If You Didn’t See Results After Thermage, Be Sure to Read This (Must-Read for Those Who Feel Thermage Doesn’t Work) / Gangnam Sinsa Station Dermatology Clinic

Hello. This is Lifton Dermatology near Sinsa Station.

Thermage FLX is a device that uses monopolar radiofrequency and is known as the representative anti-aging procedure. Because it is a proven treatment with a long history, many people get Thermage.

Today, I’d like to talk about something that may be helpful for anyone who did not feel much effect after getting Thermage.^^

1. When the treatment is performed at too low an intensity

Thermage is divided into 300 shots / 600 shots / 900 shots. It may seem like the more shots there are, the greater the effect, but in fact, treatment intensity is just as important as the number of shots.

Treatment intensity can be set from level 0 to 5, and it can also be adjusted in smaller increments of 0.5.

So, what intensity is the best?

This is a question many people ask, and I think the best approach is to treat at an intensity that delivers as much energy as possible to the dermis without causing side effects.

If Thermage is performed at too high an intensity, localized burns or fat loss may occur. That is why the practitioner tends to keep checking the skin condition during the procedure and raise or lower the intensity as needed.

In general, treatment starts at 2.5 to 3 and is adjusted between 2 and 4 depending on the skin’s reaction.

Consensus Recommendations for 4th Generation Non-Microneedling Monopolar Radiofrequency for Skin Tightening: A Delphi Consensus Panel. doi: 10.36849/JDD.2020.4807.

The figure above explains the Thermage levels described in the paper. The numbers do not represent the actual Thermage intensity; rather, they are adjusted according to pain or skin reaction.

Treatment may be ineffective if the intensity is too weak, and if the intensity is too strong, excessive heat may accumulate in the dermis overall, making the skin more sensitive. Also, if too much energy is delivered to the subcutaneous fat layer and causes fat destruction (lipodistruction), the skin may actually become sunken.

In the end, it seems that the practitioner’s experience is what matters most in finding an effective intensity while minimizing side effects.

2. When another procedure is needed instead of Thermage

Thermage is a device that mainly treats the dermis. The principle is to apply strong thermal stimulation to the dermis, causing collagen remodeling and leading to the formation of new collagen and tissue.

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For people whose dermis still has good elasticity, there are many cases where they do not notice a major before-and-after difference even after Thermage. That is why Thermage is generally not recommended for younger people with relatively good skin elasticity.

If your concerns are sagging or hollowness, Ultherapy, JuveLook Volume, fillers, or other treatments may be more necessary.

3. Too few shots

I mentioned intensity above. This time, it is the case where the number of shots is too small. If you try to treat a very wide area with a limited number of shots, the energy delivered per unit area will inevitably decrease.

4. Problems with the design

In general, compared with the outer face, many people have less elasticity in the inner face, the front cheek, and the deep cheek area.

That is why, for a 300-shot Thermage treatment, the inner face is treated first. Energy should be delivered across the face overall, and areas that need stronger treatment than others—those with more visible aging-related issues—should be treated more intensively.

Therefore, before treatment, it is necessary to design in advance the areas that need stronger treatment and deliver more energy to those areas (by allocating more shots or increasing the intensity).

MONOPOLAR RADIOFREQUENCY FACIAL TIGHTENING: A RETROSPECTIVE ANALYSIS OF EFFICACY AND SAFETY IN OVER 600 TREATMENTS.

5. When expectations are too high

The effect is not visible immediately after the procedure. Over the course of several months, old collagen in the dermis is replaced with new tissue, and the tightening effect appears gradually.

Updates on radiofrequency devices for skin tightening and body contouring. DOI: 10.1002/der2.31

In particular, I think the true value of monopolar radiofrequency devices like Thermage becomes more apparent with repeated treatments. If ongoing aging is like a clock, it cannot be stopped, but this is a treatment that can help slow the clock of aging by steadily winding the spring.

I hope this was helpful.^^