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Nothing Brings Out Anger Like Thermage

thermage.jpgIt's surprising to me how polarizing Thermage as a treatment seems to be. There are 5 threads on Thermage going on in the Physician to Physician discussion area. While the 'pro' Thermage docs seem to be relatively calm, the 'con' side is much more strident in their views. ( It appears that the docs panning Thermage appear to be plastic surgeons but who knows.) It seems to be particular to Thermage for some reason, Cutera's Titan or Fraxel  don't seem to evoke nearly the outrage.

Here's a sample: 

If you feel that you must scam your patients because you don't have a real treatment or can provide a real surgical intervention for them because you're not qualified to be doing what you are trying to "sell" to unsuspecting patients...

Pretty strong stuff. Most doctors hesitate to accuse other physicians of running scams on their patients but Thermage seems to push some right off the edge.

Reader Comments (112)

I think that initially some doctors were administering thermage incorrectly and that caused a lot of problems and anger. Now, I think it's the matter of researching to find a certified doctor and then discussing the procedure. Research is the key.
I think as more people start to use titan the post will be similar to thermage. I have not heard many good things about fraxel either.

The problem is that the technology works for some people with minimal loose skin and wrinkles. It usually has to be combined with something else.

There is also the issue of charging 80K for titan when you can get the same technology from say Palomar IR for far less. (I'm not a palomar rep. and I don't speak for any laser compamy, this is just an observation).

The reality is that IR is IR, RF is RF. Now syneron has their version of combined RF and IR.

The Truth is that they all produce some results for the right patient. Key words, "Right Person".

That is where being a doctor comes in. Evaluation and proper Treatment.

I compare it to sclerotherapy v.s. lasers for spider veins. Lasers don't to nearly as good a job as sclerotherapy. In fact, they don't even come close to the claims that the laser reps make. But I know of many Medical spas or laser clinics that use them exclusively. If a patient gets poor results, the doctor just shrugs his shoulders. This is not good business or healthcare.

Bottom line:

If your patient needs a face lift to get their desired result and you don't do face lifts or don't believe the laser will produce the results they want, send them to someone who does do them.

I think that as the medical spa market get larger many doctors will be sold by the reps on the laser and their magical properties. They will be very unhappy at the end.

03.27 | Unregistered CommenterMD
Hmmm. I, for one, am perfectly happy with Thermage. No anger here. I do think that you have to position it correctly for the patient. It's not going to shrink-wrap anyones face.

But you can't stimulate area collagen growth by stretching it either. Thermage is a technology that will, no doubt, get better over time.
03.29 | Unregistered CommenterDermgal
I agree with MD. Reps aren't much help in determining what is the best form of treatment. It's the comission stupid.
04.12 | Unregistered CommenterLexDO
If you educate your patient effectively you will not have any angry patients with either Thermage or Titan. I also think that most doctors irrationally overprice these treatments to the tune of up to 3500 per treatment!? Properly positioned, these treatments are very effective and good revenue generators. As far as lasers vs. sclero. You haven't used a good laser to treat leg veins or you would not feel as you do. I have routinely treated spiders, retics and perfs with my Cutera coolglide for the past 4 years and my patients are very happy. I also utilize sclero in some cases as well as combine the two. I will agree that there are numerous lasers on the market touted as leg vein lasers that are truly a joke!
04.18 | Unregistered CommenterLR MD
As far as reps go, any MD is foolish to rely solely on a rep's judgement as to which machine is purchased. So many doctors are duped by both the laser companies and the leasing companies lured by the tales of riches that await them....then they file for bankrupcy because they forgot that they had to do research and do their due dilligence and consult with CPA's and attorneys etc. It truly saddens me.
04.18 | Unregistered CommenterLR MD
My Thermage treatment over 6 months ago provided no improvement in my face or skin condition. Doctor talked me into it by saying that I would be very pleased with the results and proceeded to show me before and after pictures of successful treatments. Also said it would last 5 years. Haven't seen that number anywhere on the web. He even agreed with my assessment of no improvement and he was disappointed. The difference - I'm disappointed and out $2,000. He's disappointed and oh well I made $2,000. He refuses to refund any portion of the money I spent.
01.30 | Unregistered CommenterJanet
I added Thermage to my facial plastic surgery practice 3 years ago at the request of my 45y/o wife with my same concerns over our early signs of aging.We are both walking example of how skin tightening(yes,"shrink wrapping) and volume restoration has taken us from looking our age of 48 to how we looked at 33.Recently the head of the facial plastic academy was interviewed for an ENT publication as an "expert" in non-surgical treatments. He stated that the problem with Thermage was that it didn't work despite never having touched the machine. He based his expert opinion on what the guys in his town(Manhattan) were saying-anecdotal gossip. He did not respond to my email chastizing him for his irresponsible and obviously prejudiced opinion.
8 passes of Thermage will contract residual collagen and elastin as well as the connective tissue bands running from thr dermis to muscle through fat reliably in most patients under 50.
I stand by a statement I make in my consults-If $ were no object, Thermage should be a part of everyones pursuit of a younger appearance- nothing else I have seen addresses the compliance of the skin.
Yes, it takes time and is a facial sculpting technique, but since when is $25-3500 for 80 minutes of quiet marketing time a waste? Under sell and over produce and if you think they need lifting first, don't even try Thermage, you will both be disappointed.
Thermage before filling "squishy"patients. I do facial restoration with Sculptra and use Thermage to shrink wrap-tighten-the subdermal space in which I am planting the seeds for new collagen. This can be done reliably with 8-10 passes at any age but the "lifting" is a crap-shoot and I tell patients that. I lowered my price when the tip doubled in area taking me a third less time and making it more affordable for more patients needing volume restoration.
Anyone doing "one-pass'Thermage like a ghost md "medispa" in my town is administering a placebo.
Just my honest observations-no conflicts of interest.
02.24 | Unregistered CommenterMStampar

