ointment on the side next to the eye. You can feel the lens, but it’s not uncomfortable at all.

Then, the doctor will place the tiny tip on the eyelid skin and go over it pulse by pulse. Multiple passes are done, all over the eyelid skin right up to the eyelid margin, up to the eyebrows, and down to the eye socket bone. You may feel a sensation of heat, but again, it is not uncomfortable. If you do feel discomfort, ask your nurse or doctor to turn the energy down just a bit.

Usually, your doctor will treat one upper and lower eyelid. The shield is taken out.  After one side is done, you can sit up to see the difference already from the other side. Then, all of the above are repeated on the other eye.

How long does the Thermage eyelid procedure take?

Usually a treatment takes about one hour depending upon the size of your eyelids. If you’re doing your forehead too, it will take about 90 minutes.

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 may be enough. If over 50, its possible 2 treatments may be needed.

When can I have another treatment?

It’s hard to find studies on this, but we usually advise waiting at least 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, it may be best to repeat the treatment yearly.

Is  Eyelid Thermage compatible with fillers?

Yes, with some reservations, and this applies to fillers done under or around the eye. 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.

  • Restylane/Juvederm: Wait 1 month to have the Thermage treatment
  • Sculptra: Wait 6 months after your last treatment before you have a Thermage

Is there any special preparation or follow-up regimen?

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 exercise 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.

Are there any people who shouldn’t have this treatment?

Your provider should give you the complete list, but 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.

  • Age should be between 35-65
  • I tell my patients not to have eyelid Thermage treatments if they have had any eye surgery or laser treatment to the eye in the past 6 months, or have scheduled any eye surgery or eye laser treatment in the next 2 months.
  • When you go to your doctor for eyelid Thermage, make sure he or she takes a good medical eye history, including questions about prior eye surgeries, glaucoma, ocular rosacea, and other pertinent conditions.

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

Here are some of the possible side effects. Your provider should give you the full list in a consent form:

  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 blister.
  3. Swelling (mild to moderate) occasionally occurs immediately after treatment, especially on the face. This is temporary and usually dissipates within 2 to 5 days or less.
  4. Indentation. Rarely small indentations have been observed. These are usually temporary but in very rare cases may be permanent. Minor surface irregularities are 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.
  7. No visible results. Even though new collagen can be seen on biopsy, about 5% of patients do not see a visible result.

Thermage Q & A Discussion

I have an event in two months.  When would be the best time to do Thermage?

Remember that even though you will see a little bit of tightening right away with Thermage, most tightening occurs gradually over a period of four to six months. If your event is in two months, you’ll see only a little improvement prior to the event.

I have pretty bad hooding on my upper eyelid, but I am dead set against surgery. Would the Eyelid Thermage work?

Some of my patients who have moderate to severe hooding, but are absolutely against any type of plastic surgery, have asked me if eyelid Thermage could help. I counsel them that they can certainly try, though they should understand that they may not get the results they’re hoping for. Also, they may need two to four treatments. Some of my patients have now done two or three treatments about four to six months apart and have gotten nice results. I would still caution anyone with moderate to severe hooding that this might not be money well spent.

I have a really busy social life and cannot afford any downtime at all. Would Thermage work for me?

Yes. Thermage is perfect for someone like you because you can have your treatment and walk right back out with no marks on your face. There is a very slight puffiness for a day or two that no one but you will notice, and that’s it.
See Dr. Irwin’s Guide to Thermage for more information
See Dr. Irwin’s Guide to Cosmetic Areas – Eye Issues for more information

See Dr. Irwin’s expert answers to other’s reader’s questions on eyelid Thermage:
Is Thermage on the eyelids okay with permanent eyeliner?
Is it safe to use Thermage to tighten the eyelids since the skin is thin?
Is it possible to predict the success of Thermage?