Thermage is a lifting procedure that cools the skin surface while sending radiofrequency heat into the dermis. It treats periocular and facial wrinkles in one sitting without an incision, and tightening is described as continuing over several months afterward.
3-line summary
1. Thermage is a single treatment that cools the surface while sending radiofrequency heat into the dermis to contract collagen, after which new collagen is produced.
2. A periocular multicenter study confirmed changes in wrinkle scores and brow position through 6 months, and half of those treated were satisfied with the periocular change.
3. Second-degree burns and fat atrophy have been reported, so pacemaker, pregnancy, and filler locations are disclosed before the appointment.
The surface is cooled while radiofrequency heat is sent into the dermis
Thermage heats the dermis by passing current through a single-electrode tip and a return pad attached to the body. This is commonly called monopolar RF. The tip cools the surface at the same time to protect the epidermis, and energy is delivered by stamping along grid markings while the device is in contact with the skin.
In an early tissue study, collagen fibers contracted immediately after treatment, and signals that make new collagen then increased. Among the authors of this study were employees of the Thermage manufacturer. A U.S. regulatory agency permitted this device to be marketed for the nonsurgical treatment of periocular wrinkles and fine lines, including the eyelids. A mode that also uses vibration lists temporary improvement in the appearance of cellulite among its uses.
| Item | What was confirmed |
|---|---|
| Energy | Radiofrequency heat, surface cooling |
| Sessions used in measurement | A multicenter study of follow-up after a single treatment |
| Period the study examined | 6 months |
| Retreatment interval in practice | More than half of physician-survey answers chose 1 year |
| Common reactions | Heat sensation, temporary redness and swelling |
| Rarely reported reactions | Second-degree burns, small scars, fat atrophy |
The procedure proceeds in this order: consultation and cleansing, grid marking, attaching the return pad, delivering energy by area, then checking the skin immediately afterward. How shot count and tip type are reflected in the estimate can be reviewed further in the dermatology price comparison guide.
Change after a single treatment was measured in periocular wrinkles
A multicenter study that treated the periocular area once with an early device followed patients through 6 months. When blinded photographs were independently graded, periocular wrinkle scores fell by one grade or more at more than eight out of ten sites. The brow rose by 0.5mm or more at six out of ten sites. Half of those treated said they were satisfied or very satisfied with the change in periocular wrinkles.
In a survey of Korean dermatologists who use the current Thermage FLX in practice, more than half answered that it was better than the previous device, and two out of three answered that time had decreased. One in four answered that it was more painful, and more than half answered that they set the retreatment interval at 1 year. Some answers judged the response to be good in people in their 40s, and skin thickness was cited as an important condition for response.
Focused ultrasound used in Ulthera differs in the type of energy and in the sites studies measured. A comparison of mechanisms is set out separately in the Ulthera and Thermage comparison guide.
| Category | Thermage | Ulthera |
|---|---|---|
| Energy | Heats the dermis broadly with radiofrequency | Focuses ultrasound at a set depth |
| Sites the studies examined | Periocular wrinkles, brow position | Brow, submental area |
| Follow-up time point | 6 months | There are data that followed the brow and submental area longer |
| Sensation during treatment | Heat sensation | Point-by-point stimulation |
※ The Thermage follow-up time point is the grading period of the periocular multicenter study. The table only places differences in energy and measured sites side by side.
Burns and fat atrophy have also been reported
The same multicenter study reported second-degree burns, and some people still had small scars at 6 months. In later data that followed 290 people, second-degree burns, fat atrophy, and burns at the return-pad site occurred in some treatment sessions, and records that the procedure was especially painful were left in about one in ten sessions. More than 90% of the participants in this dataset were women.
After an early approach that used high energy in a single pass, practice shifted toward multiple passes while reporting heat sensation during treatment. This is why criteria for lowering energy when the burning sensation increases are set in advance. General contraindications and how adverse reactions are handled can also be reviewed in the treatment safety information.
Delivering heat to the collagen layer is also covered in the guide to methods for increasing collagen, and the range of use can be reviewed further in the Thermage FLX treatment information.
Confirm the device name and contraindications before treatment
Ask the following as written, and the device used today, the area, and history that should not be omitted will come up immediately.
- □ Whether the device used today is Thermage FLX or another radiofrequency device
- □ Which of the periocular area, cheeks, and jawline will be treated, and whether an eyelid tip will be used
- □ The criteria for lowering energy when heat sensation increases
- □ Whether pacemaker, metal, pregnancy, breastfeeding, and filler locations were disclosed before the appointment
- □ Whether the next photographs will be compared at 6 months from the same angle, then a 1-year schedule reviewed
Frequently asked questions
Q1. Does Thermage hurt?
It is a procedure that brings heat and pressure to the skin. If you report a burning sensation during treatment, the energy is adjusted.
Q2. How many sessions are needed?
The multicenter study that measured periocular wrinkles looked at change after a single treatment. Whether to repeat is decided after comparing photographs taken at the same angle.
Q3. How long do Thermage effects last?
The last time point at which the human multicenter study graded photographs is 6 months. Immediate tightening and change over the following months were observed together.
Q4. Can it be done together with filler or Ulthera?
If filler is present in the same area, the sequence and interval for applying heat are decided first. Whether to receive Ulthera on the same day is also decided after reviewing previous treatment sites, and history is disclosed following the consultation guide for filler, botulinum toxin, and lifting history.
Q5. Who should postpone the appointment?
Implanted electronic devices such as a pacemaker, pregnancy or breastfeeding, and metal or filler locations in the treatment area should be reported before the appointment. Because current travels through the body to the return pad, whether an electronic device is present must not be omitted.
Results, duration, and suitability vary with individual skin condition, age, and lifestyle, and the same outcome cannot be guaranteed.
Procedures may cause temporary redness or swelling, and contraindications may apply, so please confirm these during your consultation.
This article is general information and does not replace individual medical care. Please confirm diagnosis and treatment suited to your condition during a consultation.
Sources
- U.S. FDA: Thermage FLX 510(k) summary (2017)
- Fitzpatrick R et al. (2003), Lasers Surg Med: Multicenter study of noninvasive radiofrequency for periorbital tissue tightening (PMID 14571447)
- Zelickson BD et al. (2004), Arch Dermatol: Histological and ultrastructural evaluation of the effects of a radiofrequency-based nonablative dermal remodeling device: a pilot study (PMID 14967794)
- Suh DH et al. (2020), Dermatol Ther: A survey on monopolar radiofrequency treatment: The latest update (PMID 32902088)
- de Felipe I et al. (2007), J Cosmet Dermatol: Adverse reactions after nonablative radiofrequency: follow-up of 290 patients (PMID 17760693)
- Dover JS et al. (2007), Dermatol Surg: Results of a survey of 5,700 patient monopolar radiofrequency facial skin tightening treatments: assessment of a low-energy multiple-pass technique leading to a clinical end point algorithm (PMID 17661932)
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