Just curious, do you do all eight passes the same visit or different ones, how many tips does this take and does this affect the cost?
what do you use for pain control or do you need it, what satisfaction rating do you get and any adverse outcomes with your protocol?

I have done several thermages the most number of passes I have been been able to do is 5 passes and the results have been good although I have only done it for about 4mths and I agree with the person who states that people with volume do better
03.7 | Unregistered Commenterpcmd
The 8 passes are in one setting and actually repeated a row at a time to the patients tolerance. This allows buildup of heat higher in the dermis which has made my results more reliable. Be careful to stagger the passes on and off the squares to avoid dents-I've had a single depression in over 3 years which occured during a training session evident 2 monthes later-a demonstration of ongoing efficacy even at 70 y/o.
Pain is controlled by adjusting the treatment level to just below the painful-involentary blinking- level. Topical only block the cooling sensation, not the heat.I don't "double pulse" the same square unless I am trying to shrink a double chin or jowl and I turn it down a notch and use one square and one diamond.
I am a surgeon who recognizes the need for something more than, or other than, surgery and always look to Sculptra volume restoration when appropriate.
05.6 | Unregistered CommenterMStampar

Thanks for the input. I just did my Thermage training today. I would love to hear more about your technique. Where are you located?
05.7 | Unregistered CommenterLH
I am located in Florida. I have discovered a new form of RF which can be done at a fraction of the cost with near total control of efficacy! email me at for a half treated face example. The key is-the more collagen and elastin they come in with, the more they contract-regardless of age. I am a physician interested in providing the best efficacy for the buck and my time. I hate to disappoint patients.
05.19 | Unregistered CommenterMStampar
Perhaps love of money has indeed become the root of all medical malpractice suits. Food for thought.
05.27 | Unregistered Commenterjani

I am not sure what you sre implying.

05.28 | Unregistered CommenterLH

Are docs using Titan sfter having used Thermage in their practice and getting much better results, the same, or worse? Just curious.

06.30 | Unregistered Commenterlaser MD

I'm glad to see that Thermage is finally making some sort of move away from the traditional 'ad slick' advertising that they were using and moving to a 'conversation' with practitioners (at least on this site.) My opinion has changed slightly from one of harsh criticism to mild approval. I'll at least give them the benefit of reaching out rather than just talking down and sending us more 'Thermage' slicks.

07.20 | Unregistered CommenterDermatool

fact: thermage satisfaction across the country is < 30%

07.20 | Unregistered Commenterwps

The new Accent laser works wonders. I've never tried Thermage, but I can highly recommend the Accent.

07.21 | Unregistered CommenterA.D.

I switched from Titan to Thermage. I am seeing better early results from the Thermage than we did with Titan. Our patient satisfaction is higher with Thermage but the final jury is still out. I have only been using the Thermage for about 2 1/2 months.

With any of these skin tightening results it is definitely correct patient selection. We try to avoid smokers, chronic NSAID users anyone on steroids etc. You also must not oversell. If the patient needs a face lift then get them a face lift.

wps you need to look at the new research. That is an old stat. Patient satisfaction is much higher with the new protocol. Again pt selection is extremely important.

A.D. look at the other posts on this site. Accent does NOT have glowing reviews.

07.21 | Unregistered CommenterLH

How does it compare with radio-frequency?

08.13 | Unregistered CommenterDoctorG


I am not sure what you are asking. Thermage is a monopolar radiofrequency.

08.13 | Unregistered CommenterLH

Forgive my ignorance, but why would you avoid chronic NAID users?

