Q: What are the pros and cons of Thermage FLX treatment?

Pros This nonsurgical skin tightening treatment can be a good option for patients with mildly sagging skin. A single treatment session can reduce skin laxity. It also treats signs of aging like fine lines and wrinkles. The device can also be used to reduce the appearance of cellulite (though it's not the most effective cellulite treatmen t for people whose dimpling is moderate to severe). The procedure is suitable for all skin types and tones. It comes with no downtime. Cons Results can be subtle enough that some people say they see no improvement. As with many noninvasive skin rejuvenation treatments, the level of change is measured in millimeters. Despite the way the device is sometimes marketed, a “Thermage FLX face lift” will not compare to a true surgical facelift, which repositions muscles and removes excess skin. If you’re bothered by moderate to severe skin laxity, sagging, and jowls, you probably won’t be satisfied with the results of “Thermage lifting” (or any nonsurgical treatment option). RealSelf Tip: Thermage FLX shouldn’t be truly painful. The new device incorporates blasts of cool air to make it more comfortable, but some people may experience some discomfort from the heat. Let your provider know if it ever becomes too uncomfortable.

Question 1

What is Thermage FLX?

Accepted Answer

Thermage FLX is a noninvasive skin rejuvenation treatment that’s FDA cleared to treat fine lines and wrinkles, and to improve the appearance of cellulite. The device is also commonly used for skin tightening on the face and body.

The Thermage FLX system works by using radiofrequency (RF) energy to heat the skin’s dermis, under the surface layer. This contracts existing collagen fibers, providing subtle skin firming right away. It also stimulates collagen growth, a cellular process that doctors call collagen synthesis. This makes skin firmer, tighter, and more youthful-looking over three to six months, as the new collagen forms.

Most Thermage FLX treatments focus on the upper and lower eyelids, crow’s feet, along the jawline, and the neck. This versatile treatment can also treat mild skin laxity on the stomach, arms, backs of the hands, thighs, knees, and butt.

Used as a cellulite treatment, it boosts circulation and stimulates collagen synthesis, which makes skin look smoother and less dimpled.

The latest generation of Thermage treatment, Thermage FLX improves on the original treatment with:

vibrations and blasts of cool air, to improve patient comfort
a larger tip that allows it to cover more surface area, reducing treatment time in some areas of the face and on the body by 25%
automatic calibration of the device, for optimized radiofrequency energy delivery to maximize collagen development

Question 2

What are the pros and cons of Thermage FLX treatment?

Accepted Answer

Pros

This nonsurgical skin tightening treatment can be a good option for patients with mildly sagging skin. A single treatment session can reduce skin laxity.
It also treats signs of aging like fine lines and wrinkles.
The device can also be used to reduce the appearance of cellulite (though it's not the most effective cellulite treatment for people whose dimpling is moderate to severe).
The procedure is suitable for all skin types and tones.
It comes with no downtime.

Cons

Results can be subtle enough that some people say they see no improvement. As with many noninvasive skin rejuvenation treatments, the level of change is measured in millimeters.
Despite the way the device is sometimes marketed, a “Thermage FLX face lift” will not compare to a true surgical facelift, which repositions muscles and removes excess skin. If you’re bothered by moderate to severe skin laxity, sagging, and jowls, you probably won’t be satisfied with the results of “Thermage lifting” (or any nonsurgical treatment option).

RealSelf Tip: Thermage FLX shouldn’t be truly painful. The new device incorporates blasts of cool air to make it more comfortable, but some people may experience some discomfort from the heat. Let your provider know if it ever becomes too uncomfortable.

Question 3

How much does Thermage FLX cost?

Accepted Answer

The price you pay for Thermage FLX will depend on your provider's credentials and level of experience, their practice location, and the size and number of treatment areas. Any add-on treatments would also increase your total bill.

If you plan to keep up your results over time, you may also want to budget for annual maintenance treatments.

Question 4

Thermage FLX before and after pictures

Accepted Answer

The Thermage FLX photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Does Thermage FLX work?

Accepted Answer

Yes, the technology behind Thermage FLX certainly works. The original Thermage ThermaCool was actually the first tissue-tightening device in the U.S. market. Over the past 20 years, the Thermage system has earned a solid fanbase and become one of the most well-studied nonsurgical skin tightening procedures.

