Thermage Basics: Questions and Answers
Plain answers to the questions people ask before their first Thermage FLX session: what the device does, which layer of the face it reaches, what the treatment day is like, and who it is likely to help. Thermage works mainly on the skin itself, so the first question is always whether the skin is really the layer that has changed.
What Thermage Is
What is Thermage?
Thermage is a non-surgical skin-tightening treatment that uses monopolar radiofrequency energy to heat the deeper part of the skin. The current generation is called Thermage FLX and is made by Solta Medical. The heat makes existing collagen contract and starts a healing response that builds new collagen over the following months. The aim is firmer, smoother skin with fine lines softened, not a surgical lift or a change in face shape.
How does Thermage actually work?
A disposable tip with a thin membrane is placed on the skin, and a return pad is attached elsewhere on the body, so that current flows through the tissue between them. The tissue's natural resistance to that current turns it into heat. The heat spreads through a broad zone of the dermis and the fibrous strands just below it, while a cooling spray protects the surface. The body's repair response to that controlled heat is what firms the skin over time.
What does monopolar radiofrequency mean?
Monopolar means there is one active electrode, the treatment tip, and the current returns through a separate pad placed away from the face. Bipolar devices instead pass current between two electrodes close together on the skin, which keeps the heat shallower and more local. The monopolar design lets Thermage heat a larger volume of tissue at a greater depth than many bipolar devices. It is the main technical feature that separates it from many other radiofrequency treatments.
Which layer of the face does Thermage treat?
Thermage works mainly on the skin layer: the dermis and the fibrous septae, the connective tissue strands that anchor skin to the layers below. It does not reach the SMAS, the supporting layer that a surgical facelift repositions, in the way Ulthera's deepest depth does. Dr. Kim plans lifting by looking at every layer first, and Thermage is the tool he matches to changes in the skin itself, such as fine lines and loss of firmness. Deeper changes call for different treatments.
Is Thermage a lifting treatment or a tightening treatment?
It is best described as skin tightening. The heat firms and smooths the skin and can make the jawline and cheeks look a little crisper, but it does not reposition tissue that has slid down. People often call every device treatment a lift, which blurs an important difference. When the main problem is descended tissue rather than loose skin, a deeper treatment such as Ulthera or, for marked sagging, surgery is the more relevant option.
Is Thermage the same as Ulthera?
No. Thermage uses radiofrequency to warm a broad, even zone of the skin, and it has no imaging. Ulthera uses focused ultrasound to create small separate heated points at fixed depths, down to the SMAS, and shows the tissue on screen during treatment. In his answers to patients, Dr. Kim explains that for fine wrinkles and skin elasticity, radiofrequency devices such as Thermage are better suited to building collagen in the dermis than focused ultrasound, which works deeper.
Does Thermage make new collagen?
Indirectly. Dr. Kim writes that energy devices do not make collagen themselves; they trigger the body's natural healing response, carried out by cells called fibroblasts, which then build new collagen. That is why results develop over months rather than appearing fully on the day. It also means the response depends partly on the skin's own capacity to repair, which tends to decline with age, sun damage and smoking.
What is the difference between Thermage FLX and older Thermage?
Thermage FLX is the current generation of the device. Compared with earlier versions, it uses larger treatment tips that cover more skin per pulse, a system that adjusts energy delivery pulse by pulse, and vibration to make the heat more tolerable. The basic principle, monopolar radiofrequency with surface cooling, is the same. If you had Thermage many years ago, your experience of the session may feel different now, but the goal and the way results develop are similar.
Is Thermage FDA-cleared?
Yes. In the United States, Thermage is cleared for non-invasive treatment of wrinkles, including those around the eyes and on the upper and lower eyelids, and for temporary improvement in the appearance of cellulite. Clearance covers the device for those uses; it does not promise a particular result for any one person. How much it helps you depends on your skin, your age, which areas are treated and how the treatment is planned.
Why do so many people in Korea get Thermage?
