Thermage

Thanks to evolving technologies in laser and light source medicine more and more men and women are choosing to postpone having a surgical facelift well until their early to late 60’s if at all. Most patients who opt for a nonsurgical approach to rejuvenation cite several reasons including fear of an overly-pulled and unnatural look, fear of the risks from general anesthesia, fear of the surgical procedure itself, and an unwillingness to suffer through the necessary downtime to allow for the healing to take place.

Before I begin to explain to you what Thermage is and how the procedure is performed, you should know a little bit about me. I am an oculofacial reconstructive surgeon, a doctor who specializes in eyelid and facial repair, and a laser skincare specialist. My fellowship training which spanned two years in minimally invasive techniques of facial rejuvenation was a private fellowship with a surgeon who maintained practices in New York City and Rio De Janeiro, Brazil. I am a member of the American Society of Lasers in Medicine and Surgery and have extensive experience with laser and light source technologies in the field of aesthetic medicine. I have the pleasure of treating an international clientele that visits me from all corners of the globe. This compels me to stay in step with the global community by participating as a clinical instructor and lecturer at international meetings, most recently the World Congress on Aesthetic and Anti-Aging Medicine in Paris, France. In brief, I am constantly searching for the best technologies available to offer my elite clientele. I have been using Thermage since its inception and I have seen the technology evolve up until the present day. In my opinion, Thermage is the best skin-tightening technology available, and we have performed thousands of procedures in my practice. I have trained countless physicians on how to perform this procedure safely and effectively, and my staff and I have accumulated the most Thermage awards for clinical excellence than any provider in New York City. You could say that I am considered something of an expert in Thermage.

Thermage is a nonsurgical skin tightening procedure that is performed in the doctor’s office. Thermage uses radiofrequency energy (radiowaves) to lift and tighten the skin. Our skin is comprised of several layers, the surface layer of the skin is called the epidermis. Below the epidermis is the dermal layer, which consists of many proteins that give our skin structural support. The two main proteins are collagen, which provides tensile strength, and elastin, which lets the skin “bounce back.” When we are younger, the collagen in our skin is abundant and in a tight rope-like meshwork. As we age, sun exposure, genetics, smoking, and gravity make the collagen less abundant and it loses its organized network, and the rope begins to fray. Thermage works like a shrink wrap, using radiofrequency energy to contract the existing collagen, stimulate collagen production, and gradually tighten the skin.

The results one can expect from Thermage depend entirely upon how much collagen exists in the skin at the time the candidate is being considered. The more collagen you have, the better your initial result will be, and you can expect more profound results once the collagen remodeling begins. If there is not a lot of collagen left in the skin (due to excessive sun damage, thin, fragile, crepe-like skin), then the result will not be as dramatic because there is not a lot of collagen left to contract. In addition to collagen levels, Thermage patients should be within about 15 pounds of their ideal weight and have a solid bone structure.

The procedure itself is not painful, and the vast majority of patients do not require pain medication. Some mild discomfort may be experienced during the procedure, but it is generally well-tolerated. When Thermage was first introduced, it could be painful, but advances in technology have made the procedure more comfortable for patients.

The introduction of the Thermage NXT device in January 2007 marked a significant advancement. The new NXT machine, coupled with new tips, increased the efficiency of the procedure by 30%, allowing patients to enjoy more dramatic, immediate effects with less discomfort. The new technology and tips have made Thermage more effective and comfortable for patients.

Thermage is FDA-approved for treatment on various parts of the body, including the face, eyelids, lips, neck, hands, arms, legs, and buttocks. In May 2008, the new Cellulite treatment tip was introduced to expand its capabilities.

There are a variety of Thermage treatment tips available, each designed for specific treatment areas. The tips are one-time use per patient and have different characteristics to suit different skin areas. For example, the Thermage CPT tip is for the face, while the eyelid tip is smaller and designed for the delicate eyelid skin. The hands also have a special tip that penetrates less deeply, and there's a specific tip for cellulite treatment.

The procedure typically starts with the patient washing their face, signing a consent form, and taking pre-treatment photographs. Pain medication may be provided as needed. A grounding pad is placed on the body, and the patient is connected to the Thermage machine. During the procedure, the patient may feel cool, then a little warm, and then cool again. The heat is gradually increased until the patient reaches a comfortable level. The procedure is generally well-tolerated and comfortable for the patient, with no surprises after finding the right comfort level.

The duration of the procedure depends on the specific treatment area and the number of pulses and tips required. Face treatment typically takes about 50 minutes, while other areas may take longer. These are approximate times, and the actual duration may vary based on individual circumstances.

After the procedure, you can expect immediate, natural-looking results. The skin may appear slightly flushed, similar to post-exercise flushing, but this typically subsides within about 5 to 10 minutes. There is no downtime, and no restrictions are imposed on your activities. Makeup can be applied immediately, and you can go about your day. The important changes occur beneath the skin surface and continue to improve over the next three to six months as collagen remodeling takes place.

Collagen remodeling takes at least three months to occur, and there are no exceptions to this rule for humans. After the initial result, you'll begin to see exponential improvement in skin tightness at about six weeks, reaching its peak at about three months, and gradually improving up to six months.

Technically, the results last about 2-3 years, but the aging process continues. In practice, many patients choose to have the procedure performed about every year and a half to two years for maintenance purposes, as they like the results and want to maintain them.

Thermage is a one-time procedure. The radiofrequency energy it uses penetrates more deeply into the dermis than some other devices relying on infrared technology, which often require multiple sessions. Thermage delivers results with a single treatment.

Those with a pacemaker or implantable defibrillator, those with large pieces of metal in the body (if you can have an MRI, you can have Thermage), and pregnant women should avoid the Thermage procedure.

Thermage is safely performed on people of all skin tones. Reports of burns or fat melting are now rare with the new technology and protocol using lower energies. Fat melting, which sometimes occurs, is typically limited to specific areas, and patients are generally well-informed about it.

Yes, Thermage has been shown not to affect the integrity of hyaluronic acid fillers, Sculptra, Radiesse, or surgically placed fat fillers. In fact, Thermage could potentially reduce or eliminate the need for these fillers in the future, especially in the nasolabial grooves.

I've done the procedure on myself and my mother. I recommend the Thermage procedure based on my extensive experience with it and the positive results I've seen in my practice.