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.

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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