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How To Choose Your Thermage Provider

Thermage is an expensive procedure, and you want to get the best return on your investment. But, with so many different providers, huge range of prices, and opposing consumer reviews, walking the path to the right Thermage provider can be daunting at best.

Questions To Ask Potential Thermage Providers

1. Will I be examined by the physician prior to my procedure?

Many places that offer “free consultations” usually means that the individual sits in a consultation room with an aesthetician, technician, or nurse. You may or may not receive a physical examination. Thermage is a medical procedure and Thermage machines can only be purchased by physicians. Every potential Thermage patient should have a medical history taken and also receive a focused physical examination by a medical doctor prior to the procedure. The doctor should rule out any possible medical contraindications to having the procedure, as well as any underlying medical conditions or medications that would prevent you from getting results out the procedure.

2. Is the doctor on premises during my procedure?

Some Medispas are “overseen” by physicians who have no knowledge of cosmetic procedures or have any training in that area. Many are emergency room physicians or other specialties that have just changed careers for financial reasons.

3. Does the doctor perform my procedure? If not, who does? Can I see their certificate of training?

The doctor doesn’t necessarily have to perform the Thermage procedure. The best results occur with the most experienced providers which are identified by either a black diamond or pinnacle status on the website. These are awarded for the greatest number of procedures delivered. However as of 2012 Fraxel supplies are being counted towards Black Diamond and Pinnacle status, kind of making those designations now meaningless, since Fraxel although owned by Solta the same company, is a completely different procedure, So look for those awards going back a number of years indicating many years of experience not just one. Some of the most famous doctors on television do not perform any treatments at all. Another piece of insider knowledge is to identify a physician trainer or their direct “disciple”. Physician trainers train other doctors but that training might be just one day, whereas technicians in their employ have probably trained with them and their techniques for years and are the ones that are delivering Thermage treatments every single day and are indeed the most experienced providers. Certified Technicians are trained in the various Thermage procedures by both their supervising physicians and Thermage. Certified Technicians are trained in safe practices to prevent the occurrence of skin burns and undesired fat melting and at the completion of their training they are awarded a certificate. Ask to see their certificate. Do not allow any uncertified individual to perform your Thermage.

4. What kind of medicine will I have to take before my Thermage Procedure?

Numbing cream is not to be used for Thermage. It changes the skin resistance. Many facilities offer either a pain-pill or injection prior to the procedure, plus or minus a little valium. Thermage is not painful, but it can be a bit annoying since you have to sit still for about an hour per treatment area.
Face and eyes are pretty comfortable and can be done with no pain medications. Neck and body can be more intense and pain medications are generally recommended prior to working on these areas. Under NO circumstances is it necessary or justified to have I.V. sedation or general anesthesia for your Thermage procedure. Not only do you risk the complications of the anesthesia itself, but this is when severe burns can occur leading to scarring and the possible need for skin grafts.

5. Which machine do you have? Can I see it?

Thermage has been around since 2002 and has undergone several important upgrades and improvements in their technologies, especially over the last 3 years. The original device in 2002 resembles a square box about the size of a microwave and sits on a tabletop. This original version is now out-dated and incompatible with the newest Thermage tips because it lacks the output power and speed to effectively treat with the newest tips. Thermage performed with this tabletop version of the machine will be painful, slow, and yield sub-standard results.

In 2007, Thermage upgraded the technology to the NXT device (literally “next” without the “e”) The NXT device stands upright and is about 4’ tall on wheels (it is more like the size of a small human). The NXT upgrade makes the procedure faster and more comfortable for both the patient and the provider. At the time of the NXT release, new Thermage tips also came out that were able to deliver faster, more efficient treatments and better results. Many physicians have upgraded to the NXT device. It is capable of delivering the energy of some of the new tips, but it is not the most advanced version of Thermage.

In the Fall of 2009 Thermage launched the “CPT” comfort pulse technology upgrade. The machine looks the same as the NXT device (approximately 4’ upright on wheels), but the units were re-programmed with a software upgrade that allows the machine to accept a new hand piece that vibrates for patient comfort and the vibrating CPT hand piece also houses the newest CPT tip, which has an improved heating algorithm to heat 3 times as much tissue more precisely, achieving even better results than the NXT.

I will talk about hand pieces and tips in a moment, but to recap:
Table top Unit. Cannot support new tips, painful, and slow.

NXT DEVICE (2007) – 1ST upgrade. Faster, more comfortable, supports second generation STC tips, DC, and CL body tips, and 16.0 body tips with the special 16.0 hand piece.

CPT DEVICE (2009) Newest technology. Supports vibrating CPT hand piece with newest CPT facial tips. Also newest 16.0 body tips with the special 16.0 hand piece.

