Thermage uses monopolar radiofrequency to achieve nonablative skin tightening. This system employs a patented monopolar capacitive radiofrequency technology called ThermaCool. The ThermaCool device has been approved by the Food and Drug Administration for the noninvasive treatment of rhytids.

This system relies on radiofrequency-derived heat, which promotes skin tightening via two proposed separate mechanisms: first, heat causes immediate collagen denaturation and fibril contraction; second, long-term benefits include progressive dermal remodeling and subsequent tightening from a wound-healing response lasting several months. Thus treatment attempts to provide renewed facial contours without the need for invasive surgery. It has been clinically proven to tighten and gently smooth out wrinkles and requires no downtime from normal activities.

PATIENT SELECTION

Like many cosmetic procedures, patient selection is important. The ideal patient for Thermage has the earliest signs of aging, with mild skin rhytids and substantial laxity but minimal lipodystrophy, and does not desire invasive procedures for rejuvenation. Nonablative skin tightening via radiofrequency is not intended to replace the more dramatic effects of invasive surgical lifts. Results tend to be subtle and are not as reliably produced as those obtained from surgery. The skin contraction reportedly achieved is in the order of 1–3 mm (Sadick 2006). If patient selection is appropriate, these subtle changes are perceptible to patients, particularly eyebrow position or softening of the nasolabial fold. Educating patients on realistic expectations is paramount to patient satisfaction. In the authors' experience, patients report receiving comments such as, “You look refreshed; what have you been doing differently?