Thermage is one of the most widely known radiofrequency treatments in Korea, partly because it suits people who want gradual firming with little downtime and who prefer to avoid surgery. Radiofrequency is not absorbed by skin pigment the way many lasers are, which matters for people with darker or easily pigmented skin. Popularity, though, says nothing about whether it fits your face. The useful question is whether your main change is in the skin layer that Thermage reaches.
The Treatment Day
What happens during a Thermage session?
The skin is cleansed, a temporary grid is marked to guide even coverage, and numbing cream is usually applied. A return pad is placed on the body, and the tip is then moved square by square across the area. Each pulse gives a brief deep heat followed by a cooling spray. Several passes are made over the face, sometimes with extra passes where firming is most needed. Afterwards the grid is wiped off and the skin is usually just pink.
How long does a Thermage treatment take?
A face treatment typically takes about an hour, sometimes more, depending on the areas, the number of pulses and the tips used. Numbing cream adds time before the treatment starts. Adding the eye area, the neck or a booster such as Re2O makes the visit longer. If you are planning a visit around other appointments, ask the clinic for an estimate once your plan is decided.
Does Thermage hurt?
Most people feel a brief, deep heat with each pulse that lasts about a second, followed by a cool sensation from the spray. Bony areas such as the jawline and temples, and thinner skin, can feel stronger. The device adds vibration to dull the sensation, and numbing cream is usually used. The energy is adjusted from your feedback during treatment, so telling the practitioner what you feel is part of doing it safely.
What kind of anesthesia is used for Thermage?
Numbing cream applied before treatment is the usual approach for Thermage. Because energy is set partly from your feedback on the heat, many practitioners prefer you to stay awake enough to report what you feel. If you are anxious about discomfort, or Thermage is being combined with other treatments in one visit, other options can be discussed at consultation, taking your health and the overall plan into account.
Why is a grid drawn on my face before Thermage?
The grid marks squares roughly the size of the treatment tip, so the practitioner can place pulses evenly and track how many passes each area has received. Thermage has no imaging, so this guide helps avoid gaps and avoid stacking too much energy in one spot. The ink is temporary and is wiped off at the end. It is a simple step, but even coverage is a large part of getting a smooth, uniform result.
What is the return pad for during Thermage?
Monopolar radiofrequency needs a path for the current to complete its circuit. The return pad, a sticky pad usually placed on the back or abdomen, provides that path. You will not feel heat at the pad because the current spreads over its large surface. It is one reason clinics ask about implanted electronic devices such as pacemakers, since current passes through the body between the tip and the pad.
Do I need to remove jewelry and metal before Thermage?
Yes, jewelry, hair clips and other removable metal are taken off before treatment. Tell the clinic about anything that cannot be removed, such as metal plates, screws, dental implants or metal threads placed in the face, as well as implanted electronic devices. Some of these change which areas are treated, and an implanted electronic device usually rules out monopolar radiofrequency. Dental fillings and crowns are worth mentioning too, so the practitioner can plan around them.
Can I go back to work after Thermage?
Most people can. The skin is usually pink and warm for a few hours, and mild swelling can last a day or so, more visibly around the eyes. Many people return to work the same day or the next morning. If an important event is coming up, a gap of a few days is sensible, especially when the eye area is included or the session is combined with injections that can leave small bumps.
Can I wear makeup after Thermage?
Makeup can generally be used from the next day unless you are advised otherwise. Using it the same evening is usually avoided, because the skin is warm and slightly sensitive and you want to keep products and brushes away from freshly treated skin. If Thermage is combined with skin booster injections, the injection points need longer before makeup goes on. Gentle cleansing and moisturizer are fine on the day.
Can I exercise after Thermage?
Light activity is usually fine the same day. Many clinicians suggest avoiding intense exercise, saunas, hot baths and alcohol for a short period, often a day or two, because extra heat and blood flow can increase redness and swelling. The exact advice depends on the areas treated and whether injections were also given. If you are unsure, follow what the clinic tells you for your specific plan.
