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.

There has been significant misunderstandings of what Thermage can accomplish. Advertising and some levels of hype has led people to believe a non surgical treatment can rival surgery. For a more mature person, this is a very attractive concept, but it's not valid.Thermage has been around for 15 years, so the mere fact that it's still being used indicates there is enough satisfaction FOR THE PROPERLY SELECTED PATIENT to keep it in medical offices. And with that time period of use, improvements in the device function improve outcomes.The key is candidate selection. Thermage provides subtle skin tightening from the use of radiofrequency-induced heat. The heat is what shrinks loose collagen strands and causes new collagen formation. HERE'S THE KEY:When we talk about patient selection, it's imperative to treat skin that has a chance to respond in a satisfactory way. Someone in their late 30's and into their 40's still has collagen-making capabilities for most all heat-based devices to give visible results. On the flip side, patients with very obvious skin looseness who are into their later 50's and onward don't usually have that same collagen-making capability. Thus, outcomes are not as significant. (Some patients with genetically high quality skin get good results no matter what treatment they choose.)

I have found more consistent results with Ultherapy in the correction of loose tissue on the neck and face. I use the Ultherapy procedure as an UltraLift procedure that does not require surgery. Raffy Karamanoukian MD FACS

Thermage has a bad reputation for not working. I think this has to do with a number of factors. To begin with, the early machines and tips were not nearly as effective as the latest generation of tips and machines. Secondly, it has been oversold to people that are not great candidates and have too much loss of elasticity or gravitational changes. Lastly, there is a bit of technique involved to increase the probability for a good result and much of that has to do with pushing the energy more to get better thermal contraction of the tissue. Personally, having done it for almost 10 years on hundreds of patients and getting a 90 percent success of decent tightening I would tell you that it has to hurt a bit to consistently work. This is one reason I prefer to perform the procedure myself. Although Ulthera is the "new kid on the block" and is getting a lot of publicity, the new thermage total tip goes as deep to tighten tissue. Many physicians are coming back to thermage for more consistent results. While tightening within the first few months is the goal, I have seen thermage do an excellent job in prevention. This is an under appreciated but very important benefit if it helps delay the need for a facelift. But, it is very important to determine who is truly the right candidate so that the money is well spent.

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.

You need to ask who says something is great. Is it the physician themselves? You first need to make sure the surgeon your are seeing is really a plastic surgeon and is board certified. Lets start there. There are dermatologist and physicians out there that have thermage or other non invasives as their sole mode of facial rejuvenation. So you have to be aware. I am not saying that everyone that comes into the office needs surgery but you need to see a plastic surgeon who offers both modalities so that you can have the proper pros and cons presented to you.
Good luck.

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.

While the non surgical options are improving, no machine, device, tissue freeze, laser, radiofrequency, infrared, microwave or ultrasound can give the same result as surgery. For pure skin tightening, radiofrequency (RF) modalities seem to still be the best non operative treatments. Thermage was the original RF treatment but now there are many competitors, (i.e. Thermi, Exilis, Profound RF, Inmode, etc). I know it works because I see the results and I have been treated. Yes, there are patients, (perhaps as many as 20 or 30%) who require a second treatment and are considered "poor responders," after the first treatment. But I have never seen a patient who does not receive some benefit from the treatment.

Thank you for your message! Thermage is a great option for certain patients looking for subtle collagen building results over time. It is not a "nonsurgical facelift" type procedure so if you are looking for surgical results, the Thermage is not for you. Typically if there is too much excess skin a surgical result is usually needed!

It is important to have realistic expectations of Thermage.  It does not replace a facelift, but can deliver tightening, lifting and firmer skin.  It is important to take before and after photos since it can take up to 6 months to see the full improvement and patients do forget what they looked like 6 months ago.