Radiage vs Thermage and other laser skin tightening treatments?

Radiage, which provides continuous gradual heating with radiofrequency energy, differs from all other RF devices because it allows the patient to be treated to a definitive clinical visable endpoint rather than a predetermined "safe" dose used in pulsed devices. After 3 years as an aggressive Thermage provider and over a year and a half of Radiage development I can tell you the only limitation of efficacy in RF devices is the safety concern with pulsed devices as well as the associated pain. By using gradual continuous heat and maintaining it until no further contraction is seen, a significant visable response is obtained painlessly in every case.

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Let me start with a simple fact - heating the skin to tighten it is what all of the methods have in common, the method of heating is the core to their differences.  This means that they all take time to see the final results - months. The first difference would be that Radiage is not yet FDA approved, although it is available from a limited number of physicians within the US. The second difference would be that light-based devices, such as the Titan, provide a range of skin surface improvements - depending on the device - mainly improvement of brown/red spots.  Because these devices (especially IPLs like the Titan) tend to deliver alot of energy to the skin, the skin gets hot - sometimes very hot ... the skin tightening is a beneficial side-effect of this heating. The third difference between the two RF devices you asked about is more subtle, Thermage is associated with more aggressive heat energy delivery and has (mainly in the past) had inconsistent  and sometimes damaging results.  Radiage, on the other hand, is a very gentle treatment. The final difference between the RF devices and the light-based devices is that there is no need to avoid sunlight or tanning beds. Being in South Florida, this is a very large advantage for many of my patients. I have found Radiage to provide excellent results in both skin tightening as well as skin texture.  For my patients that have skin coloration issues, I combine Radiage and laser 'feather facial' treatments to get the best of both worlds. A Radiage treatment is very relaxing - a gel is applied to both help keep the surface of the skin cool as well as to aid in movement of the device over the skin's surface.  The device is then gently rubbed over the target skin (not that it can be used in any area on the body - not just the face).  you feel a slight warming sensation, no pain, no displeasure.  A facial treatment takes about 20 to 30 minutes and the recommended course is 4 treatments at 1 month intervals.

In order to denature or damage collagen and thereby create a permanent change to the skin, high temperatures in the dermis must be reached, over 52 C (125 F). I'm always surpised that this can be achived painlessly with some devices. Remodeling of collagen takes months to occur which is well documented in both wound healing literature as well as some dermatological journals. At low temperatures (less than 65 C or 150 F) the only immediate changes that will appear as tightening are most likely caused by edema. Giving treatments at 1-month intervals may be counter productive. There is a growing amount of evidence that heating the skin give rise to heat shock proteins that then protects the skin from future insults. I am not aware of the duration of the protective effect, but I wouldn't be surprised if these protective proteins are still abundant at 1 month.