What is the difference between skin tightening via Thermage vs. RF microneedling? Compare and contrast (Photo)

Thermage and Microneedling with RF such as the Infini device that uses insulated needles to protect the epidermis from the heat of the needle, can tighten the skin. Both devices uses radiofrequency energy ( Thermage uses monopolar and Infini uses bipolar RF). I do see in addition to tightening, in some but not all patients, improvement in pores and lines with Infini microneedling but not with Thermage. For patients that only need tightening I choose either Thermage, ThermiSmooth or Ultherapy for non invasive treatment but if my patients also could benefit from textural improvement in acne scars, fine lines and pores then I would consider Inifini microneedling, or add laser treatment such as Halo, Fraxel or PicoSure.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs

Thermage is a device that delivers radiofrequency into the inner dermal layers to constrict tissue and stimulate collagen production. Its primary purpose is to tighten up the skin and it works very well on mild to moderate skin tightening. RF microneedling is a collagen induction therapy that works by creating micro-channels that stimulate the body to produce more collagen. The additional collagen production strengthens connective tissue and smooths and firms skin from the inside out. Because microneedling is primarily designed to be a skin rejuvenation treatment, it tends to work best on mild skin laxity combined with other concerns. 
These procedures both serve as stand-alone treatments or can be used in combination to further enhance overall results. I recommend you schedule an appointment with a board-certified dermatologist who performs both of these treatments. Through a comprehensive assessment and discussion of your concerns and goals, you should be able to find a treatment plans customized to your needs for the best possible results. 

Hello and thank you for your question and photos. Both Thermage and RF microneedling can improve the tightness of the skin in treated areas by administering radiofrequency energy to the underlying layers of the skin. The RF energy heats these tissues which spurs the production of collagen and elastin, both of which support healthy skin tone and elasticity. Microneedling has the added benefit of improving scars and large pores in treated areas. Which treatment is better for you depends on the symptoms you have and the present condition of your skin. Schedule an in-person consultation with a board-certified facial plastic surgeon for a full examination and recommendation on a course of treatment. Good luck! 
 - Elbert T. Cheng, MD