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Cosmetic IPL Laser Reviews & Comparisons > Titan vs. Thermage

So, I'm thinking about Titan or Thermage for my office. I know thermage hurts. Titan does not.

Has anyone had good experience with titan. I don't mean one or two. I mean consistant results.
07.7 | Unregistered CommenterM.D.
I have no experience with Titan, but I have performed many Thermage treatments (and even had it done on myself). The idea with Thermage used to be to get the dermis as hot as possible and just do a single pass on the intended site. But with the newer generation of treatment tips, the procedure has really changed. We are no longer using any type of numbing method and patients are quite comfortable (except for a couple areas over nerves). And instead of getting the dermis "hot," we are now using a lower setting and doing multiple passes. Our results have been quite good and I would recommend Thermage any day.
I have used Titan on about sixty patients. This procedure is almost painless as against Thermage which is very painful.Results and patient satisfaction are great.Result improves in six weeks when new collegen build up.Patient can looks two and half year younger in just one procedure.We have not seen any side effects with titan procedure.Call for more info +9714-2282444
I have heard Titan is not FDA approved for skin tightening? This makes me question marketing, etc.

Thermage, which I have had, at least has been proven clinically and has full backing of FDA. I think this speaks volumes.
03.7 | Unregistered Commenteramy MD
Amy MD: I seem to recall reading recently that NO device has yet received FDA clearance to make the claim of "skin tightening". Interesting that all of the companies seem to be able to talk about it, however. It is an interesting phenomenon.
Nonablative skin tightening is a joke. The only true tightening you will ever really get to CO2 period ! All these baby primary cares, ob/gyn, and derms playing with your nonablative toys..... CO2 is THE only true tightening. PCP's please stay out of the kitchen.
03.8 | Unregistered Commentermd
IF the "kitchen" you are referring to is offering procedures with weeks of downtime, erythema for a month and persistant hyperpigmentation then you may have your wish. That kitchen is yours. While there is no doubt that CO2 gives fabulous results you might have noticed that you are on a MEDICAL SPA blog. Medical spas are not in the business of taking away your CO2 business (or facelifts for that matter). They are designed for those patients who don't want to or can't afford the downtime.
03.9 | Unregistered CommenterDexter

You are correct that the CO2 is the best for skin tightening but if this is all you offer you are going to have trouble. Most people do not want the downtime. As a business you must offer some form of non-ablative skintightening. Also, with the Sciton erbium you can get some fairly nice skin tightening using ablation mixed with coagulation during resurfacing.
05.6 | Unregistered CommenterLH
i currently use fractional co2 and can dial up to traditional. downtime 2-5 days depending on the settings. i don't think 15 IPL are worth it for time and money. i do have nonablative devices , candela, lum one, and cutera but most patients after spending so much money on these procedures are utimately disappointed with results. Active FX and Max FX are really the way to go for TRUE results.
05.7 | Unregistered Commentermd
Titan has worked well at our clinic once we learned a technique that differs from what Cutera folk taught us. Almost without exception our pre and post (immediately post) pics, we use Visia and Mirror, demonstrate changes that are not apparent to an unscrutinized glance. No drama but measurable. Two to 6 week post photos are generally great. We have not used Thermage. Have not heard much good nor seen any non-stock or company provided pictures so I have no informed or experiential opinion. As with everthing in aesthetics, Titan is best when layered with other tx's appropriate to the patient's goals.

What protocol are you using with the Titan. I have it and have seen some OK results but never have had a "WOW".
05.8 | Unregistered CommenterLH

Titan doesn't hurt? Hmm. who told you that? I had a treatment on my neck, jaw, and face in Sept., 2 passes at 35 joules with a numbing gel. It was just tolerable. Then I had my upper arms done in Oct., same settings, and she had to keep dialing it down because it wasn't tolerable. (I think I have a pretty high pain threshold, btw).

No visible results on either site yet, but I know it takes awhile. I thoroughly researched both Thermage & Titan and chose the latter because, in spite of quicker results with Thermage, pts. were equally satisfied either way, and Titan does not create *necrosis* like Thermage can. But I urge you to try these treatments on *yourself* before you start asserting what does/doesn't hurt.

11.9 | Unregistered Commentercbh

I've had both CO2 laser and Thermage treatments.

