Thermage is classified as a generation 1 & 2 device (Thermage FLX), whilst Volnewmer is a generation 3 monopolar RF machine. Volnewmer is 5 years newer than Thermage & offers significant advantages including-

1. Increased pulse width; 5 times that of Thermage. The maximum duration of heating of Thermage is only 200 ms, as compared to 1000 ms (1 second) of Volnewmer. More bulk heating = better skin tightening. 
2. Better cooling of Volnewmer. Constant water cooling of Volnewmer provides better pain relief & less side effects compared to Thermage. Better cooling = less pain.
3. Faster treatment times. Volnewmer is over twice as fast as Thermage. Fast treatment times= less discomfort with more effective outcomes.

The 3 main differences between Volnewmer & Morpheus8 are depth of penetration, pain & recovery. 

Volnewmer is a monopolar RF device. It delivers effective energy deeper than bipolar devices like Morpheus8. Deeper penetration results in more effective stimulation of collagen in both the dermal & subcutaneous layers of skin. 

If you can tolerate 4 days of downtime with moderate to extreme pain with modest gains, RF microneedling with Morpheus8, Genius or Matrix is an option. 

Oligo & Volnewmer are newer (3rd generation) devices, as compared to Thermage which is a second generation monopolar RF device.Compared to the older generation Thermage, Oligio has-

• More advanced cooling
• Less pain 
• Cost typically half the price of Thermage 
• Faster operating time compared to Thermage

Volnewmer has the edge over Oligio when it comes to comfort levels as well as treatment times, however the biggest advantage of Volnewmer is the number of clean shots fired.

A misnomer is that HIFU-Ultherapy– Ultraformer is a very useful (& powerful tool) for treatment of jowls & aging. We use this device primarily to contour facial features, especially in the lower face. HIFU works best to reduce volume in the jowls, nasolabial folds & submental areas (under the chin). 

Volnewner on the other hand is less useful as a contouring tool as the energy levels are spread over larger areas (bulk heating), whilst HIFU provides concentrated energy. The latter is better for fat destruction & contouring, whilst slow heating is better for collagen contraction, lifting & improving volume deficits. 

Though reported as a treatment for enlarged pores, Volnewmer, in the scheme of things is not the best device to reduce pore sizing; there are many better devices including- 

•     Picosure Pro/pico lasers: in an overpass setting is an excellent treatment for pores in darker skin types. 

•     Thulium 1927 lasers: in a high-density setting is best for lighter skin types. 

*Volnewmer works by increasing collagen contractility & amount in the dermis, which may account for pore size reduction. Pores should also be managed medically if there is an outflow problem – too much oil.  Skin care actives such as mandelic acid & retinoids are useful adjuncts to reduce pore sizing .

Delayed nodules, infection, & biofilm are very rare side effects. The decision to employ collagen stimulating fillers is based upon calculations of risks & benefits taking into consideration clinical findings, technique, anatomy, & dilution.

A sweet spot is early 30s to mid 40s in lighter skin types. 

For ethnic skin, mid 30s to early 50s. 

The difference in ages is due to physiology- darker skin types generally have less sun damage, with better quality collagen. This means better contractility of the dermis. For lighter skin types, Volnewmer is best employed as a prejuvenation treatment, namely a low level biostimulatory device.

2 classes of patients are suitable for this treatment-

Prejuvenation client: minimal signs of aging, usually in the early stages of facial laxity, ages 30 to 50, depending on the skin type & quality. 

Rejuvenation client: mild to moderate facial laxity with good dermal volume & moderate fat thickness. Minimal to no sun damage ensures good contractility of dermis. 

*The algorithm is complex, as we take into account factors such as age, ethnicity, background sun damage, dermal thickness, fat layer, expectations & previous treatments. Combination treatments provide the best outcomes & may include HIFU, laser resurfacing, dermal toning, & cosmetic injectables such as collagen stimulating dermal fillers.

Patients who do not respond to non-surgical lifting & tightening devices include those who-

• Have excessive sun damage with fragmented collagen
• Exhibit moderate to severe skin laxity
• Have a thin dermal layer (not enough collagen to contract)
• Excessive subcutaneous fat layer (too heavy to lift)

Candidate selection is critical for best outcomes. For patients with excessive sun damage & marked wrinkling, CO2 laser resurfacing provides the best results. 

For heavy jowling & a thick subcutaneous layer, HIFU is best. 

For moderate to severe laxity, a deep plane face lift is best.

Dermal fillers provide a one-to-one correction of volume loss, namely if you have one milliliter of filler, you will correct one milliliter of volume deficit. It’s slightly more complex than that as hyaluronic acid does take up water. Additionally, volume correction can be at different levels with fillers, most importantly, bone. 