Studies have shown that it can deliver mild tightening of the eye area, as well as the mid and lower face, with optimal results shown after about six months.

How well it works—the degree of tightening it induces—can vary from patient to patient. Outcomes are heavily influenced by the body’s ability to produce new collagen cells, and collagen synthesis wanes with age.

Patient selection and realistic expectations are key. For those seeing the very first signs of jawline sagging or eyelid heaviness, a few millimeters of lift may make a world of difference. For people with significant wrinkling and skin laxity, the effects may be too subtle. In all cases, though, patients benefit from some measure of preventative collagen synthesis, doctors say.

As with other nonsurgical treatment options, results appear gradually, over the course of many months, and they tend to be subtle. Providers should never promise near-surgical results.

Question 6

Who’s a good candidate for Thermage FLX?

Accepted Answer

The ideal candidate for Thermage FLX skin tightening has one or more of these concerns:

early signs of sagging, such as subtle jowls along the jawline
fine lines, wrinkles, and crepey skin on the face and neck
upper-eyelid sagging and hooding
lower lid laxity
mild loose skin on the body
mild cellulite

Thermage FLX is frequently combined with other facial rejuvenation procedures, like a Fraxel laser treatment or a chemical peel, to treat signs of sun damage and aging more effectively.

This treatment isn’t a good option if you have moderate to severe loose skin or cellulite, or if you have a pacemaker, cardioverter, defibrillator, or any other electronic implantable device. It’s also not recommended for people who are pregnant.

Related: The Best Treatments for Different Types of Skin Laxity

Question 7

What happens during a Thermage FLX procedure?

Accepted Answer

Here’s what you can expect during your appointment:

First, your provider uses skin-marking transfer paper to stamp a temporary grid on your face, to guide the treatment and ensure each area receives uniform heat, without overlap.
They then apply a thin layer of protective gel.
They place the handpiece flat on the targeted treatment area.
Along with a heating sensation as the RF energy penetrates your dermis, you’ll feel gentle vibration, followed by a cooling sensation.
The combination of vibration and cooling mitigates discomfort from the heat, but your provider should keep checking to ensure you’re not in pain.
A treatment session for body areas can take 70 minutes or more, while the face and neck take 45–60 minutes, on average. Treating eyelids alone takes just 30.

Question 8

How many Thermage FLX treatments do you need?

Accepted Answer

Most people have one treatment session, followed by maintenance treatments every 6 to 12 months.

Question 9

Is Thermage FLX painful?

Accepted Answer

The original Thermage treatment has been known as one of the less comfortable nonsurgical skin tightening treatments. However, current techniques have made it less painful, and the new Thermage FLX treatment offers vibrations and blasts of cool air to improve patient comfort.

When Thermage skin tightening was first available, most providers did fewer passes at higher energy levels, according to a 2010 report in the Journal of Clinical and Aesthetic Dermatology. This method was so painful that most patients had to be sedated in order to stand it.

Now providers do multiple passes at lower settings, paying close attention to feedback from their patients on how much is too much.

A study in Dermatologic Surgery comparing the two methods reported that with the newer multi-pass method, only 5% of 5,700 patients found the procedure too painful, compared to 45% with the original method.

Patient satisfaction also increased: 94% found the treatment results met their expectations, vs. just 68% with the original.

Thankfully, recovery is not painful: mild tenderness in the treatment area is the most discomfort you should feel.

Question 10

Is Thermage FLX safe? What are the side effects?

Accepted Answer

Thermage was the first tissue tightening treatment available in the U.S., and it has been shown to be safe and effective since its FDA approval in 2002.

But the treatment has some side effects that may damage your skin, particularly in the hands of an inexperienced provider. According to its manufacturer:

Irregularities in your skin’s surface can appear up to a month after your treatment.
Numbness or tingling in the treated area can last for a few weeks afterward.
Burns, blisters, or scabs can form if the upper layer of your skin gets too hot. In some cases, this can lead to scars.
Nodules or lumps can appear, usually in the neck, but they typically go away on their own within two weeks.
Hyperpigmentation is also a risk. It may fade on its own within a few months but may linger longer and require additional treatment to remove.

