Editorial note: this article was updated on August 17, 2020.
- The goal, and difficulty, with non-surgical skin tightening technologies
- What are Thermage®, Thermage CPT and Thermage FLX™?
- What are ThermiRF®, ThermiSmooth®, ThermiRase®, ThermiTight® and ThermiVa®?
- What are Ultherapy and HIFU soundwave cosmetic technologies?
- Are there other options for non-surgical skin tightening?
- Which skin tightening treatment is right for you?
If you’re looking for skin tightening treatments, you may come across several methodologies in your research. Of course, surgery would be the most traditional option, and the one with the most dramatic results.
However, these days, doctors can perform skin tightening with semi-invasive or non-invasive technologies. They provide more subtle, but still noticeable effects. In this realm of modern skin tightening procedures, there are a few popular ones, such as Thermage® CPT. But, what is Thermage® CPT? What is the old Thermage®? What is the new Thermage® FLX™? And, what are its alternatives, like ThermiRF® or Ultherapy®?
We’ll attempt to explain the differences between these cosmetic technologies below. But first, we’ll explain how skin tightening works, to give you a primer on what to look for.
The goal, and difficulty, with non-surgical skin tightening technologies
With any non-surgical skin tightening procedure, the goal is to be able to safely heat the lower layers of the skin (i.e. the dermis, or below it). That is where collagen is mostly produced. These areas are also where cellulite forms, and where ‘deeper’ deposits of fat are, too. If you have bumpy skin, the culprit is likely below the dermis.
As you age, you not only lose collagen, but your body starts producing less of it. This is what causes wrinkles, crepiness and sagging skin. Cellulite forms a little bit differently. However it can also be treated with skin tightening technologies.
Learn more about sagging skin, here.
Learn more about cellulite here.
Why heat the lower dermis to tighten skin? Heat stimulates your body’s natural collagen production response. When the body can produce more collagen in these deeper parts of your body, the skin can smooth itself out by virtue of growing more of its natural substance. Your top layers of skin can then, theoretically, have more to ‘hang on to.’ The result is a smoothing and contouring effect.
You can compare this to the process of plumping up fruits and vegetables with water, versus dehydrating them. When a tomato or an apple loses water, it gets wrinkly, and its skin ‘sags.’ Fruit and vegetable skins can more easily be pulled away from their internal fibers in this state. Of course, with human skin tightening, we’re not aiming to fill the body with water! This is just an example.
The hard part about using heat to stimulate the body’s collagen response, is that, well, it hurts! This process requires a lot of thermal energy to reach down into the lower layers of skin. If we were to run a hot handpiece on the top layers of your skin to tighten it, its heat could only penetrate so far, before it starts to burn at the top. Of course, we need to prevent burns.
So, while the main goal of non-surgical skin tightening is to heat up the lower levels of skin, an important secondary goal is to not burn or injure patients!
This is usually the crux of the matter: will it work? And if so, will it work without side effects?
Those with darker skin who undergo cosmetic procedures are also more likely to form permanent burn scars, called post-inflammatory hyperpigmentation (or even hypopigmentation). This is because darker skin types carry more melanin in their skin. Melanin production can be exacerbated due to skin trauma. However, burn marks can happen to anyone, especially if the practitioner doing the procedure is not careful.
What are Thermage®, Thermage CPT and Thermage FLX™?
Thermage® was a technology that preceded Thermage® CPT. The latest model of this technology is called Thermage FLX™.
Each generation of Thermage® uses a radio frequency wavelength to produce heat energy. The technology has become more promising than in times past, thanks to its later generations.
Thermage® CPT and FLX offer better pain management and cooling systems (i.e. vibrations and bursts of cold air). This avoids the burn issue noted above. The FLX can also deliver more heat, in a shorter amount of time.
Thermage® is a completely non-invasive skin tightening procedure, with no downtime involved. Its handpiece works only on top of the skin. That said, it can give a bit of a sting. Anaesthetic is not typically used with it, though patients can take painkillers beforehand, if they want. Some redness or swelling can occur, but this usually calms down within a day.
After a treatment session, the skin gradually begins tightening over the next six months or so. Some patients may need more than one session, depending on the case. But, results can be visible after just one treatment. Then, in order to maintain those results in the long term, follow-up sessions are needed (since the body continues to age, of course). How often? It depends on the person; every one or two years is typical.
Do Thermage®, Thermage® CPT and Thermage FLX™ work? Yes, but not in everyone. If someone has advanced aging, or their skin is already rather tight, they won’t see a big difference with it. A patient who undergoes this procedure should be in the right eligibility range for it. Some claim this would be between the ages of 30 to 60, as long as there is still some elasticity in the skin. Others call it a preventative treatment, not a repairing one.
Of course, you can google before and after photos to see the results some people get out of Thermage®. Just be mindful that everyone’s body is different, and thus, will react differently to any cosmetic technology. So, if one person got a miracle out of Thermage®, and another got moot, that’s not to say you’ll experience the same results as either.
We would advise you to consult with an honest, knowledgeable doctor about procedures like this. Practitioners can tell you more about your candidacy for skin tightening (though there’s never a guarantee).
However, it’s crucial to have realistic expectations with any non-surgical ‘lifting’ procedure; you won’t get the same effects that plastic surgery can provide. Thermage® can provide subtle results in some people.
Also – another big point: since Thermage® heats the top layers of skin, it can be less ideal for skin of colour (due to reasons noted above).
