THERMAGE - FREQUENTLY ASKED QUESTIONS
Why are people interested in Thermage?
Thanks to evolving technologies in laser and light source medicine more and more men and women are choosing to postpone having a surgical facelift well until their early to late 60’s if at all. Most patients who opt for a nonsurgical approach to rejuvenation site several reasons including fear of an overly- pulled and unnatural look , fear of the risks from general anesthesia, fear of the surgical procedure itself, and an un-willingness to suffer through the necessary downtime to allow for the healing to take place. As an oculoplastic surgeon, it is a given that I like to operate. Surgical procedures do have their place, and in my years of taking care of patients I have developed a keen sense of what people are looking for as far as a result is concerned, and sometimes that means a face-lift (rhytidectomy), or a neck-lift (platysmaplasty), or both. Generally, the conversation begins when I ask my patient to “show me with your hands what you want to achieve…” [every woman knows this maneuver because we do it all of the time in front of the mirror at home when no one is looking]! If the patient shows me a dramatic difference with his or her fingertips, I say, “that’s a face-lift.” This usually elicits a wide-eyed look of shock and the statement, “but, I don’t want surgery.” That’s when we can enter into a realistic results- oriented discussion of what non-surgical skin-tightening treatments like Thermage can deliver.
Why are you uniquely qualified to discuss this Thermage Procedure?
Before I begin to explain to you what Thermage is and how the procedure is performed, you should know a little bit about me. I am on oculoplastic surgeon (a doctor that specializes in eyelid surgery) and a laser skincare specialist. My fellowship training in minimally invasive techniques of facial rejuvenation was a private fellowship with a surgeon who maintained practices in New York City and Rio De Janeiro, Brazil. I am a member of the American Society of Lasers in Medicine and Surgery and have extensive experience with laser and light source technologies in the field of aesthetic medicine. I have the pleasure of treating an international clientele who visit me from all corners of the globe. This compels me to stay in step with the global community by participating in international meetings, most recently the 2008 World Congress on Aesthetic and Anti-Aging Medicine in Paris, France. In brief, I am constantly searching for the best technologies available to offer my elite clientele. I have been using Thermage since its inception and I have seen the technology evolve up until the present day. In my opinion, Thermage is the best skin-tightening technology available and I have performed literally hundreds of procedures in my practice. I have trained countless physicians how to perform this procedure safely and effectively and I am proud to have received the Thermage Pinnacle award two years in a row. You could say that I am considered something of an expert in Thermage.
What is Thermage and how does it work?
Thermage is a nonsurgical skin tightening procedure that is performed in the doctor’s office. Thermage uses radiofrequency energy (radiowaves) to lift and tighten the skin. Here is how it works. Our skin is comprised of several layers, the surface layer of the skin is called the epidermis. This is the skin layer that burns or freckles when we are in the sun. Below the epidermis is the dermal layer, which consists of many proteins that give our skin structural support. The two main proteins are collagen which provides tensile strength, and elastin which lets the skin “bounce back” by giving it elastic pull [hence the name]. Below the dermal layer is the layer containing fat, blood vessels, and sensory nerves. When we are younger, the collagen in our skin is abundant and in a tight rope-like meshwork. As we age, sun exposure, genetics, smoking, and gravity makes the collagen less abundant and it loses its organized network, and the rope begins to fray. This is what causes our skin and the supporting soft tissues in the face to sag. Thermage works like a shrink wrap if you will. The Thermage tips have pre-programmed computer chips with a pre-set number of heat pulses. Each burst of radiofrequency energy is sandwiched between a cooling burst of cryogen. So, I tell my patients that they will feel cool, then a little pinch of heat, then cool again. What happens is that the pre-cooling phase protects the epidermal layer of the skin and safely transmits the RF energy directly to the precise dermal level where the collagen resides. The post-cooling phase locks the nurturing heat into the dermal layer for added effect and patient comfort. Each little burst of heat causes the existing collagen in the skin to contract like a shrink wrap. Patients see an immediate, subtle effect from the initial contraction of the collagen that already exists in their skin at that moment in time. Then, about 3 months later, as a result of the skin having been heated by the Thermage procedure, the fibroblast cells (whose job it is to make more collagen) migrate to the area, lay down more collagen, and more dramatic lifting occurs gradually over time as this new matrix of collagen is spun. This is a good thing, considering that after the age of 30 years our innate collagen production decreases by 1% per year and the level of collagenase (the collagen eraser) increases. Essentially, we are fighting a losing battle in our skin and we are our own worst enemy!