The CO2 was done in my 30's. It tightened a little but did zero for pore size or improving skin surface.

The two Thermage treatments were done in my 40's. I got remarkable results. It is excruciatingly painful but I got results immediately and I'm not talking about the swelling.

After Thermange my skin looked fresher, smaller pored, tighter and had more of a healthy glow than it had my entire life.

It still looks good today and my last treatment was 2 years ago,

I am pushing 50. I look a natural 28. (I don't use Botox, haven't had a face lift.)

I am an RN and an author. There is a pic of me on my book taken when I was 45. Unretouched. See for yourself what Thermage can do.

Nice picture, CN.

Call me a skeptic, but I'd credit your good looks to the combination of good genetics, not baking too much in the sun as a youth, good skin-care, and other factors to your credit, rather than the thermage treatment. Additionally, professional help at the photo shoot with optimal lighting, photography, hair and make-up always helps us to look our best.

Best wishes on your book.

01.6 | Unregistered CommenterTF

If you are using Titan at 35 joules you are not doing the procedure correctly. I use both Titan V and Titan XL @ 65 joules always. Never have I had to stop or dial down due to patient discomfort. I suggest you go to a conference an learn the newest techniques. You will be much happier with your results and so will your clients.

01.6 | Unregistered CommenterRobert

Titan is MINIMAL dermal heating. and Robert the Titan XL max is 50J is CANNOT go past it; I have this and if anyone want it you can have this piece of junk !!! Refills are a rip off.

FDA approved for : dermal heating

Any physician who says "tightening" is a LIAR.

01.6 | Unregistered Commentercuteramd

LOL, I agree with you. At least with Thermage (I am its believer), there is scientific evidence to prove its depth of penetration and collagennesis both in-vitro and in-vivo. I have not seen any such from Cutera. If you can not safely get below 2mm depth, you really cannot make much claims of effects on collagen denaturation (breakdown of intracellular bonds and rescaffolding via intercellular bonds) and collagenesis.

01.7 | Unregistered Commenterpmdoc


Really don't care for your LIAR accusations. Any time you want, stop by my office and I will show you how to use Titan and use it at 65 Joules. I will also have plenty of happy clients lined up to prove you wrong as well. Just let me know when you want to stop by.

01.13 | Unregistered CommenterRobert

CN the RN: Genetics v Thermage. I know exactly how you feel; my brothers are upset that I got the looks AND the brains.:)

BTW: Levulan/PDT works great for pore size too

01.13 | Unregistered CommenterDermaRogue

Let's be more cordial on this post. I have been doing non-invasive cosmetics since 2002, done thermage in a few thousand cases. As physicians we are also scientists. We DO believe in in-vitro and in-vivo and evidence-based proofs. I have not seen anything scientifically speaking from Titan that is even remotely scientifically based. Thus you end up with this "wild wild west" guessing-based way of treating the public. We definitely need to learn from each others. I checked out your site and saw that one picture from titan. I have hundreds of thermage photos with chronological dates to share with you if you like to see them.

01.13 | Unregistered Commenterpmdoc

robert: i was talking about the XL not the standard hand piece. the XL handpiece MAX energy delivery is 50 J. We also use 65J on the standard or if you have V- visible. My big complaint w/ Cutera is the whole refill business; is there any reason why everyone else figured this out and thought it was a bad idea: hmmmmm NO REFILL on Palamor with their LUX IR or Syneron with their IR/RF device refirme and so on..... Is there a HUGE clinical difference in these devices.... be honest... probably not. We can argue until the cows come home but its still MINIMAL "tightening" for all these nonablative devices. The thing that makes Cutera Titan bad for anyone is refills -- a total waste of time and money. You can read what Kevin Conners CEO of Cutera says about their stocks which has plummented this last week to BELOW what they opened because Pearl has very POOR sales and most physicians like myself will be getting rid of the XEO Titan..... refills bad idea.

01.14 | Unregistered CommentercuteraMD


You are quite right. There is only one Titan picture on my website. However, I have many more stored in my office PC. I am not interested in treating my patients with brutallity therefore I am not interested in your thermage photoalbum. The fact is that my patients are happy with their results following Titan. It is actually our best selling package. How could that be if it does not work?

