Thermage At A Glance
- Best Results1-2 sessions
- Treatment RecoveryImmediate
- Procedure Time80 min
- Skin SpecialistNot used, see reasoning
- Duration of ResultsVariable
- AnaestheticSkin cooling
- Back to WorkImmediately
- CostNot offered- see below
Thermage is a skin tightening procedure that uses radiofrequency energy to contract & stimulate collagen. Thermage can be applied to the face, neck & eye area. It is best reserved for patients with mild laxity & a thicker skin. I have replaced this procedure with newer generation treatments including focused ultrasound & radiofrequency devices. Read more to understand.
FactsFacts on Thermage
- Thermage is one of the first devices for skin tightening
- It employs radiofrequency energy to stimulate & contract collagen
- Thermage can treat the face, jowls, eyes, & neck areas
- Thermage can also treat the abdomen, tightening loose skin
- Radiofrequency treatments have little if any downtime
- Radiofrequency is best for mild laxity in patients with a thick dermis
- There are many other ways to tighten & lift including focused ultrasound, collagen stimulating fillers, other radiofrequency devices & threads
- Finding the correct method/s will give the highest chance of success
What does Thermage do?
For a treatment to effectively tighten the collagen the inner layer of your skin must be adequately energized and stimulated. To date, one of the recognized methods of accomplishing this is through the application of heat deep within the tissue. Thermage was created for this single purpose, namely to provide radiofrequency energy to heat up the dermis.
How does Thermage achieve skin tightening?
A sophisticated treatment tip called Thermatip™ delivers a controlled amount of radiofrequency energy. With each touch to the skin, the Thermatip uniformly heats a collagen in the deeper layers of the skin. The overlying skin is protected with cooling.
This deep uniform heating action causes collagen to immediately tighten. Over the next 16 weeks, new collagen is produced to further tighten skin, resulting in healthier, smoother skin and a more youthful appearance. In practical terms it is important to profile each patient to predict who will get this ideal response.
Who is the ideal candidate for Thermage?
As with ALL non-surgical treatments, patient profiling is essential for results. The ideal Thermage patient should have – minimal sun damage, mild laxity, thicker dermal layer, mild to moderate jowls & lower face heaviness.
Patients with cardiac pacemakers or other active implants may be advised to seek alternative forms of treatment.
Why have I replaced my Thermage device with other skin tightening procedures?
I used Thermage for 5 years prior to updating all my skin tightening devices in 2020/2021. This is because there are better, more cost effective & more clinically effective modalities.
For non-surgical skin tightening, I use specific devices for specific areas (unlike Thermage which treats all areas, however does not treat one area exceptionally well). Additionally I select a device based upon the clinical examination, taking into account dermal thickness, degree of jowling/ lower face heaviness, ethnicity, skin quality, downtime, expectations, & budget.
For an overall skin tightening approach, I prefer Pelleve or Tempsure. For specific locations such as the eye area, neck, jowls & lower face, I employ FaceTite, Ultherapy, RF Microneedling as well as collagen stimulating fillers & threads.
A regional approach to skin tightening, matched with optimal procedures gives the best results.
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Why is Thermage more popular in Asian countries compared to Australia?
This is primarily based upon the different skin types that vary according to where you reside. Asian & ethnic skin react differently to fair skin types. As a rule, darker skin types have a more vigorous fibroblastic & melanocytic response, meaning they produce more collagen & pigment. This results in a great contraction of collagen & more lifting compared to Caucasian counterparts.
Additionally, the aging process differs between ethics and Caucasian. Lasers are best used on the latter as sun damage is more pronounced in light-skinned types. The flipside is that ethnic skin tends to accumulate more lower face fat coupled with laxity, on the background of thicker skin. This is why HIFU, & RF treatments are more popular in Asia compared to Australia, whilst lasers for wrinkles & sun damage are more frequently employed in Australia & the United States.
What is the best treatment for skin laxity around the eyes?
Thermage can be used around the eyes to rejuvenate & tighten loose skin, however there are better ways to achieve eye rejuvenation. Treatments (performed in isolation or in combination), include-
Pros: Address skin quality issues & static wrinkles in lighter skin types
Cons: Long downtime, does not address volume
Pros: No downtime
Cons: For mild laxity, does not address volume
Pros: No downtime, addresses volume
Cons: Does not address skin quality issues
Pros: No downtime, non-surgical
Cons: Does not address skin quality issues, ideal for mild cases
Pros: No downtime, great for upper lid & brow
Cons: Does not address volume, treatments off label
Pros: Painless, no downtime, cost effective compared to Thermage
Cons: Does not address volume, only for mild to moderate laxity, several sessions
Pros: Lifting predictable of lids + brow lift
Cons: Recovery, scarring, does not address volume loss
Pros: No downtime, cost effective
Cons: Does not address volume loss, last 3-6 mths
Microneedling – RF
Pros: Little downtime
Cons: Does not address volume loss
Pros: microneedling can work, PRP does not
Cons: Many more effective treatments available.