08.14 | Unregistered CommenterLA MD

There is theory that it may interfere with the healing process. You want the full cascade of healing proteins etc to take place and the NSAIDS can interfere with that process thus limiting your results from thermage.

In other words, basically you want the inflammatory process to occur. Thus allowing better results. That is the same reason for not wanting someone on steroids.

08.14 | Unregistered CommenterLH

I received my second thermage treatment in Dec. 2006. This was followed by Microbrasion and TCH peels beginning in January 2007.
Began seeing skin depressions in June, firstly, is this possible
given the time frame? Secondly, have any of you doctors heard
of similiar cases? I am not angry with anyone, "stuff happens",
simply wanted to know!

09.6 | Unregistered Commenteratl

In July I underwent full face Thermage. My physician is expertly trained in this treatment and has been performing this procedure since 2003. My temple area on both sides has sunk in leaving my brow bone very noticeable. I am starting too look 'gaunt' and everyone is noticing. My secret is that I told no one I was having this procedure. The skin on my forehead has 'thinned' and now my cheeks are shrinking leaving the very outer layer of my skin looking thin and unplumped. My Dr. who performed the procedure remarked at how he'd never seen my skin look so thin and dry and asked me what had happened. He then went on to remark at how much 'fat' I'd lost in my temple region and that I should consider 'sculptra' to plump this area. Does anyone see the corelation between the signs of fat loss and Thermage? Any advice on how I should fix my sinking face? Please help with some good advice!

09.23 | Unregistered CommenterJS CA

Yes - unfortunately, fat atrophy is a known, but relatively uncommon, adverse effect of the thermage treatment.

09.23 | Unregistered CommenterTF

Err... Not really. Thermage hasn't had any real fat atrophy problems since the first year or so since they lauched. (Search this site for Thermage in the top right) I've seen hundreds of treatments and we've never seen this problem.

Also JS CA, when it has occurred, it's always been due to extremely high settings most often performed under general anesthesia and the fat loss is not uniform, it's very obvious and 'patchy'. Hope this helps.

Err...Jeff, from Thermage's own web-page, a paragraph on fat atrophy, as an adverse effect.

One of the most serious (adverse effects) is a surface irregularity, which is attributed to the overheating of tissue in the Z-axis causing fat atrophy or excessive tightening. The best prevention for surface irregularities is as follows:

Use the treatment grid
Avoid pulse-stacking
Allow at least 2 minutes between passes
Stay within recommended treatment setting guidelines
Consider patient discomfort feedback
Use caution when treating in sensitive areas.
There is a high correlation between occurrence of surface irregularities and treatments outside current level guidelines, especially on temple areas, the forehead and the mid-cheek.

09.24 | Unregistered CommenterTF

Pretty much if you use the Thermage concensus guidelines you won't get fat atrophy. We haven't had a problem in hundreds of Tx's. If you stray and try to push the envelope,,, thats where problems start. Anyways...anybody have the NEW Thermage..supposed to be ????faster???

09.24 | Unregistered CommenterDermaRogue

I didn't say it wasn't possible, I said I'd never seen it in the hundreds of patients we've treated or heard of any physician I've ever know to have see it. Thermage if done incorrectly, can cause problems for sure, just not a uniform mass destruction of fat.

I agree with Jeff. I highly doubt that a patient would have full face thinning of the skin and symetrical facial fat loss with thermage unless the patient was under general anesthesia and the clinician was way outside of the parameters.

09.24 | Unregistered CommenterLH

No need to get defensive, guys - the patient asked if there was a known possible connection between Thermage and fat atrophy, and I replied that one does exist. Agreed that it would be unlikely for thermage to cause symmetric, non-focal fat loss, as this patient seems to describe.

09.24 | Unregistered CommenterTF

I feel it is important for the patient to have that information as well as the information that it is a possible side effect.

09.24 | Unregistered CommenterLH

YES and that is the difference between IR technology and RF . Cutera's Titan and Thermage (if done properly) results are similar BUT only Thermage may cause fat atrophy. Ask Dr. Ruiz Esparza at UCSD in California published article on fat tissue necrosis. This is impossible with IR device, not to mention the PAIN with Thermage.

09.25 | Unregistered Commentercutera

I have never seen results bt the Titan that are comparible to Thermage. I own both. The only somewhat comparible pictures is Cutera's original picture of the lady that had twins.

09.25 | Unregistered CommenterLH

Also, Titan is just as painful as Thermage but you have to go through it 3 to 5 times. One more incident of Cutera promising more than it can deliver.

09.25 | Unregistered CommenterLH

LH, you may be interested to hear that (at a lecture 2 years ago)Dr. Ruiz Esparza stated that he had abandoned the use of Thermage in his practice, and switched over to using Titan exclusively. He liked the use of multiple passes with lower settings to minimize patient pain. From someone so involved with the development of the Thermage, I thought this was particularly interesting - but I do not know if he has changed his protocol in the recent past.