Pulses, Tips and Areas
What does Thermage 300, 600 or 900 shots mean?
These numbers refer to the number of pulses delivered, since Thermage tips are supplied with a set number of pulses. In Korea a face session is often described by figures such as 300, 600 or 900. The total alone says little: what matters is which areas received how many passes and at what energy. A higher number spread thinly over a large area may do less for a particular concern than a smaller number placed where it is needed.
How many Thermage pulses do I need for my face?
There is no single correct number. It depends on the size of the face, which areas are included, how thin or loose the skin is, and whether the neck or eyes are added, so the number is best set after the face is assessed. In his answers to patients, Dr. Kim has suggested that if the effect feels short or not enough, the number of shots can be increased next time. Ask how your pulses will be distributed, not only the total.
What Thermage tips are there?
Thermage FLX uses different single-use tips for different areas. The Total Tip 4.0 cm² is a larger tip for the face, jawline and neck. The Total Tip 3.0 cm² is smaller, for curved or smaller areas. The Eye Tip 0.25 cm² gives shallower heating for the eyelids and the skin around the eyes. A larger Body Tip is used on areas such as the abdomen. The choice of tip follows the area and the thickness of the skin.
Why is the Thermage tip used only once?
Each tip is a sealed, single-use component with a membrane that contacts the skin and a set pulse allowance. Using it once supports hygiene and consistent energy delivery, since the system reads the tip and tracks pulses as they are used. It also means the number of pulses in your treatment is tied to the tip opened for you. It is reasonable to ask the clinic about the tip being used before treatment begins.
Which areas can Thermage treat?
On the face, Thermage is used on the cheeks, the jawline, the area under the chin, the forehead and around the eyes, including the upper and lower eyelids with the Eye Tip. It is also used on the neck. On the body, it is used on areas such as the abdomen, arms, thighs and buttocks for skin laxity and the appearance of cellulite. The plan depends on which of these areas has loose or thinning skin.
Can Thermage be used on the neck?
Yes. The neck is a common area, often treated together with the lower face because loose neck skin and a softening jawline tend to appear together. Thermage can firm crepey neck skin and soften fine horizontal lines to a degree. It does not remove a hanging band of skin or reposition a loose neck muscle; those need surgery when marked. Fat under the chin is also a separate issue that radiofrequency on the skin does not remove.
Can Thermage be used on the forehead?
Yes, the forehead can be treated to firm the skin and soften fine lines at rest. Deep lines caused by repeated muscle movement respond more to muscle-relaxing injections, and a brow that has dropped is a deeper problem that skin tightening will not lift meaningfully. Dr. Kim has written about how the forehead, brow and eyelids relate to one another, and the plan for this area starts from which of those has changed.
Can Thermage be used on the body?
Yes. Thermage has a dedicated Body Tip for larger areas, and it is used for loose skin on areas such as the abdomen, arms, thighs and buttocks. In the United States it is cleared for temporary improvement in the appearance of cellulite. It does not remove fat or replace surgery when there is a large amount of loose skin. Body treatment is planned separately from the face, with its own pulse count.
Does Thermage treat the whole face evenly or target specific areas?
Both. A typical session includes several even passes over the whole treatment area, so the skin is firmed uniformly without patches. Extra passes may then be placed along areas of concern, such as the jawline or the lower cheeks, when appropriate. The balance between overall coverage and targeted passes is part of the plan, and it is one reason two sessions with the same pulse count can differ.
Can Thermage slim the face?
Thermage is not a fat-reduction treatment, so it does not make a full face noticeably smaller. Firmer skin along the jawline can make the contour look a little crisper, which some people describe as a slimmer look. When the fullness comes from fat, from the chewing muscle or from the salivary glands, other approaches fit better. Dr. Kim's planning starts by finding which of these is responsible, because the treatment differs for each.
Who Thermage Suits
Who is a good candidate for Thermage?
