If Thermage is So Great, How Come People Say They Don't See Results?
- Asked 5 years ago
My doctor recommended Thermage for the loose skin on my neck, jowls and eyelids, but I don't know anyone who has done it and I don't really think it will work. If Thermage is so great how come a lot of people say they don't see results?
Yes, Thermage does work
There is absolute scientific data that shows Thermage works for approximately 94% of properly selected candidates. This has been published in peer reviewed journals and is accepted by the majority of skilled Thermage physicians. The key then becomes who is a properly selected candidate? In my experience (as a disclosure, I was chairman of the Thermage Scientific Advisory Board for 8 years and continue to consult for the company) the best candidates are those with medium sized faces and modest amount of fullness along the jawline and upper neck.
Really thin faces do not do well at all, and very heavy faces tend to do poorly. Men do great with Thermage, as do many Asian women (thought to be in part due to differences in dermal skin thickness as compared to caucasians). Thermage will not work on someone who is a poor candiadate, and unfortunately some practitioners will treat patients who are unlikely to get results. I will let you speculate as to potential motives. Thermage also works very nicely on the lower abdomen, as well as on wrinkled post-baby skin around the belly button.
Thermage seems to be a gimmick
I have yet to meet a patient pleased with Thermage, and I have seen a lot. Most patients would experience excellent results from surgical treatment that doesn't hurt (at least not much). Patients complain that Thermage is extremely painful. There is no way to shrink skin--period. Excess skin requires surgical excision.
What is also very disturbing is using Thermage as a trap for patients. There are a number of facial plastic surgeons in my community who sell a fairly useless Thermage package and then offer a substantial discount when it doesn't work for a facelift. The old bait and switch. Very disturbing.
Web reference: http://www.atlantacenterforplasticsurgery.com
Thermage = Low Satisfaction Rate
The patient satisfaction rate for Thermage is around 40% - Compare that to a Tummy Tuck with around 80%. You would think that for a "no down-time", less expensive, less painful treatment you would have greater satisfaction. The reality is that the treatment does not work very well despite all the cheerleading. Unfortunately, there are lots of companies that really "market" these products to doctors who sick and tired of dealing with insurance companies and the hassles of taking care of patients related to their formal training. They are encouraged to break into the cash-based cosmetic medicine industry.
The problem is that most of these doctors have no formal surgical training. Would they tell a patient that they need a neck lift or charge them $1000 for a thermage treatment? This is the ethical conflict that many of these doctors find themselves in - they can't personally offer the full range of therapies to their patients without suffering a financial loss.
I would recommend that you consult with a Board Certified Plastic Surgeon so you can discuss all the options that are available.
Thermage if done effectively can be a cost effective treatment. However, thermage frequently disappoints patients since practitioners overpromise its benefits and do not choose appropriate candidates. Thermage can be somewhat effective for some patients although it fails for a large number of patients.
For those that it works on, Thermage provides significant correction (generally 1 - 2 mm). The procedure may need to be repeated every year to 18 months. Therefore, we would recommend thermaqge for only the most suitable candidates.
Because Thermage isn't so great!
If you have loose skin on the neck you need surgery to get a nice correction. Thermage has been associated with so many unhappy patients that you should skip this treatment.
Thermage is a great treatment. The results depend upon two things.
- The patient as a candidate for successful treatment
- The skills of the person performing the treatment.
It really depends upon these two factors. The physician who consults you should be able to give you a realistic expectation of the results that you may see. Also, when you are doing your research to find the best place to perform your treatment, make sure you ask them:
- Who performs the procedure?
- How much training do they have to perform the treatment?
To have a good face treamtent, for example, it takes a good 2-3 hours in my hands to perform the procedure to get good results. Unfortunately, you hear about people not seeing results because often times, they are not adequately treated, are treated by an undertrained technician, or they have unrealistic expectations. Good before-and-after shots of the treament are always key.
Thermage works UPDATE: ULTHERA IS NOW WHAT WE USE AND IS BETTER THAN THERMAGE
Thermage works. It won't give you the results that surgery will, but for those wanting a NO DOWNTIME 1 hour procedure, there is nothing better. You will see upper neck and jowl tightening, improvement of the crepiness of the skin around the eyes, cheeks, knees, and abdomen. The prior negative physician's comments are all Plastic Surgeon which prefer the knife to other technologies. I'm a surgeon, but there are people who want something less invasive, with a very natural appearance. Don't expect facelift results, so set your expectations properly and you will be pleased.
UPDATE 7/31/13. No longer use Thermage. Ulthera is much more effective and reliable. We've been using Ulthera for almost 3 years and our patients are much happier.
UPDATE 11/7/13 Infini is a new RF device which uses microneedling as well. This seems to be the answer in getting the energy to the right level vs. the Thermage which tries to go through the skin to deposit energy. Seems very promising for the fine wrinkles, acne scars, thin skin.
Themage Not Ideal for loose skin
Thermage has noticeable but very limited results.Like other skin resurfacing procedures it tends to tighten the skin to an extent to smooth some of the fine lines, improve pigment problems and diminish pore size. What they do NOT do well is to minimize jowls and other signs of facial soft tissue laxity. Only a mini facelift or facelift will take care of this problem in a significant fashion. This is why satisfaction after Thermage treatments are rated so low.
This device has changed many times over the years to try to get results that are reliable and reproducible for patients. I first used it in 2005. It certainly began overpromising and underdelivering and is why you may have read many unsatisfied results at high prices and much pain. There have been efforts to change the parameters, handpieces or tips and number of passes and protocols etc to try to get better results with this approach.
Be certain that none of these tightening devices come close to mimicking a surgical procedure and beware of the term "nonsurgical facelift" as this overtstates the outcomes with this device or other nonablative lasers for that matter. There are other devices on the market that use infrared heat and other wavelengths other than radiofrequency to achieve skin tightening without downtime but consult with your local expert before investing your money and your time (since not all patients are good candidates for these procedures).
Thermage - Works or Not?
The reputation of Thermage took a pretty heavy hit early on when the pain levels were high enough that doctors reduced the number of pulses to save the patients from pain and potential injury. Obviously undertreating left a number of people unhappy.
Newer Thermage technology eliminated most of the associated pain so results got better as the technology improved and doctors began using many more pulses but at lighter energies. But...
It's good to understand how heat-based treatments work. Fibroblast response makes new collagen and new collagen is tighter. The idea behind Thermage and its successors is to increase - as much as possible - the fibroblast activity and the resulting collagen. This happens with heat - and lots of it.
The older you are, the less robustly your skin responds to this purposeful heat assault. So older patients get less results. Basically, the older you get, the lazier your collagen factory, so any treatment with collagen production as the mechanism to produce change is affected by patient age.
Thermage was also touted as a one-time treatment. But, logically, you continue to age, so you also need to continue collagen-stimulating treatments to stay ahead.
The 3rd But...
Someone with more than slightly moderate skin laxity won't see much results. There is a limit to what nonsurgical treatments can accomplish. If expectations are set at honest levels, and if subtle results are acceptable, then Thermage does have its place. Just don't expect to see a facelift in 6 months. It's not possible to create that much of a response.