Does Thermage cause loss of fat under the skin?

No, if used correctly Thermage will not cause fat loss. Keep in mind, Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, Cosmelan, microneedling/PRP, aerolase, and sometimes erbium laser (coollaser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

PicoSure is an FDA-approved laser technology that uses short bursts of energy for the removal of tattoos, moles, acne scars, and age spots, as well as the reduction of wrinkles. PicoSure's bursts are measured in picoseconds (trillionths of a second) which cause the tattoo ink or other damage to break apart into tiny particles which are eliminated by the body. If you are trying to target Malasma Picosure might not be your best option for treatment of Malasma. Fraxel is a safe resurfacing laser procedure for malasma and fine lines and wrinkles any type of scarring. If fat atrophy is a concern for you Fraxel would be a safer procedure to do for your skin concerns.  Thermage newest CPT technology tip has not shown to cause any fat atrophy due to more pulses with lower treatment levels to reach necessary heat levels for results. With my 12 years of experience with Thermage it is one of the safest skin tightening procedures to do. 

Hello and thank you for your question. Thermage will not cause fat loss to occur if the device is used correctly. Set to too high a setting, a Thermage treatment can have unwanted side effects, such as fat loss. This underscores the importance of selecting a board-certified facial plastic surgeon with significant experience performing Thermage treatments. Schedule several in-person consultations with board-certified facial plastic surgeons in your area to find an experienced provider and ask to see before-and-after photos of actual patients. Good luck!- Elbert T. Cheng, MD

Hello and thank you for your question. If you are seeking skin tightening in addition to treatment of your melasma, two procedures might benefit you. ThermiTight, which uses radiofrequency energy to heat underlying skin tissues, can rejuvenate your skin by increasing your body’s collagen and elastin production without destroying fat. A Fraxel laser treatment, in addition, can help you improve your melasma by resurfacing your skin, a process in which the fraxel laser stimulates your body’s natural healing response, clearing away dead or damaged skin cells. Schedule an in-person consultation with a board-certified plastic surgeon in your area for a full examination and discussion of the best treatment plan to get the results you are looking for. Good luck!
- Carl N. Williams, Jr., MD

Hey there,Treatment with Older thermage devices without sapphire cooling tip were painful and the radio frequency depth of penetration was unpredictable. This would have been the reason for fat loss in your case. But the recent thermage CPT system is less painful, more effective in skin tightening and doesn't cause any fat loss.  Picosure is the safest laser for melasma and wrinkles even in skin type 4 and 5.  But you need at least 3-4 sessions spaced at 6 weeks interval. Along with skin lightening topical creams and sun protection definitely picosure is best for melasma.
Hope this helps.

Thermage with the new CPT technology does not cause fat loss.  However, I have seen melasma get worse from the Picosure laser.  I would suggest Cosmelan for the melasma.  It is the best treatment for melasma and doesn't have the same side effects of the laser.  Best, Dr. Green

Thermage when used by an experience physician does not cause loss of fat and your experience is not typical. With regards to melasma, I find that combination treatments work well starting with good sun protection and hydroquinone with retinol combined with a gentle laser treatment such as the Clear + Brilliant Permea and chemical peels as needed.