Does Thermage Melt Fat?

In the early years with Thermage there were isolated reports of fat atrophy if the physician either did multiple pulses over the same area causing bulk heating if the tissue and possible fat atrophy or the patient was done under general anesthesia (not recommended) and there was no patient feedback. As far as I know, and according to the company there have been no reports of fat atrophy with the newer technology and tips as long as properly performed guidelines are followed

Thermage does not melt fat. The radiofrequency energy from Thermacool / Thermage causes the protein infrastructure of the skin, the collagen, to tighten by contracture. This is what can lift the forehead, and with that the eyelids, tighten sagging necks, loose skin of the belly, etc.
As with many procedures, there are indications and contraindications. Some people will be evaluated and found not to be candidates because they have bulging loose muscle or the fat is too thick. In the early days of Thermage, the protocol for treatment was not yet perfected and some fat thinning was noted.

When Thermage was first invented the technology and settings were completely different from what are being utilized many years later.  Current Thermage with the CPT technology and treatment parameters make this a safe and effective therapy where no fat is being "melted".

Fat isn't 'melted' the way you think of the wax melting on a candle.  The Thermage unit can be set in a way that will affect fat cells if desired.  This is not a technique that is currently FDA approved but it is seeming to be an effective way to use the device.

When properly performed, Thermage should not melt fat. Fat melting was seen in the early part of this decade (2000-2004) when some physicians were inappropriately using very high energies with the device. With modifications to technology and guidelines starting in 2005, the incidence of fat melting has all but disappeared. Fat melting with Thermage was a short lived side effect that has been corrected and eliminated.

I have treated several patients with structural fat grafting who experienced fat atrophy following Thermage treatments. Patients have been very happy with results of structural fat grafting following fat atrophy.

The explosion in medical aesthetic technology has resulted in a market that is flooded with new products, devices and procedures all claiming to be the ‘latest and greatest’ or the ‘next big thing’. Thermage was a media darling for a few years and our office received countless phone calls asking about Thermage. We did not see evidence of safety, efficacy and reproducible results. Therefore, I have never used Thermage on any of my patients.

Thermage was meant to tighten the skin and improve wrinkles, but some people using the machines were not following the protocol set for the machines. This led to excessive heat internally and, yes, causing some fat to melt. This left some people with facial atrophy (or wasting).

There has been some time that Thermage was associated with fat atrophy. We now know that as we age we lose fat in some parts of our face. Losing more fat could worsen the signs of aging.
Apparently, Thermage claims that they have modified their technology so that fat atrophy is no longer an issue. However, as far as I know there is no definite conclusion in plastic surgery society in this regard.
But in my experience most patients who wished to replace a face lift with Thermage did not have a positive response to Thermage. You may refer to the Thermage reviews on this website to get info from patients who had first hand experience with Thermage.