Guide To Thermage

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

  • the face – especially around the jawline
  • the eyelids (link to Guide to Eyelid Thermage)
  • the backs of the hands
  • the neck and chest (not as effective here but okay)
  • the body (I don’t recommend yet)

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 Eyelid Thermage treatment, you can get quite a nice result with mild to moderate problems here.  It can also be helpful on the neck if there isn’t too much loose skin.

Success on other parts of the body have not been very good or consistent despite the dramatic before and after pictures you will see on the web. Remember many photos do not show typical results or even have been shot with a particular lens or lighting to achieve a certain effect. Thermage is coming out with a new tip for body work that works more deeply; hopefully the new tip will improve the consistency and results of tightening on the body sites.

How does Thermage work?

The 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 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.

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.

Why do some people not see results with Thermage?

We know from good research studies that everyone makes collagen after a 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 laser 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 6 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 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 about body sites? Does it work as well there?

In my opinion, Thermage (done well and on the right person) has good, and sometimes great, results on the face (face includes under the chin) and eyelids.

It is less effective on the neck, but still can get good results.  Perhaps a special tip needs to be designed for that thinner skin.

On the back of the hands, there is a little noticeable smoothing of skin but plan on Restylane or Juvederm (filler) after Thermage to get a really nice result.

I don’t recommend the other body sites (arms, thighs, abdomen, etc). It is inconsistent, unimpressive, and very expensive.  Thermage is coming out with a new body tip late in 2008 so we’ll see then if it’s better.

How much does Thermage cost?

The cost for this procedure, depending on where you live, is usually somewhere from $2,000-$3,000 for a full face treament. Adding other areas will cost more.

What does a treatment feel like?

You’ll feel a brief sensation of heat each time the Thermage is pulsed. But the 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 nurse or doctor to turn the energy down just a bit. The new 3.0 tips, through which the heat is delivered, are very comfortable without sedation. Thermage treatments are no longer painful.

Usually a treatment takes 1–2 hours depending upon the size of the target area.

Here’s how the procedure goes: First, you remove make-up with a gentle cleanser. 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 (third generation) that dermatologists now use is vastly different than the Thermage of four or five years ago.

The original (first-generation) device 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 (we sedated everyone in our office), 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 (our office still sedated everyone). 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 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 to 900 pulses for the full face), and added a cooling element to the tip so there is no pain.

The treatment is now comfortable without sedation. I know from personal experience because I’ve had a treatment with each of the three generations of tips. 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 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 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 you’re over fifty, 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 3 months before repeating it.

Do I need to come for maintenance treatments?

Most people repeat their treatments every 2 years or so.  If you are over 50, it may be best to repeat the treatment yearly.

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.

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

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.

Here are some of the possible other 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 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. 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.

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

Yes. It’s 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.

I know I’m not a good Thermage candidate, but I absolutely don’t want surgery. Would I get at least some result?

Some of my patients, especially those over 60, often don’t want to undertake the risks or have medical conditions that won’t allow elective surgeries. You can certainly do two or three Thermage treatments approximately six months apart. With a combination of several treatments and a series of Sculptra treatments, you can get a “nonsurgical facelift” effect, but it will not be as dramatic as a surgical facelift.

Does Thermage work for the neck?

When I refer to Thermage on the neck, I mean the actual neck skin, not the loose skin just under the chin (some people get confused about this). I’ve not been impressed with Thermage on neck skin. I’m not sure why it isn’t as successful there. Maybe because the skin is so much thinner than on the face. Perhaps a special tip needs to be devised for the thinner neck skin. Still, sometimes even a little improvement is worth it.

I had a Thermage done and really didn’t see much change. Why?

There could be several reasons: (1) Enough pulses might not have been put in for your skin. We routinely use 600-900 hundred pulses in my office and occasionally even more if someone has a large face or a lot of laxity. (2) Technique is important with Thermage. It is important that the nurse or doctor pull in the correct directions while doing a treatment and that they do several full passes and even do five or six or seven passes with what is called the vector method. (3) There is a chance that you are in the approximately 10% who just don’t do well with Thermage.

See Dr. Irwin’s Guide to Eyelid Thermage

Next, see what Dr. Irwin uses for her own personal skincare regimen.

See Dr. Irwin’s expert answers to other reader’s questions on Thermage:
I’m 34- would I be a good candidate for Thermage?
Should I consider body Thermage for my upper arms?
Does metal, particularly braces, cause a problem with Thermage?
Can you recommend a good office in Southern California for Thermage?
Is Thermage safe for African American skin?