What treatments work for lower face laxity & wrinkles?
There are many non-surgical options for the lower face & wrinkles, however there only a few that actually work. The optimal treatment depends on many factors including the degree of laxity, downtime, skin quality, dermal thickness, ethnicity, amount of subcutaneous fat as well as budget & expectations.
Thread lifting gives good results, however the duration of clinical efficacy is short lived.
Ultherapy or HIFU gives better results than Thermage in patients with moderate dermal thickness & jowling. It is not suitable for patients with thin skin or a thin face.
Lasers are best applied to improve skin quality, whilst dermal fillers are best employed to treat volume loss.
What is the best treatment for neck & chest rejuvenation?
Thermage can treat the neck area, however there are other more effective treatments. These include –
Tempsure, FaceTite & RF: Of these treatments, FaceTite has the best outcomes. Tempsure is often combined with laser & dermal fillers/threads in this area.
Dermal fillers: one of my favourite treatments is the use of collagen stimulating fillers. In the correct setting, they can reduce wrinkles & improve neck laxity.
HIFU: Ultherapy, Ultraformer can be useful for stimulating collagen production in the neck & chest area. I often combine these collagen stimulating fillers for a synergistic effect.
Lasers & IPL: are great for improving skin texture (pigmentation). I employ Fraxel, CO2 fractional, erbium, pico & pigment lasers. Frequently I will also add dermal fillers to synergistically stimulate collagen production.
Are There Any Side Effects associated with Thermage?
Side effects are exceedingly rare following non-surgical procedures. Treated areas may be temporarily flushed & red. This will subside within 12 to 24 hours. Although major side effects are rare, our medical team will discuss all possible risks and complications to you prior to treatment. There are only a hand of cases of thermal burns with Thermage, mostly seen in South East Asia.
How long will the results last?
Although it can take a few weeks for the body to produce new collagen, visible improvements are often seen after just one treatment and can last for up to six months. Individual results may vary.
To be fair, any non-surgical skin tightening procedure including Thermage, thread lifting, HIFU, Pelleve, Tempsure, Ultraformer III & even FaceTite have a variable duration of results. Generally the results following Thermage are shorter in duration compared to HIFU & FaceTite.
How long does the treatment take?
40 minutes to 2 hours, depending on the extent of treatment & the number of pulses.
HIFU treatment with Ultherapy & Ultraformer III is much faster than Thermage, whilst Tempsure & Pelleve take alot longer. RFM & FaceTite also take up to 2 hours to perform.
How long does it take to recover from Thermage?
Much like HIFU, Tempsure, & Pelleve treatments, there is no downtime associated with Thermage. Patients can return to normal activities immediately. Unlike laser resurfacing, there are NO issues with sun sensitivity following these treatments.
When will I see the results from Thermage?
Published data shows that immediately after the treatment you may notice collagen tightening. This is universally seen with skin tightening procedures including Ultherapy, Ultaformer, Pelleve, & Tempsure. This contraction is short lived 1+ weeks for all treatments) & is due to heat.
Gradually over the next 3-6 months you may get better results when new collagen is formed.
What is the ideal way to tighten & provide a non-surgical facelift?
There are many factors to consider prior to implementing a device or procedure. I take into consideration factors such as the grade of laxity, dermal thickness, background skin quality, degree of volume loss, ethnicity, downtime, & patient expectations.
This table is a quick summary of non-surgical options. Read more on the specific treatments for more information.
|Treatment||Laxity Grade||Skin |
|Number of |
|Duration of effects|
|Liquid lifts||Mild to|
|All types||All thickness||2-3||2-4 years|
|Lasers||Mild to severe||Poor skin|
|All thickness||1-2||3-10 years|
|All types||Moderate to thick||1-2||3 -8 months|
|Good||Moderate||1-4||6 months- 3+years|
|HIFU- Ultherapy||Mild to moderate||Good||Thick||1-2||2-4 years|
How does Ulthearapy differ from Thermage?
Both devices produce controlled heating to contact & stimulate collagen production. Ultherapy or Ultraformer uses HIFU or High Intensity Focused Ultrasound, whilst devices like Thermage, Pelleve, Tempsure, FaceTite, Genius, Infini, Morpheus 8, , ePrime, Profound RF, Intensif & Venus systems use radiofrequency.
HIFU produces more heating over a shorter period of time. Depth of heating can be precisely controlled. I employ HIFU when dermal thickness is adequate in patients who are heavy in the lower face & submental areas.
RF, (Tempsure over Thermage) in patients with mild to moderate laxity of the lower face with medium dermal thickness/fat.
How does FaceTite differ from Thermage?
Both FaceTite & Thermage deliver RF or radiofrequency energy to heat up the underlying skin, in turn providing collagen contraction (tightening) as well as stimulation.