How do I know if I am a candidate for the Thermage Procedure?
Now that you understand how Thermage works it is easy for you to understand how we determine who will be a good candidate for the Thermage procedure. The results that one can expect from Thermage depend entirely upon how much collagen exists in the skin at the time that the candidate is being considered. The more collagen that you have, the better your initial result will be, and you can expect more profound results once the collagen remodeling begins [3 months post-procedure]. If there is not a lot of collagen left in the skin (excessive sun damage, thin, fragile, crepe-like skin) then the result will not be as dramatic because there is not a lot of collagen left to contract. Now you can understand why I have 28 year old models coming to my office seeking Thermage as a “preventative treatment.” Aside from the collagen level in the skin (analyzed clinically), Thermage patients should be within about 15 pounds of their ideal weight (otherwise gravity works against me) and have a solid bone structure. That’s it!
Does Thermage Hurt?
The procedure itself is not painful. I know that there are a lot of blog sites out there, and everybody has a friend of a friend who said that Thermage hurts. Believe me, 99% of my patients have the procedure performed without the need for pain medication. The only time I may advise the patient to take a medication is when I am treating the neck [which can be a bit uncomfortable], but nothing that one little pain pill 15 minutes prior to the procedure can’t cure. When Thermage first came out the procedure was painful, I’m not going to lie to you. That was during a time when physicians were still figuring out how to best use the technology and the powers were turned up higher. Patients would require a pain-killer and an anti-anxiety medication and they were still flying out of their chairs. Some people even requested to be “put asleep” under general anesthesia. Those days are gone. What we have learned is that it doesn’t matter how hot the skin is, but how long the minimum temperature is maintained. Multiple passes over the area at lower powers actually yield the best results.
What is the difference between the old and the new Thermage NXT machine?
Another major advancement was the introduction of the Thermage NXT device in January 2007. I was the first physician in New York City to purchase the Thermage NXT and it has made a big difference for my patient’s and my own comfort level. The new NXT machine, coupled with the new tips, has increased the efficiency of the procedure by 30% so that my patients enjoy more dramatic, immediate effects with less discomfort. Sometimes I have patients who have had Thermage in the past with the old technology, who claim that “nothing ever happened.” These are the hardest patients to win over, but I tell them that with the new machine and the new tips, they will look in the mirror afterwards and see results. Another question that I get asked frequently is, “have you ever treated anybody and not seen a result?” The answer to this question is “no.” If I don’t feel that a patient is a good candidate for Thermage, I offer another collagen boosting procedure such as facial resurfacing –[everybody leaves my office on a positive note].
What parts of the body can be treated with Thermage?
Thermage is FDA-approved for treatment on the face, eyelids, lips, neck, hands, arms, legs, and buttocks. In May 2008, I was the first physician in New York City to debut the new Cellulite treatment tip.
What is a Thermage Tip?
There are a variety of Thermage treatment tips available, and I have all of them in my office. The tips are one use per patient only. With the exception of the eyelid tip the Thermage tips measure 3.0 cm2. The Thermage STC tip is for the face. The eyelid tip is smaller and the heat penetrates less deeply taking into consideration that the eyelid skin is the thinnest skin on the body. The hands also have a special tip that penetrates less deeply because the hands have little subcutaneous fat. The Thermage DC tip is for treating the body and heats a little more deeply. Finally, the Thermage CL is the exclusive cellulite tip that has undergone some adjustments in its cooling parameters to address some of the factors that give rise to cellulite formation including increasing the bloodflow to the area and repairing the damaged collagen that allows for the fat to dimple beneath the skin.
What can I expect during the procedure?
