How can Thermage Treatment be Made Comfortable and Painless?

Introduction

Thermage, scientifically known as “capacitive monopolar radiofrequency,” is a globally recognized first-line treatment for non-invasive skin tightening, often referred to as the “gold standard” for non-invasive skin tightening. Since its invention in 2002, Thermage has undergone several technological upgrades.

To be honest, the first-generation Thermage treatment was truly excruciatingly painful, practically a case of “paying money to suffer.” However, the 4th and 5th generation Thermage adopted Comfort Pulse Technology and employed a low-to-medium energy, multi-pass treatment method, significantly reducing pain.

However, even so, for those with low pain tolerance, the pain can still be unbearable. Even for those with high pain tolerance, it’s not entirely painless. The goal is to minimize pain without compromising effectiveness, allowing those who are deterred by pain to benefit from Thermage’s anti-aging benefits.

So, can Thermage truly achieve “comfort and painlessness”?

In fact, based on the working principle of Thermage, it is entirely possible to do so, and it is not difficult at all.

Thermage Painless Treatment Theory

Several prerequisites for Thermage to achieve “comfort and painlessness”:

1. Low energy per shot

Thermage treatments deliver a sufficient number of treatment pulses, more than enough for most patients. This means that very high energy levels (e.g., above 5) are not required to achieve good results. Therefore, each pulse has relatively low energy and is not very painful.

2. The Unique Mechanism of Thermage

Most radiofrequency (RF) cosmetic devices heat polar water molecules in the skin using an electric current. These water molecules rotate at high speed under an alternating electric field, rubbing against each other to generate heat, thus heating the dermis and fat layers and accelerating fat metabolism.

Thermage, however, uses a volumetric heating unipolar circuit radiofrequency. Thermage’s mechanism of action is not based on water molecule friction generating heat, but rather on the resistance heat generated by the current passing through the tissue.

Therefore, we can effectively utilize the impedance and conductivity of different tissues to improve therapeutic effects and reduce pain (important).

3. Pain Originates from High Temperature

Thermage treatments typically work by heating tissue, with a temperature of 60℃-70℃ being a basic requirement for effectiveness. However, it is precisely this high temperature that causes the unbearable pain.

Although the high-tech treatment head of Thermage sprays cool air onto the skin during the treatment, as heat accumulates, the skin temperature rises further, and the cooling effect of the air spray becomes increasingly ineffective.

Therefore, to reduce pain, it’s necessary to find ways to cool the skin. Some might think: wouldn’t cooling the skin to a pain-free temperature reduce the effectiveness? Read on to find the answer!

4. Lowering Surface Skin Temperature

We know that the main nerve trunks are in the dermis, but the nerve endings that sense pain are in the epidermis. If we can lower the temperature of the epidermis without lowering the temperature of the dermis and subcutaneous fat layer, we can alleviate pain while enhancing the therapeutic effect!

Therefore, a low temperature in the epidermis, but a high temperature in the dermis and subcutaneous fat layer, is a combination of both comfort and effectiveness.

Comfortable and Painless Thermage Methods

1. Impedance and Conductivity of Different Tissues

Please note that radio frequency (RF) is an electromagnetic wave, which is essentially electric current. We know that different tissues have different conductivities.

Impedance is generally inversely proportional to conductivity.

Impedance values: Bone > Fat > Skin (fibrous septa) > Tendon > Muscle > Blood Vessel > Nerve

As the table shows, blood has the highest conductivity (although this is not directly related to the technology used in Thermage). Moist skin and fibrous septa are next, while bone, fat, and dry skin all have very low conductivity.

In other words, dry skin has high impedance, making it more prone to generating high temperatures and causing pain.

2. The Significance of Conductivity

Many people don’t accurately understand the difference between conductivity and impedance. In reality, tissues with high conductivity allow more current to flow through them. The more current flows, the more energy accumulates, and the higher the temperature generated.

The human body can be described as a parallel circuit. Current will bypass tissues with high impedance. That is, there isn’t just one circuit; when current encounters high-impedance tissue, it will bypass it and choose to flow through tissues with low impedance and high conductivity.

3. Increase Epidermal Moisture Content

This is the most important point. When the epidermis is dry, its conductivity is low and its impedance is high. This high impedance can generate high temperatures, leading to significant pain.

Furthermore, a dry epidermis is also prone to burns due to high temperatures. Based on the different conductivity and impedance values ​​of dry and moist skin,

we can increase the conductivity and decrease the impedance of the epidermis by replenishing its moisture. Increased conductivity allows current to be more easily guided to the deeper dermis and fat fibrous septa.

So, will increased epidermal conductivity lead to excessive energy accumulation and burns due to more current flowing through the epidermis?

No, this is not the case. The main reason is that the epidermis is much thinner than the dermis and fat layer. Therefore, there is not much energy accumulation. In addition, the cooling air from the Thermage treatment head further reduces the risk of epidermal burns.

4. How to Hydrate the Epidermis?

An early 1975 English paper titled “Skin Impedance and Moisturization” stated that “increased relative humidity leads to increased water content in the stratum corneum, resulting in decreased impedance. Dry skin, without moisturization, will experience increased impedance due to decreased relative humidity. Barrier moisturizers can correct dryness, thereby reducing stratum corneum impedance.”

