In order to understand Thermage, you must know a little bit about proteins. A protein is simply a long chain of amino acids linked together. When you heat a protein, it shrinks because the amino acid chain tightens up. Think about a piece of steak heating on a grill. Isn’t it a little more compact when it is done cooking? The more well done the steak, the smaller it becomes (yes, there is some fat lost, but you get the general idea).

Thermage acts by the same principal. The skin tightening device delivers energy to the proteins deep within the skin and heats them. These proteins hold the upper layers of skin to the deeper tissues. As we now know, heated proteins shrink. Thus, the outermost skin is pulled tighter to the deep tissue.

Contrary to popular belief, Thermage is not laser skin tightening. Laser skin tightening uses light energy, either externally or internally (surgically), to heat the proteins of the skin. Thermage uses monopolar radiofrequency energy. This is closer to ultrasound sound waves than it is light energy. In fact, Thermage device uses the same kind of energy that has been used by physicians to ablate (destroy) abnormal tissue for years. The skin tightening device delivers a less potent form of the radiofrequency energy, however, than that used to ablate tissue.

While the energy is less intense, early versions of the Thermage system were still a bit powerful. Patients often reported pain during the procedure because of the deep skin heating. Unfortunately, the only way to achieve the desired skin tightening effect was to heat the skin a certain amount. As a rather ingenious solution, the makers of Thermage produced a second generation device called Thermage CPT (Comfort Pulse Technology™). Thermage CPT does not reduce the intensity of the radiofrequency energy, but instead adds a second type of energy to make the procedure more comfortable.

In Thermage CPT, the device creates a vibration while it is heating. The vibration stimulates the nerves of the skin that normally detect and transmit pain signals. Instead of collecting pain information, the nerves simply detect a humming vibration on the skin. The nerves and brain are fooled into thinking there is no burning sensation in the skin. With the addition of Thermage CPT technology, patients report minimal discomfort especially compared to earlier devices. When given a choice in a clinical study, 100% of patients choose the vibrating CPT head.

In the Thermage skin tightening procedure, a grid is drawn on the treatment area. Common treatment areas are the eyes, face, arms, abdomen, buttocks, and hands. The grid is used to track the progress of the treatment so that any one area is not overheated or missed. The treatment area is then coated with a lubricant (just like the lubricant used in traditional ultrasound procedures). This lubricant helps transmit the radiofrequency energy from the device, through the skin, and ultimately to the deeper tissues. The Thermage CPT device then delivers precisely timed bursts of energy to heat the skin. The entire process takes about an hour.

The before and after photos of Thermage treatment are very impressive though individual results will vary. The few scientific reports that have been published seem to indicate that the technology is effective, but may not be so for all patients. Younger patients tend to see more dramatic improvement than older patients. Also, patients with less subcutaneous fat (just under the skin) get better tissue heating and achieve a higher degree of skin tightening.