01.14 | Unregistered CommenterRobert

We can sit here talking about why those "presumably happy patients" I have a staff employee who paid close to $3000 for the titan 360. She had no results but did nothing against that physician. Thus I am sure that MD would have the same presumption. I am not saying thermage is better than titan. However, as scientists we are also trained to look at a technology with critical eyes and thru certain "well established" methods. At least with Thermage, I know FOR FACTS of scientific proof of its depth of penetration and histologic evidence of its effects on collagen on a time-stamped pattern. The truth about Thermage is that the "seemingly inconsistent outcomes" have nothing to do with its monopolar RF technology at all. Monopolar RF is a very powerful and clinically effective mode for collagen denaturation and genesis via its original applications in oncology (tumor necrosis) and neurology (nerve destruction). The problem is due to the lack of scientifically and clearly defined treatment guidelines that ALL practitioners can duplicate. When we talk about the Titan. First of all, it is not FDA approved for skin tightening. There is no in-vitro nor in-vivo nor histologic evidence of its effects on the collagen level that I am aware of. Because of this, Cutera created this "360" scheme in hope that the other "technologies" would somehow make things look decent enough so the patients would not be too ticked off. Anyway, if you and your patients are happy with Titan then good for you. I am simply trying to speak from a scientist perpective.

01.14 | Unregistered Commenterpmdoc

I am not sure I want to get in the middle of the "pissing" match but I have to agree with pmdoc. I have had the Titan for almost 3 years and have not had great results. I have never been able to get to 65 joules/cm2 due to patient discomfort. I have had some patient response and some minimal but never a "WOW". I have since replaced the Titan with Thermage and my patients have been happier. This is just my experience with the Titan. I have tried all of the tricks recommended by Cutera with no better results. I was doing more passes before it was even recommended by Cutera. My Titan could just as well be a $40,000 coat rack. I would sell the system if I wer not still using the 1064nm laser. Titan was the worst financial decision I have made.

01.14 | Unregistered CommenterLH

Let me know when you are in Los Angeles area so we can meet. I really look forward to meeting you since there are lots of things I am sure we can intellectualize about.

01.14 | Unregistered Commenterpmdoc

I don't mean to create some unfriendly atmosphere between us. What we need to do is to be united against bad people like that one chiropractor from FL who hid behind the back of an MD to run this "laser teaching operation" supposedly teaching MD's how to get into the laser business charging thousands of dollars. There he claims his IPL machine can do literally 20 different procedures safely for all skin types. He essentially runs a "legalized scam operation", hiding under the FDA approval stamp. The problem that most of us MD's did not realize, including me, was FDA approval for medical equipment was vastly different from medication approval. For equipment, they only need to prove the equipment "safety", the bar for clinical efficacy is very low (studied subjects are less than 24). That is just for the first device to be approved. For any subsequent devices, they can simply file for a 510K as a "similar" one to the first one. Here it gets even easier. For example, Sciton can get its 1319 Lipo machine approved much easier now that CoolLipo 1320 has already been OK'ed. Anyway, I sent this scamming FLDC a posting asking him for scientific proofs on how his IPL's could be safely done on all skin types for permanent hair removal since early December without his reply since. I am sure he is still making $$$ in conducting seminars telling MD's his 600's nm IPL head is the "gold standard" in LHR.

01.14 | Unregistered Commenterpmdoc

Not to create more argument but.... Some clinical studies from from very respected derm/plastics docs. however still they are white papers just like Thermage. By the way Thermage can cause "fatty tissue necrosis" which Titan or IR device cannot. you can retrieve these online. Dr. Esparza at UCSD terminated the Thermage due this risk.