Your results and safety will depend heavily on your provider’s technique, so it’s worth finding an experienced, board-certified dermatologist, plastic surgeon, or other qualified provider.

RealSelf Tip: Having treatment with deep-heating devices like this one prior to a facelift can make surgery more challenging, according to various facial plastic surgeons. If you plan to have a facelift in the future, discuss this with your provider.

Question 11

What does Thermage FLX aftercare involve?

Accepted Answer

There’s no downtime afterward, but your provider should talk with you about aftercare and how to maximize your results.

The treated area may look inflamed for a few hours following your session, but it shouldn’t hinder your normal activities. You can even wear makeup afterward, if you feel the need to.
Swelling is usually mild and resolves within five days, though in rare cases it can last a few weeks.
Until the swelling resolves, wash your face in lukewarm water and pat it dry with a towel.
Your skin will be especially sensitive, so wearing sunscreen with 30+ SPF daily is important to optimize and prolong your results.
For at least a week afterward, avoid abrasive facial scrubs and apply gentle topical skin care products without harsh active ingredients.

Question 12

How soon will you see results?

Accepted Answer

Some patients notice slight tightening immediately after their treatment, but you can expect to see your full Thermage FLX results three to six months later, once new collagen has formed.

Question 13

How long does Thermage FLX last?

Accepted Answer

Results from a Thermage FLX treatment can last up to two years. Some doctors recommend follow-up treatments every 6 to 12 months, to help maintain your results over time.

The longevity of your results will depend on your aging process and how well you care for your skin. You can help prolong your results by wearing sunscreen with an SPF of 30+ every day and following a medical-grade skin-care regimen.

Question 14

Thermage FLX vs. Ultherapy: What’s the difference?

Accepted Answer

Ultherapy is also a noninvasive skin rejuvenation treatment, but it uses ultrasound energy instead of radiofrequency technology to heat the tissues, stimulate collagen production, and firm skin.

Ultherapy is known to deliver energy deeper into the tissue than Thermage. Its ultrasound monitor also allows providers to see the tissue they’re treating, so they can adjust the treatment depth and ensure that it’s effective.

While Ultherapy is also considered safe for all skin tones, it isn’t safe to use on eyelid skin.

Reviewers on RealSelf also give Thermage FLX a higher Worth It Rating than Ultherapy.

Related: The Best Surgical and Nonsurgical Fat Reduction and Skin Tightening Procedures for Every Trouble Spot

Question 15

What are the alternatives to Thermage FLX?

Accepted Answer

Other nonsurgical skin tightening treatments to consider include Pellevé, SkinTyte, ThermiTight, and Sofwave.

If you have more significant skin laxity or looseness, a surgical facelift, eyelid lift, body lift, or arm lift will give you the best results. These procedures remove excess skin, tighten the underlying muscles, and redrape the remaining skin.

“Nonsurgical options give only mild improvement compared to surgical lifting,” according to West Hollywood, California, dermatologic surgeon Dr. Jason Emer.

A qualified dermatologist or plastic surgeon can advise you on the most effective treatment for your concerns.

Related: The Treatments Dermatologists Use to Anti-Age Their Own Necks

Question 16

Sources & studies

Accepted Answer

Dong Hye Suh, et al. “A survey on monopolar radiofrequency treatment: The latest update.” Dermatologic Therapy. November 2020.

Araújo AR, et al. “Radiofrequency for the treatment of skin laxity: myth or truth.” An Bras Dermatol. 2015.

Gold, MH. “Update on Tissue Tightening,” The Journal of Clinical and Aesthetic Dermatology. May 2010.

Solta Medical. “Thermage: Efficacy in a Foundational Device.” Modern Aesthetics. March/April 2018.

THERMAGE FLX

Jolene Edgar

RELATED TREATMENTS

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	Thermage FLX nonsurgical	Pellevé nonsurgical	SkinTyte nonsurgical	ThermiTight nonsurgical	Sofwave nonsurgical
Worth It Rating	80%	67%	76%	75%	61%
Average Cost	$2599	Not yet available	Not yet available	$3913	$2418
Downtime	No downtime	No downtime	No downtime	2–3 days of downtime	No downtime
Anesthesia	No anesthesia	No anesthesia	No anesthesia	Local anesthesia	Topical numbing cream

Jolene Edgar

Thermage

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