09.25 | Unregistered CommenterTF

just like thermage, titan is operator dependent. you can own a mercedes but if you can't drive it ..... etc.

09.25 | Unregistered CommenterLH

Don't give me that crap. That is what they all say. They say it is operator dependent. I have used every trick Cutera has recommended ie. sliding, wiggling, circling, multiple passes patient selection and have yet to see great response. They over sold this product and promised more than they could deliver. I have talke d to others that own the Titan and they feel the same way. We have had them in our office multiple times without benefit. I am not new to this game.

The above post to me was not from me so I do not know who posted it.

09.25 | Unregistered CommenterLH

We have gotten great results from Titan. We have outstanding before and after pictures. Our customers rebook and refer friends to us and were not giving this service away.

09.26 | Unregistered CommenterWPS

Then tell me your tricks. Cutera sure can't give any insight. I am tired of the $40,000 coat rack.

09.27 | Unregistered CommenterLH

I have had thermage procedure in September 2005 in london performed by MD Rita Rakus. I have since lost ALL the fat from my face. My face is totally distorted with over tightness around nose area, chin and around the eyes, which have sunk in so deeply, they remind me of a look on a corpse. I had a very full face despite beeing quite slim. I have also been told that I looked more like a 30 year old than my real age at the time of 47.I am experiencing a lot of pain and up till now had seen a number of doctors including oral and maxilofacial surgens, nurologists, plastic surgens and dermatologists. There is no help!!!! I had nine separate procedures to restore some of the fat to my face using various fillers. My face is still changing and at present I look more like a sixty year old.My next appointment is to see a leading radiologist as the damage resembles radiofrequency indused fibrosis. My face is slowly and painfully dying. I have instructed a top London law firm to take action against Thermage but we are also taking law suit against the doctor who was without doubt over agressive, though this technique has been tought to her by the vice chairman of Syneron himself. New tip and new protocol...

09.28 | Unregistered Commentermf


You are going to have to explain why you are talking about Thermage being taught by the vice chairman of Syneron. These are 2 totally seperate companies and they are in direct competition with each other.

09.28 | Unregistered CommenterLH

Dear MF,
Best wishes on taking suit against Thermage. I have the same damage and symptoms you are experiencing. My Thermage was performed 4-12-2006 in the USA.

I reported my Thermage adverse event to the Food and Drug Administration (FDA). They followed up with me - they have hundreds, maybe thousands of reports just like ours in their database. But they need more evidence before they will issue an alert.

Please consider writing a book about your experience and include photos. All Thermge victims will eventually experience what we are experiencing - faces that are dying a slow, and painful, death. Someone who is further along in the progression of damage is best to show what this dangerous product is doing to us.

Thank you for sharing your story. I hope my post will encourage you in some way. Best wishes, take care and God Speed. PS, there is a gifted and compassionate physician who also teaches at Yale University, who is treating other Thermage injured people. For me, it has been phyically and emotionally comforting to be under this doctors' care.

I have chosen an alias to protect my identity, "Dante" - in the Thermage Inferno.

10.28 | Unregistered CommenterDante

Why can't doctors who claim to have faith in their work do 'Thermage' on a -results- basis: Make a virtual 'before & after' set of drawings or altered photos, to be approved by the patient, along with a legally binding guarantee. If the -real- 'before and after' photos don't match up favorably, the doctor doesn't get paid. It's a lot of money, put it in an escrow account until the results are in, just like any other majot transaction. If it goes to court, promises made and results achieved will be crystal clear to the judge and/or jury.

11.20 | Unregistered Commentermark


I my be willing to do that but I am also going to charge you 3 times the price. So in the long haul who wins?

11.20 | Unregistered CommenterLH

Dante: I don't believe it was Thermage that Daniel received 3 times for. I think i knew which device that was but I don't want get in trouble making speculation!!!

I am sorry to hear of your situation. In general, those "tightening" devices work on your "existing" collagen. I doubt if you have much anymore. That is why on Thermage site, they have the recommended age limit of around 65 years. I am usually very careful in offering this technology to anyone above 60 unless I carefully check for the person's skin integrity.

11.20 | Unregistered Commenterpmdoc

Need opinions on tatoo removal Q switched ND yag. We are leaning toward the Medlite C6 because of the 2 handpieces, but it is more expensive than Cynosure's Affinity. Does anyone have experience with the handpieces of the Medlite pro or con? Other Q switched tatoo removal lasers? Thanks.

01.3 | Unregistered CommenterJK

JK try to demo the Candela Q-switch (called (i think) alextrivantage. might be a good alternative for a new machine. I have a older medlite 4 w/ the dye handpieces and haven't had one wear out yet. good luck..

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