Multi-Center Clinical Perspectives on Titan
Eliot F. Battle MD, Edgar F. Fincher MD PhD, Ronald L. Moy MD, Gregory Nikolaidis MD, Amy Forman Taub MD

Painless Skin Contraction Produced Via a New Infrared Light Device
Javier Ruiz-Esparza MD

Ultrastructural Effects of Titan Infrared Handpiece on Forehead and Abdominal Skin
Brian Zelickson MD, Victor Ross MD, David Kist, Roth Sanner, Jeff Counters, Scott Davenport, Greg Spooner PhD

Nonablative Infrared Skin Tightening in Type IV to V Asian Skin: A Prospective Clinical Study
Sze-Hon Chua, FRCP (EDIN), Por Ang, MRCP (UK), Lawrence S. W. Khoo, MRCP (UK), AND Chee-Leok Goh, FRCP (EDIN)

Skin Laxity of the Face and Neck: Treatment Approach with the Titan Device

An Objective Evaluation on the Effects of Non-Ablative Skin Tightening with a Broadband Infrared Light Device
Kei Negishi M.D., Kaori Takeuchi M.D., Kumiko Nagao M.D., Nobuharu Kushikata M.D., Shingo Wakamatsu M.D.


Multicenter Clinical Perspectives on a Broadband Infrared Light Device for Skin Tightening
Amy Forman Taub MD, Eliot F. Battle Jr. MD, Gregory Nikolaidis MD

01.14 | Unregistered Commenterslskdmd

Thanks for your list. I will check them out later. Fatty necrosis was caused by the old generation tip which has gone thru 3-4 changes now which have not resulted in fatty necrosis since about 2005 that I am aware of. The effect of monopolar RF has been proven in-vitro, in-vivo, and electron-microscopic histology. As I stated before, the power of monpolar RF has never been an issue. It is when it is manufactured initially that caused much pain and adverse side effects. Infrared light was attempted as a way to fill the gap caused by thermage's initial PR problems. I do want to admit that IR has been much used nowaday with some successes. I do not believe monopolar RF is the best skin tightening technology neither b/c of certain limitations. But I believe it is the best presently when correctly used due to its depth of penetration. The second best technology is 1064 Nd-YAG. My bet for the future is ultrasound b/c of its depth of penetration and better safety and pain profiles. That is my 2-cents on this issue.

01.14 | Unregistered Commenterpmdoc

I was able to read up on the first paper sited by you. I also went to Cutera website. I find it perplexing that the site has no photo gallery nor clinical papers there. I checked out the "testimonials" area. Most of those 6 comments are about the " initial excitements" by the owners upon getting the machine and how much PR Cutera created for them at that early point in time. Actually I then stumbled upon this article by Dr.Amy Forman Taub which I thought was pretty balanced

It was also somewhat consistent with what I had suspected about IR in general was that it might work only on thin skin people and thn skin areas such as the neck. Also, most of what was adopted for Titan technically had been pioneered by Thermage new protocol. In addition, Dr. Taub also said what I had previously said from a scientific perspective was that you must bring the collagen to the right temperature to have long lasting effect. Often this would result in patient's discomfort. As you look at a sample picture on the article of a split face (left side treated with Thermage one time and right by Titan 2 times) you could appreciate the more marked improvement of the Marionette's line on her thermage side than titan one. At the end of the day, you can only do so much with a 1-2mm depth of penetration vs a 4-6mm depth technology. By the way, thermage will have a new tip for cellulite in 1-2 months and another one for fat reduction by the end of this year. All will be FDA-approved.

01.15 | Unregistered Commenterpmdoc

Sounds great. Look forward to seeing it. Hope to see everyone at the Conversations and Controversies in Whistler Canada this year. great discussion ; great debate.

01.15 | Unregistered Commenterslslmd

Yes, old generation Thermage had some fat necrosis; but I haven't seen any w/ the new "consensus guidelines" that Thermage uses. Actually, I believe the Fat necrosis spurred Thermage into trying to develope a "cellulite" tip for the machine. We have seen some superficial burns w/ the new Thermage "deep" tip ,not at our clinic(..yet..)but reported by Thermage.
BTW Robert if you have some good pictures of Titan results, send them to Cutera ..they could use them:)

01.15 | Unregistered CommenterDermaRogue

Interesting article from Dr. Taub. So, in summary both Thermage and Titan achieve similar results especially in the long term. Patients are satisfied and the risk of complications with Titan is extremely low. What's the problem? Does Titan have limitations, sure. Learn to choose your clients based upon their likelihood to respond and meet their expectations. Standard procedure for ALL elective services. What else is new? Regarding Cutera and Titan pictures, Good Idea! The pics are on the way. Booked two full Titan packages today who were referred by very satisfied clients.