The method of delivery is vastly different. FaceTite uses precise & focal heating performed by the surgeon to deliver energy in target areas. The temperatures achieved with FaceTite are also higher. I can also control the number of passes with FaceTite, concentrating on areas of laxity. Additionally with the use of liposuction during the FaceTite procedure allows me to remove excess fat in the lower face & sculpt the neck & jawline.
Threads vs Thermage- which is better?
Hard one to answer as both treatments have very similar clinical effects as well as actual (not advertised) duration of effect (3 to 8+months).
Suspension threads (MINT/Silhouette etc, ) gives much more predictability in the context of lifting (as I design & pull the vectors). The problem is the duration or longevity of results. Monofilament threads (MINT) can give a modest lift in some patients.
In my practice I combine threads with energy devices such as Tempsure, Pelleve & Ultherapy. I suspect the answer lies in combination therapy over just threads or just Thermage.
*Thread companies state threads last up to and sometimes beyond 12 months. I do agree that in some exceptional cases we do see longer lasting results. The majority of patients will have improvement for 3-6+ months on average.
Can you get Thermage if you had dermal fillers?
Yes. I published a paper in Dermatological Surgery in 2018 outlining the safety of RF & dermal fillers.
Hyaluronic acid fillers are sterilized at over 110 degrees celsius for 4-14 minutes as HA are made by streptococcus bacteria. RF energy is delivered at around 64 to 70 degrees for a very short time. This means fillers are heat stable in vitro & in vivo. Lasers, IPL, RF, RFM, HIFU will not break down your dermal filler. Additionally fillers are usually placed deeper than the targeted energy ball from RF devices.
What is the logic with Tempsure & CO2 laser resurfacing combination therapy?
Balanced skin rejuvenation entails treating 3 aspects of skin, namely improving skin texture or quality, skin tone & volume.
Lasers including Ultrapulse CO2 can improve the upper layer of skin, as well as providing collagen contraction. Tempsure, Theramage, FaceTite, Genius, Ultherapy & Ultraformer can address the deeper layers of skin, in turn providing contraction & lifting.
Volume replacement can be achieved using dermal fillers & or autologous fat transfer.
What is the best treatment for moderate to severe skin laxity?
A deep plane facelift gives the most predictable results, followed by a short scar face lift. In some cases, if there is excessive skin, a neck lift (with or without associated liposuction) is performed at the same time. I do perform short scar or mini S face lifts, however if you have significant jowls & laxity, I would recommend seeing a plastic surgeon who regularly performs deep plane lifting.
How would I know what is the best treatment for me?
Book an appointment with my clinical team for a real time assessment. My nurses can review your skin, & have an understanding of your expectations.
We will match a particular procedure/s based upon your degree of skin laxity, sun damage, dermal thickness, subcutaneous fat & heaviness, ethnicity, downtime, expectations & budget. Skin tightening is more involved than recommending one or two types of devices.
For surgical & complex cases, book an appointment with myself. Reception will guide you through the referral process, wait times & consult fees.
Davin’s Viewpoint on Thermage Treatments
I did use Thermage for over 5 years before implementing newer & more predictable devices such as FaceTite, RFM, Pelleve, Tempsure, Ultherapy & Ultraformer. The majority of dermatologists have been there, done that with Thermage as this technology approached its 20 year anniversary. There are only a handful of dermatology clinics left still adopting this older radiofrequency technology.
Does it work? To be fair radiofrequency, delivered non-invasively (Thermage/Tempsure/Pelleve), can deliver acceptable results if the patient profile fits- namely thick dermal layer, good skin quality, mild laxity. This especially applies to Asians as the fibroblast (collagen producing cells) response is often exaggerated. Histological differences in the skin of ethnic patients also skews the subset of ‘good responders’ in favor of those who have little or no elastosis (sun damage), a thicker dermal layer & a more brisk response to neocollagenesis.
I had the chance to compare many RF devices including Pelleve, Tempsure, Thermage as well as other forms of RF such as ePrime, Profound RF, eMatrix, Intensif RF, Genius, Intracel, Infini, insulated cannula devices Ionoto+, FaceTite, Pollagen & others over the past 15 years. Non-invasive RF such as Thermage & Tempsure/Pelleve have similar response rates (25 to 60% patient satisfaction), whilst invasive RF devices such as Facetite & more powerful RFM devices (Genius/Infini) are associated with a higher satisfaction rate (60-85%).
Narrowing it down to cost vs clinical effectiveness of treatments is the reason why I do not like Thermage (in the current arena of non-surgical skin tightening). The fact remains- Tempsure is far more cost effective (and much less painful) compared to Thermage. Typically Tempsure is less than one third the price of Thermage.
In the context of what works better, I do believe that HIFU treatments in the CORRECT candidate, gives more predictable results than Thermage. For effective skin tightening, it is application of surgical as well as non-surgical modalities including an array of energy devices as well as threads, & dermal fillers to the clinical findings of the patient. It is never about a device.
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