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Excess and Saggy Skin

Thermage Treatments

Excess and saggy skin is treated through Thermage. Thermage is a non-surgical procedure to tighten and lift the skin. Thermage works best on excess and saggy skins on these areas:

On the face, the whole face and jaw line are treated to tighten the cheeks, reduce the nasolabial fold (between the nose and the mouth), tighten and lift skin along the jaw line. Thermage can also be performed on saggy skin on the forehead to lift the eyebrows and make the eyes look more open. Used with the Eyelid Thermage treatment, you can get quite a nice result with mild to moderate problems here. Thermage can also be helpful on the neck if there isn’t too much loose skin.

How does Thermage work?

The Thermage procedure uses radio frequency energy to create a uniform heating effect in the deep dermis. This gentle heating tightens existing collagen in the excess skin and stimulates the production of new collagen. Thermage reduces wrinkles and achieves brow lifting, cheek lifting, and jaw line lifting. The saggy skin tissue lifting and tightening is caused by immediate collagen contraction followed by gradual collagen tightening. The result is a more youthful appearance to excess and sagging skin.

What kind of results can I expect with Thermage? When will I see results?

In a 2007 study, fifty-seven hundred patients with excess skin were surveyed at multiple clinics. With the newer, third-generation multi-pass Thermage, 87 percent observed some immediate tightening, 92 percent had tightening six months after treatment, and 94 percent found that treatment results met their expectations. All patients show an increase in collagen in biopsy studies, so even if you don’t see a noticeable result, the procedure should help prevent more sagging. Although a few patients show immediate improvement, response to treatment for most patients is gradual with progressive improvement over 1 to 6 months. 80-90% of patients show measurable and noticeable effects at 6 months with their saggy and excess skin. All patients show an increase in collagen in biopsy studies.

Why do some people not see results to excess and saggy skin with Thermage?

We know from good research studies that everyone makes collagen after a Thermage treatment. To use a baseball analogy, it’s realistic to expect a single, double, or triple from Thermage, but not a home run. So sometimes there is a perceived lack of results that is related to expectations that are too high. Thermage is for mild to moderate sagging, not for full fledged jowls. Good research studies also show that about 90% of patients show a measurable and noticeable effect at 6 months with saggy skin. Many patients see some results immediately. For the 10% who do not see visible tightening to excess skin, there is a good result because it helps to prevent sagging over the next year or two. Preserving what you have is still a benefit.

How long will the effects of the Thermage procedure last?

While treatment results have been observed to last for at least 2 years, studies indicate that the beneficial changes to skin collagen can last over 2 years in some cases. As with virtually all skin restorative techniques, including surgical facelifts, the original aging symptoms may slowly return as the aging and sun damage process continues.

What about body sites? Does it work as well there?

Thermage, done well and on the right person, has good, and sometimes great, results on the face (face includes under the chin) and eyelids. It is less effective on the neck, but still can get good results. On the back of the hands, there is a little noticeable smoothing of skin but plan on Restylane or Juvederm (filler) after Thermage to get a really nice result.

What does a Thermage treatment feel like?

You’ll feel a brief sensation of heat each time the Thermage is pulsed. But the Thermage device monitors the surface temperature of your skin and applies a cooling cryogen spray, which is delivered before, during, and after the application of heat. If you do feel discomfort, the energy can be turned down. Thermage treatments are no longer painful. Usually a treatment takes 1–2 hours depending upon the size of the target area.

Here’s how the procedure goes: First, you remove make-up with a gentle cleanser. Then, a small rubber patch (grounding pad) is placed on your abdomen. Usually, your doctor will treat one side of your face at a time—pulse by pulse. Your doctor will do multiple passes, all over one side of your face, including extra pulses in your problem areas and always under the chin. After one side is done, you can sit up to see the difference already from the other side.

What will I look like right after the treatment? What will the healing time be?

You may return to your normal activities immediately after the Thermage treatment, as there is no down time. Makeup can be applied immediately after the treatment session. Minimal redness is seen in some patients after treatment, but it generally disappears within several hours. Bruising and discomfort are rare after the Thermage procedure. Occasionally mild swelling is noticed after the treatment but disappears in two or three days.

How many treatments will I need?

If you are 30-50, one may be enough. If you’re over fifty, plan on two treatments six months apart for optimal results, then maintenance every one to two years.

When can I have another treatment?

It’s hard to find studies on this but we usually advise waiting at least 3 months before repeating it.

Do I need to come for maintenance treatments?

Most people repeat their Thermage treatments every 2 years or so. If you are over 50, if may be best to repeat the treatment yearly.

Is Thermage compatible with fillers?

Yes, with some reservations. You should observe the wait times below since there isn’t much data on these. There have been some reports of problems with Sculptra bumps if Thermage is done too soon after Sculptra. With Restylane or Juvederm, wait one month to have the Thermage treatment. With Sculptra, wait 6 months after your last treatment before you have a Thermage. With permanent fillers, if you have permanent fillers like silicone or Artecoll, then Thermage is not recommended over or near the filler.

Is there any special preparation or follow-up regime?

No. Unlike plastic surgery, there is no bruising. There is no need to interrupt any medications or to do any fasting the day before Thermage treatment on excess skin. You can return to normal activities the day after the procedure. Some patients exhibit a temporary redness for a few hours after treatment but there is usually no swelling or bruising to the saggy skin treatment areas. Rarely, a superficial blister may occur.

How safe is Thermage?

Radiofrequency energy has been used in operating rooms all over the country for more than 25 years. The Thermage device was cleared by the FDA for cosmetic indications. Studies showed a very small incidence of minor and temporary side effects. Small, possibly permanent indentations were reported with the original tips at offices where the energy used for the treatment was very high.

Are there any medical or cosmetic side effects of the Thermage treatment?

Generally, anyone who has a pacemaker or internal cardiac defibrillator, active skin infections in the treated area, or is pregnant should not have this procedure. Possible side effects include:

What if I have an event in two months. When would be the best time to do Thermage?

Remember that even though you will see a little bit of tightening right away with Thermage, most tightening on excess skin occurs gradually over a period of four to six months. If your event is in two months, you’ll see only a little improvement prior to the event.

I have a really busy social life and cannot afford any downtime at all. Would Thermage work for me?

Yes. Thermage is perfect for someone like you because you can have your treatment and walk right back out with no marks on your face and saggy skin. There is a very slight puffiness for a day or two that no one but you will notice, and that’s it.

I know I’m not a good Thermage candidate, but I absolutely don’t want surgery. Would I get at least some result?

Some patients, especially those over 60, often don’t want to undertake the risks or have medical conditions that won’t allow elective surgeries. You can certainly do two or three Thermage treatments approximately six months apart. With a combination of several Thermages and a series of Sculptra treatments, you can get a “nonsurgical facelift” effect to excess skin sites, but it will not be as dramatic as a surgical facelift.

I had a Thermage done and really didn’t see much change. Why?

There could be several reasons: (1) Enough pulses might not have been put in for your skin. We routinely use 600-900 hundred pulses and occasionally even more if someone has a large face or a lot of laxity. (2) Technique is important with Thermage. It is important that the nurse or doctor pull in the correct directions while doing Thermage and that they do several full passes and even do five or six or seven passes with what is called the vector method. (3) There is a chance that you are in the approximately 10% who just don’t do well with Thermage.

To find out if you are a good candidate for Thermage to resolve your saggy and excess skin, call Radiant Medspa at 206-402-3063 in Seattle or 425-640-5900 in Lynnwood for a complimentary consultation.