How much sagging can Thermage tighten? Efficacy and limitations of radiofrequency treatment

Thermage is a radiofrequency (RF) treatment that heats the deep layers of skin to shrink collagen and stimulate collagen remodeling, thereby tightening the skin[1]. Mild sagging (skin laxity) and fine lines are expected to improve gradually, but the effects are reported to be smaller than those of surgery or injection[2]. No research specifically on the Thermage device itself was found in this review; the explanation here is based on studies of radiofrequency treatment in general.

What happens in the skin with radiofrequency?

When radiofrequency heats the deep layer of skin (dermis) and the fibrous tissue that separates it from the fat layer below, collagen shrinks and is remodeled[1]. This process is thought to lead to skin tightening[1].

The change does not end immediately after treatment. In one study, the increase in collagen bands in the skin showed no clear difference immediately after treatment (12%), but had increased to 59% at 3 months[3]. It is helpful to think of this as a treatment that changes gradually over time.

How much change occurs, and when will it be visible?

Changes are gradual. In a study where 60 women received treatment three times over 2-month intervals, wrinkle severity scores decreased on average from 3.00 to 2.71, and 88.24% of participants reported improvement[4].

In a study of 23 people who received a single treatment, visible improvement in appearance was observed at 4 weeks, and skin elasticity had increased by 24 weeks[5]. Satisfaction was highest at 12 weeks[5].

Sagging that responds well and sagging that does not

It is suitable for mild sagging (skin laxity) and fine wrinkles visible even without facial movement.[4]Effects on expression lines and moderate to severe wrinkles may be limited.[4].

Guidelines from Japan's aesthetic surgery association also state that high-frequency treatment for wrinkles and sagging (skin laxity) does not match the effectiveness of surgical procedures or injectables.[2]On the other hand, scarring is rare, and the advantage is that no foreign material remains in the body.[2].

Pain, side effects, and downtime?

In a study of 60 people, no serious side effects were observed.[4]Flushing and redness after treatment typically subside within 24 hours.[4].

However, pain during application and short-lasting results are noted as drawbacks.[6]The final result is also influenced by the energy adjustment made by the operator.[7].

High-frequency treatment has been reported to also reduce subcutaneous fat.[8]If you tend to have hollow cheeks, discuss in advance where and how much to apply the treatment.

What should be confirmed during consultation before treatment?

Whether Thermage is suitable depends on the severity of sagging (skin laxity) and how much change you desire.[2][4]If sagging is pronounced, other treatments may be more appropriate.[2].

During consultation, confirm whether high-frequency treatment suits your degree of sagging (skin laxity), how many visits you may need, the timeline until results appear, and the area and intensity of application.