6. Which tip will you be using for my treatment? How many pulses will I need for my treatment?
Thermage units consist of a power source (upright for NXT and CPT), a hand piece (eyelid, face, CPT face, 16.0 body) and the Thermage tip itself. If the hand piece is the gun, the Thermage tip is the bullet that is loaded into the gun. The tip has on one side a flat membrane (3x3 for face, larger for body, smaller for eyes) that touches the skin surface. Inside the tip is a computer chip with a pre-determined number of “pulses” loaded onto it. Each pulse consists of a cycle “cool-heat-cool” to cool the skin prior to the heat burst, then followed by another cooling burst to lock in the heat energy and protect the skin. Not only do you need to be sure that you get the most recent upgraded tip, but also that you are getting a sufficient number of energy pulses for your desired result. Since Thermage is an expensive procedure for most medical doctors to provide, the more tips (pulses) you need, the more expensive the procedure becomes.IMPORTANT – Each Thermage tip is shipped in a sealed package and is intended for single patient use only. Once the number of energy pulses that were pre-programmed on the tip are delivered, the tip stops working. This is for safety reasons as there can be membrane breakdown from excessive delivery of heat pulses.Some unscrupulous types will buy “re-furbished” Thermage tips that are used tips that have been “unlocked” so that the tip can be used again. Thermage issued a statement warning of the safety hazards inherent in these tips and asked providers not to buy them. Ask to see the unopened package that your tip came in prior to your procedure.

Types of Thermage Tips, compatible units and # of pulses on each

Color Tip Compatible Unit # of pulses
Lt. Blue STC Face tip (oldest) Original, NXT 300, 600
Grey Eyelid (225 shallow tip) Original, NXT 225, now 450
Orange DC Body tip (3x3 small) NXT 600, 900, 1200
Red CL Cellulite Tip NXT 600, 1200
Orange 16.0 Body tip NXT, CPT 300
Orange 16.0 Body tip (upgrade) NXT, CPT 400
Blue CPT Face CPT 900
Lt. Blue Hand (shallow) NXT,CPT 600

Long story short, the most advanced tips are the CPT Face tip and the Upgraded 16.0 400 pulse body tip. Each of these tips required the purchase of a new hand piece, so not all physicians upgraded. There have been no upgrades in the eyelid or hand tips since their original release.

In general, a full face treatment requires 900 pulses and takes about 1 hour to perform with the newest CPT hand piece. If you are told that you will be receiving less than 900 pulses on your face, ask why. Either the provider does not intend to treat your full face (i.e., limiting treatment to a cheek-lift), or you are being given only a partial treatment and another patient is lined up behind you to receive the remaining pulses (unethical and ineffective for the recipients), or you are being treated with an older STC tip that is outdated technology.

Eyelids are generally considered a separate procedure because they require a unique tip that is smaller and has a shallower depth of penetration. Eyelid treatments require the insertion of a plastic contact lens after an anesthetic drop is placed into the eye. In my opinion, only doctors should treat eyelids because insertion/removal of the contact lens can lead to corneal abrasions if done improperly. Eyelid tips come pre-loaded with 225 pulses and take about 20-25 min to treat. The number of pulses required depends upon the patient’s needs and their ability to pay. The more tips needed, the more expensive the procedure.

Physical Condition Desired Result # of tips # of pulses times
Mild skin laxity overall tightening 1 tip-4 lids 225 20 min
Moderate laxity correction 2 tips (1 each eye) 450 40-45 min
Mod/severe laxity strong correction 4 tips (1 each lid) 900 1 ½ hours
Severe laxity Not a Thermage candidate, consider surgery

Body Treatments
Body treatments include neck, arms, hands, stomach, buttocks, thighs, and the area above the knees. Thermage should not be performed on the breasts. Hands are relatively painless and yield excellent results. Stomach is a real crowd pleaser and is the #2 best treatment outcome for Thermage (face is #1). Thermage also works very well for the arms and cellulite. It is getting better results on the neck now that we have the CPT.

Hands are always treated with the 600 pulse shallow-tip. I usually find 1 tip divided by 2 (300 pulses per hand) to be sufficient. This takes about 45 min.

I generally treat arms with either the 1200 DC tip (600 pulses for each arm) or the 1200 CL tip (600 pulses each arm). In our opinion, more tightening occurs with the DC tip. The CL tip is hotter, it treats cellulite, but you don’t get as much circumferential reduction. We have tried using the newer 16.0 Body tip on the arms, but most people are too sensitive. The 16.0 tip is a hot tip, and there are many large nerves located on the inner arm that prevents the use of the larger 16.0 Body tip here due to safety concerns.

Abdomen and Flanks
This area should be treated with the newest 400 pulse 16.0 tip. Only the 16.0 Body tip with either the NXT or CPT machine is effective. One tip is usually sufficient and takes 45 minutes to administer.

Note: The neck and abdomen are the most sensitive places for Thermage, especially for lean individuals. However, we have our tricks at Precision Aesthetics to see you through!!


Only the 16.0 Body tip with either the NXT or CPT machine is effective. This is where the physician consultation and examination are crucial to determine whether you actually are a candidate for the procedure, as well as allowing the doctor to assess your physical condition to determine what bothers you and how many energy pulses it will take to fix the problem.

