Thermage: Where to have it done? Choose based on assessment of sagging severity and explanation of power settings

Monopolar radiofrequency (RF) treatment like Thermage should be performed at a facility that assesses the degree of sagging to determine suitability, and explains power output and pain management[1][2]. This is because selecting the right candidate is considered one of the most critical factors determining results in radiofrequency treatment.[1]. Note: we found no research on the Thermage device itself in this review; we explain based on research on similar equipment.

Will they assess whether your sagging is suitable for treatment?

First, you want to know if they will evaluate whether radiofrequency treatment is sufficient for your sagging. Radiofrequency treatment is not a substitute for surgery; when the right candidates are selected, it is considered an effective treatment.[1].

In a 60-person study, fine lines and static wrinkles responded well, whereas the effect on expression lines and moderate or severe wrinkles was limited.[3]. If you have significant sagging, confirm whether they will compare surgery as an option.

How are power output and pain management decided, and by whom?

Monopolar radiofrequency is said to deliver heat to approximately 20 mm beneath the skin surface.[2]. For this reason, if power is too high or depth adjustment is inadequate, pain is more likely to occur, and comfort depends on the practitioner's skill.[2].

In a study of 23 people who received one monopolar radiofrequency treatment, the average pain score was 0.30, and recorded side effects were minor only.[4]. It is reassuring to ask who decides the power output and how pain is adjusted if it is strong.

When do results appear, and how long do they last?

A characteristic is that results appear not only on the day but over several months. Skin collagen (the fiber that forms firmness) was reported to increase from immediately after treatment through 6 months.[5].

In the 23-person study, appearance assessment improved at 4, 12, and 24 weeks, with the highest satisfaction around 12 weeks.[4]. In another study, three treatments every 2 months resulted in 88.24% of people perceiving improvement in wrinkles and sagging.[3]. However, the need for multiple sessions and a prolonged treatment period has been noted.[3].

What are the risks such as burns, and how are emergencies managed?

Most side effects are mild and temporary.[1]. Redness and flushing after treatment typically resolve within 24 hours.[3].

On the other hand, serious complications are more common with monopolar devices than with bipolar devices using two electrodes.[1]. Burns from monopolar radiofrequency treatment have rarely been reported in cellulite treatment on the legs.[6]. Confirm that you can be examined immediately if a burn is suspected.

Will they discuss future surgery?

If you are considering Facelift or other surgery in the future, you should ask about this point as well. Plastic surgery textbooks state that having undergone tightening treatment with radiofrequency or ultrasound can be a reason to limit certain steps in later surgery.[7]. It is reassuring to keep a record of the treatment you received and when you received it, so you can share this information.

Where to have it done? Guidelines if you are unsure

During consultation, ask the following:

Assessment: Do they evaluate the degree of sagging and compare options including surgery?[1][3]

Power output: Is there an explanation of who decides power and pain adjustment, and how?[2][4]

Timeline: Do they discuss the timeframe for results and the number of sessions recommended?[4][5]

Emergency: Is there examination and management available if complications such as burns occur?[1][6]

Whether Thermage is right for your sagging cannot be determined by this article alone. At your consultation, inform the physician about the area of concern, the degree of sagging, and any previous treatments, and discuss the expected number of sessions and timeline.