01.15 | Unregistered CommenterRobert

I am glad you had happy titan clients. On long term basis, thermage results can last up to 5 years in the best case scenario. Risk of complications are <1% in thermage, based on close to 600,000-700,000 cases as of today. I think you meant the pain level. However, you missed the point of what has been a well-acknowledged fact in collagen treatment, regardless of technology, as elucidated in Dr. Taub's article and multiple other medical articles which said to denature the collagen you need to heat it to about 59C or higher. It would be ludicrous for anyone to think it is possible to heat the dermal layer to that degree without some measurable pain to the person, at least with current technologies. When comparing monopolar RF vs IR in collagen tightening arena, it is reasonable to say that we need to "dial down" RF so it won't do more than just that whereas for IR, as I can extrapolate from what I have read so far, you would need to run it at almost maximal level to get there if at all. One thing to keep in mind is soft shallow wrinkles such as crow's feet can be eliminated " epidermally speaking via LED, pulse dye, IPL and IR. Some of us might have assumed this phenomenon as equal to dermal collagen tightening effect.

01.16 | Unregistered Commenterpmdoc

I had Titan laser treatments and was BADLY burned. I have scars from the treatment. Although the Spa is working to repair the damage using Genesis laser, some of the scars still persist. I'm very disappointed. My face had several open oozing sores. I was treated at an emergency room and told I had 2nd degree burns. The Spa has been concerned and caring, the Cutera company not so much, telling me "that's why we have you sign a release, these are HOT lasers".

01.16 | Unregistered CommenterCheyenne

Wow! I am surprised that you suffered such complications. Obviously the technique of the Titan operator was very poor. I can't imagine that you could receive several 2nd degree burns. The individual performing the Titan should have been able to see ominous changes within the epidermis during the procedure. Also, unless a potent anesthetic was applied I can't imagine that you would have sat through the procedure willingly. I have had some blistering occur with IPL but never with Titan.

01.16 | Unregistered CommenterRobert

Sorry to hear of your ordeal. I believe this is a classic example of certain manufacturers who tried to "dumb down" the technology to get impressionable and less knowledgeable MD's into buying. I was one of them in 2002. I paid dearly for that mistake. Here on this site, I have been trying to be of help to all by being as informative as I can. In most cases,it is highly incorrect for anyone to claim that any of his/her technology is free from pain or adverse side effects. This claim from the manufacturer is true only because they "dumb down" the technology technically and instructionally spreaking. This is a very sad and unfortunate situation that I see often from reading online postings here from other physicians and the public. The best thing we can do is to share information and be of help to each other.
1) What is your ethnic skin type?
2) How long ago was your titan treatment??
3) What does your skin now look like??? Redness?? Dark spots?? My guess is you had burns on your forehead.cheeks, temporal and neck areas??

01.16 | Unregistered Commenterpmdoc

I had my treatment in June of 07 and the burns were to my cheeks, chin, side of nose and neck. The treatment itself was painful but I was told there would be no adverse side effects from it, no down time so I trusted that the pain was "normal". Any ideas on what I can do now to minimize the scars I still have. Some of them look like indentations, some of them are still a bit red and others are thick and white (the worst ones).
thank you so much for your time.

01.18 | Unregistered CommenterCheyenne

Oh, forgot to say I am Caucasian and have the type of skin that would sunburn easily.

01.18 | Unregistered CommenterCheyenne

It is funny that the side effects you had were identical to some of what had occurred to Thermage when it first came out in 2002. We don't see these anymore b/c the techniques and tips have vastly improved. I am surprised and actually horrified to hear that these problems can be ever allowed to happen any longer. When high heat is applied to shallow bony areas such as the cheeks, chin, forehead areas, the skin "sizzled" up thus creating the "dimple=indentation" effect.
1) Indentation: try some strong skin resurfacing like CO2 laser or plasma rhytec. It costs you less if the doctor would charge for only the local area instead of the whole face.You should minimally see some decent improvement. Otherwise you would need filler. Its downside is you might need to get it every few years or so depending on how long lasting that filler lasts unless you are comfortable with permanent one such as Artefil. I heard rumor that granuloma can form after 5-6 years
2) Redness: try IPL or pulse dye laser ASAP while the redness is still there. It would help
3)Thick and white: sound like keloid (raised scars)!. Conservatively, try steroid (kenalog) injection. Skin resurfacing as in #1 works much better in getting rid of raised scars.
Good luck. I hope that clinic pays for your current problems.