Volnewner on the other hand increases dermal volume, but to an unquantified amount. RF can also increase & contract dermal collagen, whilst dermal fillers do not provide collagen contraction. The ideal treatment plan depends largely on your age, facial structure & goals. It also depends on the injectable product used, namely hyaluronic acid vs collagen stimulating injectables.  

Correct, both stimulate collagen however their mode of action is different, in addition to volume changes & repeatability (frequency of treatment). 

With collagen stimulating injectables such as PLLA, PCL, CAH, & hybrid complex HAs, the amount of ‘tightening’ is less predictable than volume correction, acknowledging that in some cases, volumetric increase produces displacement that accounts for ‘skin tightening’.

The actual amount of ‘volume’ from stimulation of collagen (measured in milliliters) from collagen stimulating injectables is variable. Once you hit the optimal volume distribution from these injections, any more will tip the balance to add more volume over ‘tightening’. This is when you look overfilled, overinflated &, truthfully, weird.

Volnewmer on the other hand tightens & lifts with minimal addition of ‘filler volume’ or CMC/carboxymethylcellulose. The downside? The amount of collagen stimulation is variable, & the volume replaced (contrary to the name), is minimal. The upside is that you can have this procedure repeated as many times as required, without the overfilled & overinflated look. 

Lasers are best for surface correction, namely fine lines, superficial wrinkles, pigmentation & enlarged pores. RF monopolar energy (Volnewner) is best for skin laxity & changes that are under the skin’s surface. 

The most predictable laser for improving skin quality is the CO2 laser. 

Volnewmer employs monopolar RF energy, whilst Softwave uses ultrasound energy. Monopolar RF has deeper penetration, whilst Softwave penetrates to only 1.5 mm. 

Deeper penetration means Volunewmer has better lifting & tightening capabilities than Softwave, however Softwave may have an advantage in the more superficial aspects of the skin, namely the dermal layer.

No. Nothing is a substitute for a deep plane facelift. Surgical options provide the best & most predictable results when it comes to skin tightening or lifting. Surgery repositions the deeper layers of skin (SMAS or sub-SMAS for deep planes) & is the treatment of choice for moderate to severe deep plane laxity. 

The flipside is that the upper layers of skin should also be addressed (skin quality, fat quality) with lasers & EBD (energy based devices), volume replacement should be considered with soft tissue dermal filler injectables. Balanced rejuvenation takes into consideration the balance between skin texture/quality, tone & volume. 

Research has shown that Volnewmer can improve the quality of your skin, namely, to reduce brown spots, pigmentation & homogenize red splotchy areas. Limited data shows up to 53% reduction in these concerns. 

Whilst results can be good in some patients, if your primary concern is improving skin texture & quality, lasers do a much better job than Volnewmer. Volnewmer is best reserved for skin tightening & improvement of volume.

We use Volnewmer exclusively on facial areas for lifting & tightening, however monopolar RF can also tighten skin on –

• The arms
• Legs
• Abdomen

Non-surgical lifting in these areas can be unpredictable. For best results we recommend a combination of collagen stimulation with injectables such as PLLA or CAH combined with RF energy. 2-4 sessions are recommended. Skin that is lax without excess fat responds best. 

Side effects are exceedingly rare but include-

•     Prolonged redness lasting 48 hours
•     Wheals, hives & persistent skin sensitivity

Unlike Thermage, skin burns have not been reported with Volnewmer. The constant water cooling of this device is very different from the gas cooling of Thermage.

It’s a complex algorithm, but here is the breakdown of combinations I use.

Volnewmer + HIFU/Ultraformer MPT: Best for skin tightening & facial contouring in suitable patients, especially in the low ⅓ of the face, namely the nasolabial & jowl fat pats, in addition to pre platysmal fat. Candidate selection is critical for best results. Ideal in younger to middle age patients with no sun damage & good skin quality. MPT is best for focal fat destruction in the above described areas. Ultherapy is outdated as it is a 14 year old device.

Volnewmer + CO2 laser resurfacing: Best for non-surgical skin tightening in lighter skin types. The CO2 laser can tighten the lower, mid & upper dermal layers, whilst RF monopolar is best for deeper subcutaneous skin tightening. Suitable for middle aged clients with sun damaged skin with poor quality-fragmented collagen (elastosis). 

Volnewmer + cosmetic injectables: This combination of soft tissue injectables & muscle relaxants can lift & tighten. Suitable for all skin types. The ideal placement depends on facial volume & structure. 

Volnewmer + dermal collagen stimulating injectables: The ideal product depends on your facial volume, shape, & degree of laxity or dehydration. Here is the algorithm for selection. 