What are ThermiRF®, ThermiSmooth®, ThermiRase®, ThermiTight® and ThermiVa®?
One could say we are biased on this topic, since we carry the ThermiRF® machine. Still, we would say that this technology is where things get interesting when it comes to radio frequency skin tightening.
In the past, we have used Thermage and Thermage CPT in our practice. However, nowadays we offer multiple other options, which we feel are superior. These include the ThermiRF® series, and the truSculpt® iD.
Back to business though, let’s answer this question more directly:
ThermiRF® is the name of the ‘core’ machine. Like Thermage® and its varieties, ThermiRF® uses radio-frequency energy to provide thermal heat during a cosmetic procedure. However, its hand pieces provide more functionality, greater flexibility and more precise treatments. The handpieces are called ThermiSmooth®, ThermiRase®, ThermiTight® and ThermiVa®.
The ThermiRase® and ThermiTight® handpieces offer minimally invasive procedures for skin tightening. They use a small probe and cannula under the skin, to reach deeper, heat higher and not affect the top layers of skin. This makes them much more suitable for skin of colour. They also provide visible results after just one treatment. However, like with Thermage®, it takes a few months to start seeing those differences.
ThermiRase® is typically used on the face and neck, to provide a ‘facelift’ effect (but again – not as much as surgery could). ThermiTight® is used on the body, from the shoulders downward. It treats thighs, arms, abs, breasts and can be used on the neck, too.
ThermiRF® treatments also come with an infrared camera. A heat map is displayed on a computer screen so the practitioner can monitor the treatment area closely. They can then precisely heat, or avoid overheating, any area.
Due to the insertion of the probe under the skin, anaesthetic is used before this type of procedure. Insertion points are chosen carefully, and are small, to avoid scarring.
ThermiRF® also provides two non-invasive handpieces, which work externally. These include ThermiSmooth®, which is applied similarly to Thermage®, and ThermiVa®, which is a vaginal tightening wand. Because these are used without breaking the skin, their effects take more time to appear than the probe options. They can also require more sessions to see results.
We have a page dedicated to ThermiRF®. You can learn more about its uses and benefits, here.
What are Ultherapy and HIFU soundwave cosmetic technologies?
Ultherapy® and other HIFU (High-Intensity Focused Ultrasound) used in the world of cosmetic technologies are those that use ultrasound to provide thermal energy. Sometimes they are referred to as soundwave or sound energy technologies.
Ultrasound treatments of this kind usually require multiple sessions in a short timespan, to be effective. For that reason, they can be less convenient for the patient. Maintenance follow-up sessions are also needed more frequently (about every 6 months to every year).
Since these technologies use ultrasound, they can provide imaging for the practitioner. This way they can monitor treatments as they are happening – like with the ThermiRF® machine.
Also similarly to radio-frequency skin tightening, the effects of ultrasound treatments can take a few months to become apparent.
HIFU systems can reach deeper into the skin without being invasive, but only by about 1.5mm more than surface-level radio frequency technologies.
Thermage® reaches about 3mm deep. ThermiRF®, by comparison, bypasses the top layer of skin altogether, and reaches about 2mm deep.
HIFU can reach about 70°C while being non-invasive. Thermage® remains between 40°C – 55°C. ThermiRF®, using ThermiRase® under the skin, can go up to 90°C.
HIFU is also more directional in its treatment, whereas radio-frequency heats larger areas at a time. There are pros and cons to each style of energy delivery.
Are there other options for non-surgical skin tightening?
Yes! Skin tightening can be done with a variety of tools. This is the advantage of choosing a clinic that has multiple options available. Not only can your treatments be better targeted, you can get a mix of solutions for the maximum effect you’re looking for.
For example, at our clinic, we can use truSculpt® iD to both remove fat and tighten skin on larger areas (such as the entire stomach). Then, we can treat the smaller, hard-to-reach areas with ThermiRF®. Or, we can use ThermiRF® to smooth any bulges left behind after fat removal.
On the face, we could use ThermiSmooth®, but we can also switch to Infini™ RF microneedling. We can then address the top layers of skin with advanced laser rejuvenation treatments, such as with the Fraxel® DUAL laser or a Fractional CO2. And, by having multiple tools on hand, skin treatments can be mild to strong, depending on your preference and eligibility.
It’s also important to know that most radiofrequency and ultrasound technologies can’t be used on people with a pacemaker or medical device. For these cases, it’s great to have other suitable options.
Which skin tightening treatment is right for you?
Ultimately, the solution that’s right for you will depend on the specifics surrounding your case. This can include the size of the area to be treated, the main culprit causing the issue, the speed and intensity at which you want results and other health issues you may have.
A qualified, experienced, trained and knowledgeable doctor should be making recommendations on what is best for the concern at hand. There may be solutions that you’ve never heard of, or haven’t considered before. Sometimes, people can be surprised to learn that what they thought they needed was actually not the right fit at all. There are plenty of solutions for many types of cosmetic conditions out there.
If you live in the Vancouver area and are looking for skin tightening with Thermage®, Ultherapy® or other technologies, we encourage you to book a consultation at our Surrey clinic. We’ll take a close look at your area of concern. We’ll also learn about you and your goals. From there, we can make our best suggestions on what we think will work on you.
To give you a full disclaimer we’ll let you know up front that we don’t currently offer Thermage® or Ultherapy®. Instead, we have plenty of suitable options that are just as good, if not better (in our opinion).