01.18 | Unregistered Commenterpmdoc

Thank you so much for your advise. I am going to consult a plastic surgeon regarding CO2 and see what he says.
The spa has been very good to me but I think they have done all they can do to help me.
The spa says the "head" was bad and Cutera replaced it. They tell me an employee & their spouse also got minimal burns from it before they sent it back. They say since they got the new head they have had no more problems with their laser.
The two scars that are white and thick are flat but they were the worst ones. I should post a photo of day 2 - horrid, oozing, painful sores.

01.23 | Unregistered CommenterCheyenne

Good Luck

01.23 | Unregistered Commenterpmdoc

Safe CO2 would probably be fractional. Check out Deep FX, MIXTO, or upcoming RE:PAIR .

01.24 | Unregistered Commenterdeepfx

Would I contact a plastic surgeon for that? thank you.

01.24 | Unregistered CommenterCheyenne

I would recommend you to check out: , their product is the ActiveFX. I checked the site out yesterday. Their before and after pics were very impressive (the scar on the nose) Call them for some MD referral locally. STILL I must warn that you make sure that physician can show you his/her personal experience with the technology (# of cases, his/her patients results) Ask if the nurse or the MD would do it???(Nothing against RN's here, I have worked with some of the best before) For your case, don't leave room for errors anymore!!!! When you found the right place, ask for the DeepFX option (make sure you take prophylactic anti-viral and anti-bacterial medications). My guess is your skin type would respond beautifully and you will get additional rejuvenation and tightening effects with it.
Re:Pair by Reliance: as I said in another thread here, it is new and still evolving in treatment protocol even by its leading investigators, Dr. R. Fitzpatrick and R. Geronemus (20J vs 30J vs 70J and amount of times)

01.25 | Unregistered Commenterpmdoc

Can anyone tell me the model number of the latest generation of Thermage? It sounds like earlier models may have caused fatty necrosis and I'd like to make sure the Dr I choose is using the latest technology available. Thanks in advance!

02.29 | Unregistered CommenterThermagr

The machine base unit is simply a power generator. Whether it is the older (TC) or newer(NXT) base unit you have this does not matter. What is important is the TIPS. Make sure you use either the 3.0 cm2 TC or 3.0cm2 STC tips for the face. The tips for body are all good.

02.29 | Unregistered Commenterpmdoc

Protocol for Deep FX and Active FX , we have never placed anyone on antibiotics, occasionally Valtrex or Famvir. Thats why its fractional, safer. Results maybe not as great as hardcore CO2 but we don't want the risks. We haven't seen any nor has there been any published. BTW its Reliant not Reliance that makes the Re:Pair and its USA lasering (a third party distributor in California) with the cheaper continuous wave MIXTO from Italy. After having worked with MIXTO and Re:pair I found that you cannot change shape or density you have to do a double pass on the area, which is very imprecise. How do you ever know you will double pulse an area? You don't. RE:pair has a roll on method which I don't like and disposable tips. Yeah, Deep FX has one too but their cost is minimal 13-20 bucks. Not hundreds like the Reliant's Repair. Good luck to you all. See you on the other side. fractional CO2 is here.

02.29 | Unregistered Commentercutera?


What are you seeing for true patient downtime following the active FX and Deep FX? What is the difference between the two?

03.1 | Unregistered CommenterLH

True downtime ranges between 4-6 days. The difference between Active FX and Deep FX is the spot size. Active FX is kind of a pseudo fractional device - ( I guess the true question would be : How big can you have a spot size and call it fractional ? ) Active FX spot size is 1.25 mm and the Deep FX is .12 mm . Why ? because the true challenge for resurfacing would be safely resurface the skin but then sink enough heat deep within the papillar and dermal layers of skin to tighten and create new collagen. Active FX resurfaces the top safely while Deep FX really works deeper level to create even more heat. I have been truly amazed at the results.

oooooohhhhh...... like I said... see you on the other side.

03.1 | Unregistered Commentercutera?

Where are you located? If need be, email me privately

03.4 | Unregistered CommenterJennifer

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