If Thermage is So Great, How Come People Say They Don't See Results?

I have yet to meet a patient pleased with Thermage, and I have seen a lot. Most patients would experience excellent results from surgical treatment that doesn't hurt (at least not much). Patients complain that Thermage is extremely painful. There is no way to shrink skin--period. Excess skin requires surgical excision.

What is also very disturbing is using Thermage as a trap for patients. There are a number of facial plastic surgeons in my community who sell a fairly useless Thermage package and then offer a substantial discount when it doesn't work for a facelift. The old bait and switch. Very disturbing.

The patient satisfaction rate for Thermage is around 40% - Compare that to a Tummy Tuck with around 80%. You would think that for a "no down-time", less expensive, less painful treatment you would have greater satisfaction. The reality is that the treatment does not work very well despite all the cheerleading. Unfortunately, there are lots of companies that really "market" these products to doctors who sick and tired of dealing with insurance companies and the hassles of taking care of patients related to their formal training. They are encouraged to break into the cash-based cosmetic medicine industry.

The problem is that most of these doctors have no formal surgical training. Would they tell a patient that they need a neck lift or charge them $1000 for a thermage treatment? This is the ethical conflict that many of these doctors find themselves in - they can't personally offer the full range of therapies to their patients without suffering a financial loss.

I would recommend that you consult with a Board Certified Plastic Surgeon so you can discuss all the options that are available.

There is absolute scientific data that shows Thermage works for approximately 94% of properly selected candidates. This has been published in peer reviewed journals and is accepted by the majority of skilled Thermage physicians. The key then becomes who is a properly selected candidate? In my experience (as a disclosure, I was chairman of the Thermage Scientific Advisory Board for 8 years and continue to consult for the company) the best candidates are those with medium sized faces and modest amount of fullness along the jawline and upper neck.

Really thin faces do not do well at all, and very heavy faces tend to do poorly. Men do great with Thermage, as do many Asian women (thought to be in part due to differences in dermal skin thickness as compared to caucasians). Thermage will not work on someone who is a poor candiadate, and unfortunately some practitioners will treat patients who are unlikely to get results. I will let you speculate as to potential motives. Thermage also works very nicely on the lower abdomen, as well as on wrinkled post-baby skin around the belly button.

If you have loose skin on the neck you need surgery to get a nice correction.  Thermage has been associated with so many unhappy patients that you should skip this treatment.

Thermage works. It won't give you the results that surgery will, but for those wanting a NO DOWNTIME 1 hour procedure, there is nothing better. You will see upper neck and jowl tightening, improvement of the crepiness of the skin around the eyes, cheeks, knees, and abdomen. The prior negative physician's comments are all Plastic Surgeon which prefer the knife to other technologies. I'm a surgeon, but there are people who want something less invasive, with a very natural appearance. Don't expect facelift results, so set your expectations properly and you will be pleased.

UPDATE 7/31/13. No longer use Thermage. Ulthera is much more effective and reliable. We've been using Ulthera for almost 3 years and our patients are much happier.

UPDATE 11/7/13 Infini is a new RF device which uses microneedling as well. This seems to be the answer in getting the energy to the right level vs. the Thermage which tries to go through the skin to deposit energy. Seems very promising for the fine wrinkles, acne scars, thin skin.

Thermage if done effectively can be a cost effective treatment.  However, thermage frequently disappoints patients since practitioners overpromise its benefits and do not choose appropriate candidates. Thermage can be somewhat effective for some patients although it fails for a large number of patients.

For those that it works on, Thermage provides significant correction (generally 1 - 2 mm). The procedure may need to be repeated every year to 18 months. Therefore, we would recommend thermaqge for only the most suitable candidates.

This device has changed many times over the years to try to get results that are reliable and reproducible for patients. I first used it in 2005. It certainly began overpromising and underdelivering and is why you may have read many unsatisfied results at high prices and much pain. There have been efforts to change the parameters, handpieces or tips and number of passes and protocols etc to try to get better results with this approach.

Be certain that none of these tightening devices come close to mimicking a surgical procedure and beware of the term "nonsurgical facelift" as this overtstates the outcomes with this device or other nonablative lasers for that matter. There are other devices on the market that use infrared heat and other wavelengths other than radiofrequency to achieve skin tightening without downtime but consult with your local expert before investing your money and your time (since not all patients are good candidates for these procedures).

Thermage is a great treatment. The results depend upon two things.

1. The patient as a candidate for successful treatment
2. The skills of the person performing the treatment.

It really depends upon these two factors. The physician who consults you should be able to give you a realistic expectation of the results that you may see. Also, when you are doing your research to find the best place to perform your treatment, make sure you ask them:

• Who performs the procedure?
• How much training do they have to perform the treatment?

To have a good face treamtent, for example, it takes a good 2-3 hours in my hands to perform the procedure to get good results. Unfortunately, you hear about people not seeing results because often times, they are not adequately treated, are treated by an undertrained technician, or they have unrealistic expectations. Good before-and-after shots of the treament are always key.

work for everyone.  Couple that with the fact that it can take up to six months after treatment to achieve the result, and many patients expect their results yesterday, and you know why many people say it didn't work for them.  Having said that, in the properly selected patient, who is educated about the process and what to expect realistically, Thermage can be an excellent rejuvenating treatment that many patients are happy with.  I think the key here is to see an open minded surgeon who offers both surgical and non surgical treatments, and have an open and honest discussion about the pros and cons of each procedure, in your particular case.  Unfortunately, for many physicians who aren't familiar and confortable with both surgical and non surgical approaches, they tend to try to match the patient to the procedure they are comfortable with, rather than the other way around.  If your only tool is a hammer, than the whole world starts to look like a nail... 

Thermage has noticeable but very limited results.Like other skin resurfacing procedures it tends to tighten the skin to an extent to smooth some of the fine lines, improve pigment problems and diminish pore size. What they do NOT do well is to minimize jowls and other signs of facial soft tissue laxity. Only a mini facelift or facelift will take care of this problem in a significant fashion. This is why satisfaction after Thermage treatments are rated so low.