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How Does Thermage Skin Tightening Work? Is It Safe?
how does thermage skin tightening work

How Does Thermage Skin Tightening Work? Is It Safe?

You might already know that Thermage is a non-invasive skin tightening procedure that gives you firmer and tighter skin. Experts call it a Thermage Skin Tightening procedure. FDA approved it in 2004 for treating wrinkles around the eyes, and facial wrinkles in 2004, and cellulite and body laxity in 2005. However, the primary concern is, how does it work, and does it even work? What outcomes can be expected, and when to expect them?

What Is Thermage, And How Does It Work?

thermage rf

Technically, Thermage works fantastically and can do wonders. It uses monopolar radiofrequency (RF) energy for delivering electrical power generated via the inherent electrical resistance of subcutaneous tissue and dermal tissue. Let us understand the physics of this process by a clear explanation.

In Thermage treatment, a device is used that directs an electrical current to the target area to the cells within that area. Their resistance converts the RF energy into heat energy, helping an increase in collagen. Have you ever thought about how eggs look like when you scramble them? Collagen, just like eggs, is a protein that gets drastically affected by heat.

So, the heat generated in Thermage treatment denatures collagen in the skin’s lower layers. In the short term, the heating collagen breaks down the hydrogen bonds in its chain and causes its structure to thicken and shorten. Instantly after the procedure and after a few weeks, this shortening might lead to a tightening effect. However, this initial effect does not last as the body removes the damaged collagen.

However, in the longer-term, this denatured collagen protein stimulates the fibroblasts present in your skin to synthesize new collagen, which results in the tightening seen after a few months of the procedure. Moreover, the heat stimulates the blood blow, leading to an increase in the fatty layer’s metabolism.

As opposed to bipolar current, Thermage is monopolar. It means that the current travels from the handpiece into the body; however, it does not return to the handpiece. Thus, it requires a grounding electrode known as a “return pad” placed elsewhere on your body to take the current back.

Whereas bipolar radiofrequency moves from one pole on the handpiece to another. The benefit of monopolar radiofrequency is that it penetrates more profoundly than the later radiofrequency, thus reaching the deepest skin layer.

Thermage is non-ablative. It means that its effects happen under the skin and leaves the skin surface intact with shorter downtime.

Each pulse comes off with the cooling procedure first, and the next pulse is delivered. It helps prevent any damage to the skin and limits all the effects of Thermage to the deeper tissue.  

What To Expect For Your Thermage Procedure?

Once your doctor confirms your eligibility for the procedure, consent will be taken from you. Next, they will follow the following policy, and this is what you can expect from it.

thermage treatment

The Procedure

The steps followed are as under:

  • The doctors start by taking ‘before’ photos of the target area to compare them with the ‘after’
  • Any jewelry is prohibited over the target area.
  • They place a return pad on your back
  • Next, they gently cleanse the target area with alcohol to remove makeup, dirt, or cream as it helps prevent anything from interfering with radiofrequency delivery.
  • A temporary grid is made on the skin with a quick ink while the skin is still wet from alcohol. The doctors pre-draw it on a sheet, and then the sheet is placed onto the skin. Next, they use a piece of cotton soaked with alcohol to make it smooth. The grid gets transferred to your skin once it is removed. As the grid is solely formulated for ease of removing, therefore, the grid provided by Thermage should only be used. It has squares and circles that are helpful as a guide to the physician to avoid overlapping of the pulses.
  • A unique plastic eye shield is provided if the eyelid is to be treated for placing it into the eye like a lens.
  • After doing a test pulse, the doctor asks for the heat if it is tolerable or not. On a scale of 0 – 4, the aim is 2 to 3; however, it is painful but bearable, the doctor adjusts it accordingly. Next, he works by using the grid as a guide. Later, a coupling fluid is continuously reapplied for improving the delivery of radiofrequency.
  • Depending on the disposable tip being, it is a predetermined number of pulses, and the doctor works for distributing these pulses evenly across the target area using different methods. After that, he concentrates on the target area where he thinks more attention is required. The body Thermatip has 900-1200 pulses, and the face Thermatip has 600-900 pulses.
  • Depending on the target area, one session lasts between 45 to 120 minutes. However, different sizes can be treated on alternative days.
  • You will mostly feel a drilling sensation, although every pulse is accompanied by cooling. There is heat that is painful yet tolerable.
  • Doctors do not give anesthesia because they want instant and constant feedback from the patient regarding the heat level. Besides, anesthesia might alter the tissues’ heat resistance in the target area and make the heating process unpredictable.
  • Lastly, the skin and the grid are cleaned using alcohol.