Thermage tends to suit people whose main change is in the skin itself: mild looseness, fine lines, crepey texture or skin that feels less firm than it used to. It suits people who want gradual improvement with little downtime. It suits less well those with heavy jowls, marked sagging, a lot of excess skin or a strong expectation of a dramatic change. An examination of all the layers, not only the skin, is how suitability is decided.
What is the best age for Thermage?
There is no fixed age. Many people consider it from their thirties onward, when the first loss of firmness and fine lines appear, and it is also used in the forties, fifties and beyond. Younger skin generally has a stronger repair response. Older skin can still benefit, but when tissue has descended a long way, skin tightening alone often gives a small visible change. The condition of the skin matters more than the number of years.
Is Thermage worth it in my 20s?
Usually it is not needed in the twenties, because most people that age have firm skin and little to tighten. Some people consider it as early maintenance, but there is little evidence that starting very young prevents later aging in a meaningful way. Sun protection, not smoking and good skin care do more at that stage. If a specific concern exists, it is worth finding out which layer it comes from before choosing any device.
Is Thermage good for people in their 50s and 60s?
It can help with skin quality and firmness in the fifties and sixties, but expectations need to match the layers involved. At these ages, change in the deeper support layer, fat and bone often contributes more to the overall look than the skin alone. Dr. Kim also writes that repeated energy treatments can seem to work less well when the skin's capacity to regenerate has declined. When sagging is marked, surgery may be the more effective route, and he will say so.
Is Thermage suitable for men?
Yes. Men's skin is generally thicker, and the beard area has more hair follicles, but Thermage can be used on male faces and necks. The pattern of concerns differs: men often focus on the jawline and neck. As with anyone, the treatment helps most when the change is in the skin layer, and less when heavier tissue or fat along the jaw is the main issue. Energy and coverage are adjusted to the skin's thickness and feedback.
Does Thermage work on thin skin?
Thin, crepey skin is one of the situations where radiofrequency is often considered, because the aim is to firm and thicken the dermis over time. Thin skin also needs careful energy settings, since there is less tissue to absorb the heat. If the skin is very thin and the underlying volume is also low, firming the skin alone may not change the overall look much, and volume or skin-quality support may be planned alongside.
Does Thermage work on thick or heavy skin?
Thick, heavy skin can be treated, but the visible change from skin tightening tends to be smaller when the face carries more weight, either from fat or from heavy soft tissue. In those faces, the main issue is often the fat layer or the deeper support, not the skin itself. Ulthera, which can place energy in the fat and SMAS layers, or other approaches may be more relevant. The plan depends on what the examination shows.
Is Thermage safe for darker or Asian skin tones?
Radiofrequency is not targeted at skin pigment the way many lasers are, so Thermage is generally considered suitable across skin tones, including Asian skin that tends to darken after injury. Pigment changes can still occur, mainly when a burn or blister happens, which is rare. Telling the clinic if you have a history of dark marks after skin treatments helps the practitioner plan energy and aftercare.
Can I have Thermage if I have a pacemaker?
Generally no. Monopolar radiofrequency sends current through the body between the tip and the return pad, which can interfere with a pacemaker, implanted defibrillator or other implanted electronic device. These are standard reasons not to use Thermage. Tell the clinic about any implanted device, including those you may not think of as relevant, so that a safer alternative can be suggested.
Who should not have Thermage?
Thermage is generally not used in people with a pacemaker or other implanted electronic device, during pregnancy, or over skin with an active infection, open wound or flare of a skin condition. Metal implants in the treatment area, recent surgery there, bleeding disorders and certain medicines are discussed case by case. People whose main problem is marked sagging or excess skin may be poorly served by it. Your full medical history decides the plan.
Preparing and Planning
How do I prepare for a Thermage appointment?