The majority of women complain about loose skin/cellulite on the buttocks, back of thighs, and saddle bags. I call this the “ham hock” region [buttocks+back of thigh+saddlebag = ham hock]. Other ladies are only bothered by their buttocks. Some are only bothered by the back of the thigh and the butt is okay. Some are just bothered by the front of the thigh. Here is the breakdown of a typical treatment by area.

Area Tip/# of pulses # of tips times
Ham hock 16.0 – 400 pulse 2 (1 each leg) 1 ½ -2 hours
Buttocks only 16.0 – 400 pulse 1 tip (200 pulse each cheek) 45 min-1 hr.
Back of thighs 16.0 – 400 pulse 1 tip divided by 2 45 min-1 hr.
Front of thighs 16.0 – 400 pulse 1 tip divided by 2 45 min-1 hr.

Note: For front of thighs, 1 tip is usually all that is tolerable in one sitting. I tell patients they can come back later if they want more results and offer a discount on the 2nd tip.

The only body part that should be treated with the smaller DC and CL tips are the arms because the arms have superficial nerves that should not be put at risk with the more intense 16.0 Body tip.

All other body parts only respond well to the faster, stronger 16.0 tip that comes loaded with 400 pulses. You should receive all the pulses on the tips. After all, you paid for them.

Which Hand piece will you be using?
Essentially, there are only 3 hand pieces on the market; the most advanced providers will have all three.

Original Hand piece (Blue) – Used for face, still used for eyelids

Newest CPT Hand piece (White) – vibrating hand piece for CPT face tip

Body Hand piece (Grey) – only hand piece that can house the newest 16.0 body tips.

How much do you charge for your procedure?

This is the most important of all questions, but the hardest to explain away the disparities. Let’s just say that the price varies first of all upon the region (it costs more to get Thermage in Manhattan or Los Angeles versus less urban areas). The price also depends upon the experience level of the physician and staff, as well as the type of equipment being used. Be suspicious of any Thermage procedure less than $2000.00. Likewise, be suspicious of any Body treatment costing more than $5000.00 per area.

In general, the cheapest treatments will be performed by uncertified technicians in an unsupervised environment using the oldest technology and possibly re-furbished tips.

The more costly procedures will take place in metropolitan award-winning facilities under the direct care or supervision of an award-winning medical doctor with technicians certified by both Thermage and trained in the physician’s protocols, using the most advanced technologies available to date and delivering the maximum treatment. Since we here at Precision Aesthetics are recognized as the premier Thermage facility in New York City, we encourage you to shop around before selecting your provider.

I have attached a checklist for you to print out and take to your various Thermage consultations.

Precision Aesthetics has won four Thermage Pinnacle and Black Diamond Awards in a row and Dr. Zdinak is a much sought after International Physician Trainer for Thermage. Even if you cannot use Precision Aesthetics for your Thermage procedure, we want you to get the best out of the technology and we have comprised a checklist to help you to decide who the best Thermage provider will be for you. If the provider is not willing to answer these questions we advise that you do not make use of their services.

Please, feel free to contact us at 212-799-1411 or at should you need further help or guidance regarding your thermage procedure.

If you cant make it here, please start at Thermage.comfind a multiyear black diamond and or pinnacle award provider and ask them the questions to insure that they know at least as much as you do now.

We hope to see you soon.

Lisa A. Zdinak, M.D. Chief Surgeon, Precision Aesthetics . 10 West 74th Street, New York, New York 10023. 212-799-1411

I hope that this has been helpful, and I hope to see you soon.

Dr. Zdinak


The following services are offered by
Dr. Zdinak and offer visible results when used in combination as prescribed during your consultation. Offering both surgical solutions & nonsurgical solutions.

Ophthalmic Plastic Surgery [surgical correction of the eyelids and eyebrows]
Non Surgical Body Shaping
Non Surgical Face Lift  
Scarless Mole Removal
BOTOX® and Natural Fillers
[Restylane®, Perlane®, Juvéderm™, Sculptra®, Radiesse™, Artefill]
Lip Augmentation
Treatment of Dark Undereye Circles [Carboxytherapy]
Treatment of Stretch Marks & Cellulite [Carboxytherapy]
Acoustic Wave Therapy for Cellulite
Exilis NonSurgical Fat Reduction
EuroGlowFacial Mesotherapy
Laser Hair Removal Services
Cryolift Cryotherapy Facial
Black Tie Facial Treatment
Australian Ultrasonic Facial Treatment
Lumixyl Skin-Brightening
Total Hand Rejuvenation
Torn Earlobe Repair
Intense Pulsed Light (IPL) Phototherapy
Pixel Laser Non-Ablative Skin Resurfacing
Removal of Superficial Facial Veins and Cherry Red Spots
Superficial Chemical Peels
SilkPeel™ Diamond Microdermabrasion
PRP Dermal Blood Fillers
Read Michelle A.'s review of Precision Aesthetics on YelpRead Isonomist T.'s review of Precision Aesthetics on Yelp

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