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Home Education Thermage™ Noninvasive Skin Tightening (Face/Eyelid/Body)

Thermage™ Noninvasive Skin Tightening (Face/Eyelid/Body)

Quick Facts:


  • Thermage® treatment is currently the gold standard of noninvasive skin tightening
  • Noninvasive skin tightening can be used to help rejuvenate the face, neck, eyelids, abdomen, thighs, and other areas
  • Treatments are performed with minimal discomfort and no “down” time or recovery period
  • Some tightening is usually visible at the conclusion of treatment but continuing improvement occurs over several months as collagen is remodeled and produced
  • Thermage® treatment is not a substitute for surgery.  Ideal candidates either do not have enough changes to warrant surgery, have already had surgery and are starting to see some relaxation, or do not wish to undergo surgery but understand that Thermage® will not produce the same result as an operation
  • Thermage® treatments are complimented by fractional resurfacing, IPL, and injection of Botox® and/or fillers
  • Dr. Biesman developed the Thermage® eyelid treatment, specifying the guidelines and testing the equipment for safety and efficacy

Background and history of Thermage treatment

We have known for over a decade that heating the skin can produce a tightening effect.  This occurs due to tightening of collagen, an important part of the skin’s structural framework, as well as to the stimulation of new collagen production in a process that continues for months after treatment.  In the case of Laser skin resurfacing, the entire outer layer of skin is removed requiring a prolonged recovery period.  The concept of noninvasive skin tightening is to heat the skin’s deeper layers in a very carefully controlled manner without injuring the surface with the goal of producing 3 favorable effects.  These include immediate contraction of collagen fibers resulting in visible tightening and contouring, shortening of the collagen fibers connecting the skin to the underlying tissue leading to tighter application of the skin to its underlying support structure (a “shrink wrap” type of effect) and stimulation of new collagen production, a process that continues for up to 6 months after treatment.  These outcomes are achieved with no “downtime” or recovery.

Several technologies have been used to accomplish noninvasive skin tightening. I have been fortunate enough to play an instrumental role in the testing and/or development of most of the devices currently available.  By far the best studied and understood is the Thermage® device. This device uses electrical energy to heat the deeper layers of skin in a uniform manner without disruption of the surface.  When the Thermage device was first introduced in 2002 the concept underlying our treatments was to deliver as much energy as possible to the skin.  Intuitively this seemed to make good sense, in a manner somewhat analogous to driving a car- the harder you step on the gas, the faster the car will go.  Unfortunately, we learned that high energy levels are extremely painful and can lead to tissue injury.  In early 2004 we began to realize that delivering much lower doses of energy in a repeated fashion during a single treatment session eliminates the pain while producing a superior result. . This was subsequently proven scientifically.  In early 2005 I became part of a multidisciplinary group of 15 physicians (plastic surgery, dermatology, facial plastic surgery, ophthalmic plastic surgery) tasked with the goal of reaching a consensus on the safest and most effective manner in which to perform Thermage treatments.  We produced a set of recommendations referred to as the Consensus Guidelines that was implemented shortly thereafter.  Since then outcomes have improved markedly to the point where visible tightening can be observed in greater than 90% of patients at the time of treatment.  In fact, we now treat to a visible endpoint meaning that we continue treating until maximum response is achieved.  In addition to improving outcomes, the Consensus Guidelines have enhanced the safety of the Thermage procedure to the point where there have been no serious complications reported since their adoption.

When Thermage treatments were first introduced in 2002 they were slow and painful.  Results were variable, ranging from minimal to excellent, depending on a wide variety of factors.  Fortunately there have been many advances in Thermage therapy since 2002.  Treatments are now faster, far more comfortable, and more likely to yield a beneficial effect.  The risks associated with Thermage treatment remain minimal.

Thermage treatments today can be divided into 2 categories:  more superficial treatments for skin tightening and deeper treatments for body contouring.  Superficial treatments are performed on the face, neck, and eyelids to induce a tightening effect while deeper treatments are performed on the abdomen, thighs, buttocks, and arms to induce more contouring.  Both superficial and deep treatments are performed in the office.  Anesthesia or sedation is not required for Thermage treatments although some patients choose to take medication to help them relax about an hour prior to their appointment.  There is no recovery period after Thermage treatment; patients may resume their normal activities immediately.  There are no special instructions or limitations after Thermage treatment.

Most patients undergoing superficial Thermage treatment (face, eyelids, neck) can appreciate some results immediately after treatment.  Results continue to improve for up to 6 months.  Patients undergoing deep Thermage treatment can often see a change in their measurements at the conclusion of the treatment.

What are the best applications for Thermage treatment?

Thermage treatment of the face and neck:  The upper and lower face and neck were the first areas to be addressed via Thermage and treatment of these areas remains popular today.  Changes produced are most visible along the jawline, the neck, and in the eyelids.  Typical changes that occur following treatment may include elevation of the eyebrows, upward movement of the cheeks, contouring of the jawline, and reduction in neck laxity.  It is important to note that Thermage treatment is a not a substitute for surgery!!  Those individuals who need to see marked elevation of their jowls, neck, or eyelids in order to be satisfied need to have surgery.  In all areas of the body, the results from Thermage treatment are less dramatic than those achieved with surgery.