Arrive with clean skin, without makeup if possible, and remove contact lenses if the eye area is being treated. Tell the clinic about medicines, supplements, previous procedures and implants, including fillers and threads. Avoid sunburn in the weeks before, and pause strong exfoliating products for a few days if advised. Eating normally and staying hydrated beforehand is sensible. The clinic will tell you if anything specific applies to your plan.
Should I stop retinol before Thermage?
Many clinicians suggest pausing retinol, retinoids and strong exfoliating acids for a few days before and after treatment, because they make the skin surface more sensitive to heat and irritation. The exact timing varies with the product and your skin. If you take oral isotretinoin for acne, tell the clinic, as some practitioners prefer to wait after stopping it. Follow the specific advice you are given for your skin.
Can I get Thermage if I have a tan or recent sunburn?
A recent sunburn is a reason to wait, because the irritated skin is more sensitive to heat and more likely to react. A light, settled tan is less of a concern with radiofrequency than with many lasers, since the energy is not absorbed by pigment. Protecting your skin from strong sun before and after treatment is still sensible, especially if your skin tends to darken after irritation.
How much downtime should I plan for Thermage?
Very little for most people. Redness and warmth usually settle within hours, and mild swelling can last a day or two, more noticeably around the eyes. Temporary small marks or a faint grid pattern occasionally appear and fade within days. If you have an event or photographs coming up, plan treatment at least several days before, and longer if injections such as boosters are combined in the same visit.
Can I have Thermage during a short visit to Seoul?
Yes, the low downtime makes it one of the easier treatments to fit into a short visit. A consultation and treatment can often happen close together, but allow time for numbing, the session itself and a day or two of mild swelling, especially around the eyes. Remember that results build over months, so you will not see the final effect before you leave. Practical details for visiting are on the clinic page.
Can I fly after Thermage?
Flying after Thermage is generally fine, as the treatment does not involve incisions or anesthesia that would make flying unsafe. Cabin air is dry, so moisturize the treated skin, and remember that any swelling around the eyes may be a little more noticeable after a long flight. If injections were combined in the same visit, follow the clinic's advice on the timing of travel and on what to watch for afterward.
How is it decided whether I need Thermage, Ulthera or something else?
By examining which layer of the face has changed. Dr. Kim writes that lifting should start by looking at every layer to find the cause: skin, fat under the skin, the supporting muscle layer, deep fat and bone. Thermage suits changes in the skin; Ulthera reaches the deeper support and the fat; Sculptra restores volume; and marked descent may call for surgery. Many faces need more than one, which is why the examination comes first. See Fine lines or sagging: how do you tell which layer needs treatment?
Can Thermage and Ulthera be done together?
Yes, and they are often planned together because each treats a different layer: Thermage the skin, Ulthera the deeper support and fat. In his answers to patients, Dr. Kim has described around 300 shots of Ulthera together with around 300 shots of Thermage as a light way of keeping things maintained, with more shots if the effect feels short. The right amounts and order depend on your face and are decided after examination, not from a package.
Can Thermage be combined with a skin booster?
Yes. Thermage firms the skin, while a skin booster aims at skin quality such as texture, hydration and thickness. Dr. Kim combines Thermage with Elravie Re2O for people whose concern is both looser skin and thin, tired-looking skin. When both are done on the same day, the device treatment usually comes first and the injections afterward. The details are on the Re2O questions page.
What should I ask before booking Thermage?
Useful questions include: which layer of my face is the main problem, and is Thermage the right tool for it? Which areas will be treated, with which tips, and how will the pulses be distributed? What change is realistic for my skin, and when will I see it? What are the risks for me, and what happens if I react? Who performs the treatment? Clear answers to these tell you more than the total pulse count.
Can Thermage replace a facelift?
No. Thermage can improve skin firmness and soften fine lines, but it cannot reposition tissue that has descended or remove excess skin. When sagging is marked, a facelift or mini facelift moves the deeper layers and removes skin in a way no device can. As a surgeon trained in facial surgery, Dr. Kim can tell when another device session is unlikely to help and will say so, even though he does not perform surgery at Violacell.