I don't understand how it's even possible to advertize Thermage CPT as painless procedure?

Thermage doesn't hurt nearly as much as Ultherapy (its competitor).  With that said however, it really is the person doing it that determines the pain. I do many per week, I do not delegate the procedures I perform them myself for the past 8 years and have very few patients with pain.  People who are concerned get a little anxiety and pain medication before.  I have never had a problem with any patients and this procedure, I only have patients coming back for it. I suggest you go to a thermage expert your next visit and have a physician perform the procedure (if you did not have that before). Best, Dr. Emer.

Thermage has become the most popular skin tightening procedure in my office and patients have returned to repeat this procedure for two reasons.  The first reason is that they have received great results.  The second reason is that there has been no pain or down time.  The goal of Thermage is to deliver the heat but it should NOT be painful.  If the heat is "too high" we adjust it lower to deliver great results without any discomfort.  Since there are so many pulses done with the 1200 tip CPT technology, there is no reason to have any pain.  In fact, if it is painful it is a sign to lower the heat for the patient. For the best results please consult a board certified dermatologist with a great deal of experience with Thermage.

I've used Thermage since it was first approved in the US and have had the treatment myself.  In the early years, we used 1 cm2 tips to apply 100 or 150 pulses of high heat.  My, how times have changed.  Modern Thermage using the Total Tip with CPT is a game changer.  For a full face, we now use 3 cm2 tips to apply 900 - 1200 pulses of low to medium heat.  These tips provide more even heating than even the last version. Plus there are so many pulses delivered in one treatment that even low heating levels produce great results.  The key is to customize the treatment level for the individual patient.  We set the treatment level based on the patient's discomfort.  On a scale from 0 = no pain to 4 = never do that to me again, the goal is a 2 = I feel the heat but its comfortable. If the pain goes above that level, the level is reduced.  There is no reason to push through pain - the heating builds up gradually with overlapping passes of pulses.  Most patients need a lower level treatment along the bonier jawline and brow but tolerate more on the fleshier cheek and lips.  And the treatment level can be changed instantly if the patient feels a 'hot spot'.  An advantage of Thermage is that without any pain medications, and with no post treatment redness, swelling or bruising, patients can go right out and back to normal work and life afterward (other than some shine in the hair from the serum-like coupling fluid we apply to the skin during treatment).  In fact, with the vibrating CPT and warmth, my patients say it's relaxing.

Ultherapy does not hurt nearly as much as thermage. Experience is key when performing these procedures and so is listening to the patients, adjusting energy levels to achieve a comfortable treatment environment. 

Thermage can be uncomfortable and I have patients take extra strength Tylenol and Advil one hour before their procedure.  It is important to take into account the patient's feedback about discomfort so the settings can be adjusted.  A lower setting for one patient can give the same results for another patient at a higher setting.  Almost all of my patients love the results from Thermage and repeat the treatment every one to two years.