Volnewmer + Pico laser: my favorite combination for treating darker skin types, including Asian, Middle Eastern & South American. More on pico toning laser.

Volnewmer + PN Rejuran: Addresses fine textural changes without addition of volume. Ideal for around the eyes, in addition to improving fine lines, enlarged pores in the younger age group looking for ‘Glass Skin’.

Fat destruction is rare with Volnewmer, unlike HIFU. The energy profile of monopolar RF is over a long period of time, reducing the chances of fat atrophy. 

HIFU devices such as Ultherapy & Ultraformer MPT are very effective at fat destruction, hence their use for facial contouring of the jowls & under chin area. 

In practice, we often combine treatments with Ultraformer MPT & Volnewner to contour (reduce superficial fat pads), & to volumize/lift. 

*Refer to the 2023 publication by Kim,  Evaluating the Efficacy of Continuous Water-Cooling 115-Watt 6.78-MHz Monopolar RF Therapy for Fine Wrinkle Reduction. 

‘One of the most intriguing applications of RF therapy lies in face slimming in the author’s clinic, where it offers a nonsurgical avenue for facial sculpting. Research on Asian women revealed that RF therapy led to a reduction in fat accumulation in the lower face for more than 90% of participants, accompanied by high levels of satisfaction. The minimal post procedure side effects, primarily mild redness, underscore RF therapy’s safety profile.’

Comment: My staff & I are aware of anecdotal tightening followed by possible fat destruction in some patients, hence we are mindful to apply energy devices such as HIFU & monopolar RF in suitable candidates. In most cases we WANT fat loss to aid in contouring of the lower face, esp. Jowls & jawline.

Dermal filler destruction has not been reported with Volnewmer, at least in the context of RF energy. This has been confirmed in our publications in 2019. Reason is that the temperatures of RF energy reach a peak of 67 degrees in the dermis, whilst HA fillers are stable at temperatures well above 100 degrees. 

Deformation properties of CAH, PLLA, PCL & CaOH depend on the substance itself. Your injector will know the data.

I have reviewed many devices Disclaimer: these are paid campaigns. Take this into consideration. 

Microcurrent at home devices, including companies such as Foreo Bear, NuFace Trinity, Ziip & others are great as a novelty treatment, however the results (if any) are short lived & subtle. 

Microcurrent can – 

1. Firm the skin due to immediate collagen contraction. Firmness does not mean lifting or tightening, it is a subjective feeling. Think of fruit; you need to touch to tell the difference between soft & firm. Firmness is generally short lived, 6 to 12 hours at most. 
2. Microcurrent rarely, if ever, lifts or tightens. 1% of the population will objectively demonstrate lifting of the mid-lower face. Heating of the skin with microcurrent is minimal, additionally penetration of the energy is confined to the superficial layers, unlike monopolar RF which penetrates deeply into the skin.
3. Application: It takes time. Time that most people don’t have. Microcurrent devices are uncomfortable to use, especially if the current is turned up. 

RF devices such as Volnewmer, Thermage, Oligio, Pelleve,& Tempsure  all have higher success rates when compared to microcurrent.

Volnewmer, along with other devices are best indicated for mild to moderate skin laxity, in suitable patient profiles. It goes something like this-

Skin of color, namely Asian, Islander & African – African American will generally respond better to heat based treatments better than white skin types. This is based upon the physiology of skin.

Collagen quality, amount & contractility differs in ethnic skin. Fibroblasts are larger, more numerous & react more briskly in ethnic skin.

The downside? With increased fibroblast activity comes the increased incidence of keloid & hypertrophic scarring, as seen in darker skin types. Additionally, darker skin types are not candidates for CO2 lasers or phenol peels, which are very powerful collagen stimulating procedures. 

So, now you know the reason why Asians seem to do better with treatments such as Volnewmer, Thermage, Ultherapy, HIFU, Oligio, Morpheus8, FaceTite & other skin tightening procedures. 

*The two studies quoted are based on an Asian population of patients, the results may be biased towards ethnic skin due to the physiology. More studies are required in lighter skin types as the % of patients that respond well to Volnewmer & other devices may actually be less in comparison to the quoted figures. 

Volnewmer & tretinoin are not mutually exclusive. Contrary to the hype of tretinoin, it is not a miracle anti-aging cream that adds volume & provides skin tightening.

Tretinoin is best as a preventive for photoaging of the skin, namely to help preserve & improve skin quality (think very fine lines, pigmentation, textural changes, pigmentation & sun damage). Vonewmer works as a bulk heating collagen stimulator that goes much deeper than tretinoin. Both are advantageous when it comes to prejuvenation & correction of mild changes in different layers of the skin.