A Publication of Skin Deep World
Written by Boris Ackerman, M.D.

In the last decade, there has been an explosion of various modalities to treat aging skin. Specifically, there are a number of last-like devices that treat aging, sun-damaged and sagging skin that tout the fact that these treatments involve “no down time”.  Thermage is a device that fits into this category. It’s not a laser or a light-activated device. A specifically designed handpiece transmits radiofrequency energy to the skin that causes the skin to heat up selectively in the deeper skin layer called the dermis. The most superficial part of the skin, the epidermis, is left intact and not heated. This selective skin heating allows for “no down time”. Since the outer layer of skin is left intact, there is no need for any visible, external wound healing to occur.

Thermage treatment causes the collagen in the dermal layers to contract which causes some immediate skin tightening that can be appreciated immediately after the treatment. But that is not all; the body reacts to the heat treatment of collagen by replacing the contracted collagen with new more elastic collagen. This rebuilding process can take up to six months. This replacement of old collagen in the skin with new more elastic collagen causes the skin to tighten even further. Typically, the doctor plans to perform only one treatment on a patient, as opposed to a series of weekly or monthly treatments that are required with other laser-like non-invasive treatments. After a few months, the patient can elect to undergo another Thermage treatment for even further skin tightening.

This device was developed initially to treat loose skin on the face. The Thermage treatment showed mild to moderate improvement in the loose skin in the jowl, neck and cheek areas. Thermage was noted to be able to lift droopy eyebrows. Thermage’s effect can be seen in before and after photos. Obviously, the change in appearance can never replicate the dramatic changes seen with facial rejuvenation surgery. Nevertheless, for patients who are not ready for surgery and who desire a mild improvement, or who can’t afford the down-time associated with surgery, the modality fits in quite nicely. Admittedly, there are some patients that won’t be impressed with the results obtained with Thermage.

In the last year, Thermage has been used to tighten the skin on the arms, thighs and abdomen. Just like on the face, the results are not very dramatic. But for some patients, the change is enough to warrant the expense of the procedure. In my practice, I tend to use Thermage in combination with some type of surgical procedure. A good example would be a patient that has somewhat loosened skin on the abdomen, but who is not interested in a tummy tuck. In this type of a patient, I perform a conservative liposuction followed by Thermage treatment, resulting in a significant improvement without excessively loose skin. I have used this type of approach in the treatment of necks, arms and thighs. Most patients are quite happy with the results, although some have opted to proceed with more advanced surgical procedures down the road. For example, a patient that initially had a neck liposuction with Thermage went on to have a neck lift. Another patient that underwent liposuction of the abdomen with Thermage, chose to later proceed with an abdominoplasty or tummy tuck.

The Thermage treatment is quite safe if performed y an experienced professional. Nevertheless, some complications can occur. The radiofrequency energy can cause some superficial skin burns which in turn can lead to some scarring. Another untoward occurrence of this treatment can be fat atrophy, especially on the facial areas. This could lead to the development of depressions on the cheek areas. These depressions complications are quite rare, especially if specific protocols of treatment are adhered to. Currently, Thermage is performed without any anesthesia or topical numbing creams. The patients experience a mild to moderate sensation of heat or stinging. This stinging sensation is used as a feedback to the professional who performs the treatment to adjust the settings to lower, safer levels. The level should be high enough to cause skin tightening, but not high enough to cause burns or skin atrophy. I have modified the protocol somewhat. After establishing the safe parameters for the patient, I apply some numbing crease to the remaining skin, so that the rest of the treatment is more comfortable.

In summary, Thermage is one of the non-invasive treatments currently in use for aging skin. It does provide some skin tightening, but the patient needs to be well-informed with respect to the limitations of correcting the signs of aging. Thermage does not treat fine lines or facial age spots. The patient can choose to combine Thermage with a non-invasive laser or intense pulsed light treatment (that would be used to treat the other sign of aging) for a combined effect. This combined treatment could provide the patient with visible improvements in their appearance, without any down time at all. Minimally and non-invasive techniques continue to evolve. For the foreseeable future, if the patient wishes to achieve a more dramatic improvement in their appearance, there is still no substitute for a well-planned and executed surgical procedure.

Boris M. Ackerman, M.D.
PRIVATE PRACTICIONER
BOARD CERTIFIED PLASTIC SURGEON
AMERICAN BOARD OF PLASTIC SURGERY
NEWPORT BEACH, CALIFORNIA