Themage treatment of the body (abdomen, buttocks, arms, thighs):  Advances in technology have made Thermage treatment of the body a reality.  Thermage treatment can be used to tighten and contour the abdomen (belly), buttocks, arms, and thighs.  The abdomen is the most popular non-facial area to treat.  Thermage treatments are best for those individuals who have moderate skin laxity without excessive underlying fat.  Thermage treatment of the abdomen is not a substitute for abdominoplasty (tummy tuck surgery) or liposuction but can be used to enhance the results achieved with these procedures.  Thermage treatment can also be used to tighten the thighs, upper arms, and buttocks.  Again, the amount of improvement anticipated after Thermage treatment will not rival that achieved by surgery.   Thermage remains an attractive option for many patients who are willing to accept less dramatic outcomes in exchange for avoiding the risks, recovery, and scarring associated with surgery.

Who is a good candidate for Thermage treatment?

The best candidates for Thermage treatment are individuals with mild to moderate skin laxity who do not need modification of muscle or fat underlying the skin and who have appropriate expectation of outcome.  Those individuals who anticipate a dramatic tightening response should not undergo treatment as outcomes may be modest.  Unfortunately, we are still unable to predict in a prospective manner which patients will achieve excellent outcomes and which will not.  This remains the subject of ongoing research in our practice.  Ideal candidates for Thermage treatment have mild to moderate skin laxity, only modest sun damage, do not smoke, and do not expect to look as if they have undergone surgery.  Typically patients are between 30 and 70 years of age.  I commonly perform Thermage treatments on those individuals who do not have enough aging changes to warrant surgery, who have already undergone surgery and have either residual or recurrent skin laxity, or who are surgically averse but do not expect to achieve a surgical-type outcome.  If your goal is for guaranteed, dramatic, clearly demonstrable elevation of sagging tissues that all your family and friends will notice, you should undergo surgery (browlift, eyelift, facelift, abdominoplasty, etc.).

Is Thermage treatment safe?

Thermage treatment is perhaps the safest technology-based treatment available.  When performed properly, discomfort during treatment is minimal and the risk of scarring or being harmed in some way is extremely low.  Anesthetic injection, pills, or creams are not required prior to Thermage treatment.  As mentioned above, there is no downtime associated with Thermage treatment.  You could literally undergo treatment at 11:00 am and have a lunch date at noon without redness, swelling or significant soreness or discomfort.  Makeup may be applied immediately after Thermage treatment.

How soon will I see results after Thermage treatment?

Thermage treatments are typically performed to an endpoint of visible tightening.  This means that treatment is generally administered until the treated area demonstrates improvement.  It is important to remember that the Thermage treatment stimulates collagen production, thus enhancing the skin’s structural integrity.  This is a gradual process that can progress for at least up to 6 months after a single treatment session.  It is therefore important to remember that the final outcome of a Thermage treatment cannot be judged for a period of 6 months.

Thermage Treatment of the Eyelids

I recently completed a 5 year long process in which I developed and tested a treatment tip for the Thermage® device designed specifically for the eyelids.  In order to achieve desirable effects on the face and body, energy needs to be delivered at a deeper level than is safe on the eyelids.  We therefore set out to develop a treatment tip that would permit safe and effective eyelid treatment.  Testing initially focused on safety concerns and ultimately on effectiveness.  We are now able to use Thermage treatments on the eyelids to produce noninvasive eyelid tightening and toning.  While Thermage eyelid treatments do not reduce the “puffiness” or fine wrinkling that sometimes occurs in eyelids, in our initial studies they were found to improve eyelid tightness and reduce the appearance of excess upper eyelid skin in nearly 90% of subjects.  As is true in other anatomic regions, improvement in outcome can continue for at least 6 months after Thermage treatment.

To achieve ideal eyelid rejuvenation, Thermage treatments may be combined with laser treatments to smooth fine wrinkles, Botox treatments to reduce the appearance of deep lines caused by action of eyelid muscles and fillers to restore volume to the lower eyelids and eyebrows.

Logistics of Thermage Treatment

Thermage treatment is performed in the office.  Anesthetic creams, injections, and/or pills are not required.  Some patients request a valium-type medication prior to treatment but this is not necessary or required.  Treatment of the face and neck takes approximately 1 hour.  Treatment of the abdomen or arms also takes about 1 hour.  The treated skin may be slightly pink for a short time after treatment but patients typically resume their normal activities immediately unless they have taken medication for pain or sedation prior to treatment.  There is no crusting, bruising, or “healing” process.  The treatment effects persist as long as the newly generated collagen lasts before beginning to break down.  While this time varies from patient to patient, typically treatment results last 1-2 years.

Thermage treatments are HIGHLY technique dependent.  Make certain that whoever provides your treatment is both knowledgeable and experienced.  Even in the best of hands, the outcome of Thermage treatment can be variable.  Some patients achieve a dramatic response while others do not.  In my experience, patients with advanced sun damage, severe laxity, and heavy smokers are not the best candidates for treatment.  Thermage treatment does not affect skin color.  Similarly, patients with any color skin (including sun tan) may be safely treated with Thermage.

The best candidates for Thermage treatment are those with mild to moderate skin laxity of the face, eyelids, abdomen, arms, or thighs.  The effects of Thermage treatment are typically less dramatic than surgery but the cost is much lower and there is no “down time” or recovery period.

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Tightening Loose Skin