Thank you for your question. I understand you are 33-years-old and you received one Pellevé treatment. Your initial result after the treatment was your face felt firm; however, after doing some research, you discovered that Pellevé or Thermage can potentially cause facial fat loss. You’re now concerned you may have done something harmful to your face. I can certainly help you with your concern. To give you a little information about myself — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. Over the years, I’ve had the opportunity to use many different devices under both laser and radiofrequency categories, so I’ve gained a lot of experience and knowledge regarding the challenges that come with radiofrequency technology. I also currently use a laser device that performs non-surgical fat reduction as well as skin tightening, so I can certainly help guide you with regard to what one device does versus another. There is a growing awareness that certain thermal devices are aggressively promoted as capable of non-surgical skin tightening, but it is also no secret that these non-surgical devices are quite limited when it comes to skin tightening. Ultimately, there is a science behind the principles of non-surgical skin tightening, non-surgical collagen stimulation, and non-surgical fat reduction. What is critically important when it comes these treatments is patient selection and the judgment of the practitioner. One of the big issues I have with these types of procedures is when they are performed by a non-physician or when the physician’s assessment is not done in person. In situations like these, there will always be a risk of complications. When it comes to radiofrequency devices, the answer to the question ‘is it possible’ is always ‘yes’. In medicine, if it has occurred, then it is possible. Pellevé makes use of a very slow and progressive elevation of skin temperature until it reaches a critical level, and in my experience, this is less likely to cause undesirable fat loss in comparison to a device which quickly heats skin to a very high level. In our practice, we use a device called the Fotona laser for non-surgical skin tightening. This device follows a certain protocol in which a specific amount of time and temperature has to be achieved for the goal of skin tightening, versus that which is required for the goal of fat reduction. If you are considering any of these treatments, for the neck area for example, if you have extra fat then you will want to do treatment that has fat reduction, and if you have loose skin you will want a treatment that tightens skin, so customization is very important. In the case of the 33-year-old woman who had one Pellevé treatment, the chances of significant fat loss are unlikely. It is not in my experience that Pellevé would cause a person to lose facial fat, especially since it takes a while to achieve that kind of critical temperature that would cause such a thing to occur. It is important you do not panic and you discuss the situation with your provider, who is hopefully a physician. Ask about the risk of fat loss, ask about science behind it, and ask about distinguishing the methodologies to ensure you get the best benefit with minimal risk of fat loss. Every day we help patients who have experienced fat loss from various types of thermal devices elsewhere. We help them by using platelet-rich plasma and other regenerative medicine techniques to stimulate the production of collagen under the skin and to stimulate the fat. It is important to keep in mind that fat is an essential part that makes up youthful skin quality. I hope that was helpful and I wish you the best of luck!