Is Thermage Treatment Safe?

Thermage treatment is considered safe as it is maintained around 40 degrees Celsius, which is equivalent to 104 degrees Fahrenheit. As for the deeper tissues, the collagen heats between 65 and 75 degrees Celsius, which equates to 149 – 167 degrees Fahrenheit.

Also, it is safe when an experienced and licensed practitioner conducts it. However, some necessary care should be taken to avoid hurting the patient or burning their skin. The safety measures include:

  • The pad that is placed on the back takes care of the current
  • The Thermage device gives a beep and an error message. It does not work unless the device is reset and the head is placed correctly.
  • The coupling fluid serves the optimal pulse penetration
  • Any jewelry is prohibited in the target area.
  • To avoid any skin contact, the doctor wears gloves during pulse delivery.
  • The cooling is provided pre-, during, and post-delivery of the electrical current to prevent overheating the skin.
  • The grid helps prevent the overlapping pulse and evenly distributes them, eliminating the chances of overheating.
  • Constant response of the patient keeps the doctor informed of the comfort level of the patient.

Possible Side Effects

The possible side effects of thermage include:

  • Scabbing (crusting of the skin) is transient.
  • Acne that is treatable
  • Skin depression is brief. However, it can be corrected with the fillers if required
  • Transient dysesthesia and tenderness, an abnormal sensation or anesthesia, counted as the loss of sense.

However, Thermage has produced multiple generations of the device after the FDA approved it in 2002. With every new device, there have been fewer side effects. The various generations include:

  • ThermaCool TC
  • ThermaCool TC-3
  • ThermaCool NXT
  • Thermage CPT

Thermage Cost In Singapore

The cost of a Thermage treatment session can range between $1000 and $5,500, depending on the area being treated and your treatment center’s location. However, you can ask for a discount from the clinic for your next appointment too. One of the reasons for this treatment being costly is that the tips used are disposable to maintain quality and sterility.

How Many Sessions Are Needed?

Generally, one session is enough. The results of thermage are durable yet not permanent. Since the effects of aging and gravity do not stop, you can have another session, usually after 1.5 to 2 years.

Who Is A Good Candidate?

thermage skin lifting and tightening

You are a suitable candidate for thermage treatment if you:

  • Are a person of age 30 to 60 having mild to moderate skin laxity
  • Have dry, oily, or normal skin types
  • The ones who have realistic expectations
  • Have had a surgical facelift and experiencing saggy skin again.
  • Have wrinkles and fine lines which you wish to improve
  • Have visible pores which you wish to minimize

Who Must Not Use Thermage?

The following people should not go for thermage:

  • Extremely obese people
  • Extreme skin redundancy
  • People with defibrillator implant or pacemaker
  • People having metal implant of any kind
  • People having habits or situations of impairing wound healing.
  • People who have had Lasik or corneal surgery.


There is visible edema and tightening immediately after thermage treatment. It is the wanted endpoint whose presence shows that the treatment level was right, and the outcome is positive.

Erythema and edema disappear the next day, and the improvement procedures continue for six months post the first thermage session. The results, depending on the target area, include:

  • Enhanced complexions
  • Contoured and tighter skin
  • Lifted eyebrows
  • Corrected hooded eyelids
  • Corrected wrinkles around the eyes
  • Enhanced laxity of the neck and the jawline
  • Enhanced nasolabial folds
  • Enhanced and well-treated acne scars
  • Tightening of the skin of the arms, buttocks, abdomen, and thighs.
  • Enhanced cellulitis.

Thus, thermage treatment offer effective skin rejuvenation results.

About Dream Aesthetics and Plastic Surgery

Bespoke surgical for cosmetic or medical reasons is what Dream covers to bring out the beauty in every individual. Going beyond the aesthetics and working on physical anomalies are what we value the most in leading our patients to cherish self-improvement and confident lifestyles.

Derived from Associate Professor Vincent Yeow’s long-standing experience performing plastic surgery in Singapore, our treatment plans deliver physical remodelling in our patients’ favour. One of the notable remodellings is droopy eyelid correction. The ptosis surgery used for treatment eventually fixes drooping eyelids, improves vision and enhances appearance.

Most importantly, as a trustworthy plastic surgery and aesthetic clinic, we treasure positive and natural outcomes for each individual. We will ensure to deliver the beauty refinement of your dream without compromising your safety and privacy.