I tell all of my patients that I know exactly what all of my procedures feel like because the first patient that gets treated with any new technology is me! I have performed Thermage on my face twice and on my eyelids twice. First, the patient washes his or her face, signs a consent form, and then I take pre-treatment photographs. Pain medication as needed is provided after the consent is signed. A sticky patch is placed either on your back, your upper arm, your stomach, or your thigh (depending upon which area is to be treated) and you are then connected to the machine. This is the grounding pad that captures any stray radiowaves circulating in the skin near the treatment area. The first pulse that you feel from the machine will be cool only (no heat) as the machine takes a pre-treatment skin measurement of your skin’s resistance. I start by selecting a setting that I know will be cool, then a little warm, then cool again. This allows you to get used to the whole sensation. Then, I increase the heat in a step-wise fashion and advise you that my goal is on a scale of zero to four, zero being “I didn’t feel that at all” to four being “don’t ever do that again,” I want you to be at about a 2 or 2.5. In other words, I want you to feel some heat, but not so much that you pull away from me. That’s it! Once we find your comfort level, I tell you that there will be no more surprises and then we can have a nice time chatting away until the procedure is completed.
How long does the procedure take?
These are estimates only - the actual amount of time depends upon the number of pulses and tips required to achieve the desired effect.
Face = 50 minutes
Face & Neck = 1 hour and 15 minutes
Eyelids = 20-40 minutes
Abdomen = 90 minutes to 1 hour and 15 minutes
Front of legs = 1 hour and 15 minutes
Back of legs = 1 hour and 15 minutes to 2 hours
Buttocks = 1 hour and 15 minutes
Arms = 1 hour and 15 minutes
Hands = 40 minutes
Again, these are approximations and the actual time required depends upon individual circumstances.
What can I expect after the procedure?
Immediate, natural looking results! The skin may appear to be a little flushed [like you just got off of the treadmill], but this goes away in about 5 or 10 minutes, that’s it! There is no downtime and no restrictions are imposed upon your activities after the procedure. You can immediately apply make-up (or not) and go about your day. The epidermal layer of the skin is left intact; all of the important changes have occurred beneath the skin surface and will continue to occur over the next three to six months. You can go into the sun if you like [but, please don’t! We just spent all of this time building more collagen and sun exposure is the number one collagen destroyer].
When will I see additional skin tightening?
This is where you have to have faith. Collagen remodeling takes at least three months to occur. There are no exceptions to this rule for the human species. Your body needs this minimum amount of time for this important change to occur. However, from my experience, this is what you can expect-- The initial result will be very good. Then in about 6 weeks, there will be the beginning of an exponential improvement in the tightness of the skin that reaches its peak at about three months and then continues to improve at a more gradual rate up until six months.
How long do the results last?
Technically, the results last about 2-3 years. However, we continue to get older every year on our birthday, so the aging process continues. In practice, most of my patients like the procedure so much that they usually want to have it performed about every year and a half to two years for maintenance purposes.
How many times do I have to come back for the Thermage procedure?
Thermage is a one-time procedure. The radiofrequency energy penetrates more deeply into the dermis than some of the other devices that rely in infrared technology. Infrared doesn’t penetrate very well into the skin and that is why it is always being combined with something weird like suction or laser light. That is also why you have to go back 4 to 5 times to see the same results with infrared versus the one time treatment of Thermage.
Who is absolutely prohibited from having the Thermage Procedure?
Those with a pacemaker or implantable defibrillator
Those with large pieces of metal in the body (if you can have an MRI, you can have Thermage)
Are there any risks to the procedure?
Thermage is safely performed on people of all skin-tones. In the past, there were reports of some people sustaining burns or fat melting, but this is typically no longer the case. With the new multi-pass protocol using lower energies the reports of burns are rare. Fat melting nowadays usually only occurs on purpose when the operator “stacks” the pulses [delivers 4 to 5 bursts of energy in rapid succession to a small pre-determined area]. I encourage my patients during these “power-sets” that usually occur below the chin or on the abdomen because to quote the personal trainers, “the results are worth it!”
Can I have Thermage if I have fillers in my face?
Yes. Thermage has been shown to not affect the integrity of any of the hyaluronic acid fillers [Restylane, Perlane, or Juvederm], Sculptra, Radiesse, or surgically placed fat fillers. In fact, having the Thermage procedure could potentially eliminate or diminish your needs for these fillers in the future because the nasolabial grooves are improved by the Thermage technique.
Would you recommend the Thermage procedure?
I’ve done the procedure on myself and my mother…
I hope that I have answered many of your questions regarding the Thermage procedure. I will be more than happy to respond to any and all of your questions during our consultation visit. Please give Joan or Danielle a call in my office at 212-799-1411. They will be happy to assist you as well and to help you to find a convenient time to meet with me.
Regards, -Dr. Zdinak