From this early paper, we can learn that topical moisturizers with water-locking properties can increase epidermal water content, thereby reducing impedance and increasing conductivity.

Therefore, applying a highly moisturizing occlusive moisturizer (preferably) for 2-4 weeks before a Thermage treatment can increase skin hydration.

However, I recommend a simpler and more direct method to quickly increase epidermal hydration.

We often use face masks to hydrate in our daily skincare routine, although I don’t recommend frequent use.

However, applying a face mask before a Thermage treatment to quickly increase skin hydration is a good method. Studies have found that 5-10 minutes of hydration can cause a dramatic change in skin impedance.

Therefore, applying a face mask for 10 minutes before a Thermage treatment can quickly increase skin hydration, improve conductivity, and reduce epidermal impedance (important).

This method is called the “impedance reduction method” by Thermage manufacturers!

However, the high temperature generated during the Thermage treatment causes the epidermis to lose moisture.

To maintain high hydration levels in the epidermis, the doctor must continuously apply a large amount of water-based coupling agent during the procedure.

The coupling agent is mainly composed of gel and water. The gel has excellent moisturizing and thermal conductivity properties, allowing heat to be better dissipated into the air and absorbing moisture from the epidermis. Frequent and generous application of the coupling agent during the procedure is an important way to maintain epidermal hydration.

I personally recommend that this be an important step in the standardized procedure.

Remember! Don’t wait until the coupling agent is significantly reduced before reapplying; apply it frequently! !

The above is the most important method: by increasing the water content of the epidermis, the resistance of the epidermis is reduced, allowing more current to be directed to the deep dermis and subcutaneous layer.

5. Hydration alone is not enough.

The cheekbone area, a key target for Thermage treatments, has a thinner fat layer than other areas.

Therefore, repeated treatments on the cheekbone, even with high epidermal moisture content, will lead to increased current accumulation in the epidermis due to reduced downward current penetration, resulting in significant pain. Therefore, when treating the cheekbone area, we can lift and accumulate the underlying skin tissue above the cheekbone to thicken the tissue layer before proceeding. This significantly reduces pain in the cheekbone area.

Lifting techniques also help reposition tissue, achieving the goal of lifting sagging fat tissue.

In addition, because Thermage treatments take a relatively long time, the skin gradually accumulates heat to reach a high temperature in order to achieve its effects.

High temperatures evaporate surface moisture. While the coupling agent has some moisturizing effect, it obviously cannot achieve the rapid hydration of a face mask. We are unlikely to stop during treatment to apply another face mask due to the patient’s pain. Therefore, I’m sharing a method that I’ve personally tested and found effective.

When experiencing unbearable pain due to high skin temperature during treatment, a handheld mini fan can be used to blow air onto the facial skin for 30-60 seconds to cool the skin surface. Because the fan’s power is low and the blowing time is short, it’s unlikely to affect the temperature of the deeper dermis. However, by lowering the skin surface temperature, it reduces the patient’s pain.

During Thermage treatments, informing clients to report significant pain to the doctor promptly allows for repeated cooling with a fan; this method has proven consistently effective.

Through these methods, a comfortable and painless treatment can be achieved without significantly reducing energy levels.

Comfortable and Painless Monopolar RF Machine

Monopolar radiofrequency (RF) is a highly effective anti-aging and skin-tightening device with remarkable results.

However, in today’s market, customers not only seek treatment results but also place great importance on treatment comfort.

If you need a monopolar RF anti-aging device that offers both excellent treatment results and exceptional comfort, you might consider Liton Laser’s 6.78MHz monopolar RF machine.

We not only provide high-quality machines, but also prepare clinical treatment guidelines to ensure accurate treatment outcomes.

Frequently Asked Questions

Q1: What is the Thermage treatment process?

• After determining the treatment area, the face is cleansed, and a temporary grid is applied using 75% alcohol. Ensure all metal objects have been removed.
• Electrode pads are attached to the patient’s back, coupling gel is applied to the treatment area, and the appropriate treatment probe is selected. Treatment is then performed area by area according to the marked grid lines.
• The entire process takes approximately one hour.

Q2: Is Thermage treatment painful?

Early Thermage treatments required the application of topical numbing cream. During the treatment, you might feel warmth or slight pain, which most people can tolerate.

Currently, Thermage treatments have not only improved in effectiveness but also in comfort, allowing for treatment without numbing cream.

Furthermore, using Liton Laser’s methods of increasing skin hydration and using a fan for physical cooling can further enhance the comfort of Thermage treatments and reduce pain.

Q3: How long does the effect of a single Thermage treatment last?

It is generally believed to last 1-2 years. With proper maintenance and a healthy lifestyle, the effect can last even longer.

Q4: What should I pay attention to after Thermage treatment?

• Mild redness may occur after treatment; apply ice for 30 minutes.
• Do not wash your face with hot water (water should not exceed body temperature) for one week after treatment. Do not use acid-based creams or skincare products (such as glycolic acid or salicylic acid). Focus on moisturizing.
• It is recommended not to use face masks more than twice a week. Use a moisturizing lotion and cream before bed.
• Avoid spicy and irritating foods for one month. Try to avoid smoking and staying up late.
• Avoid high-temperature environments such as saunas and yoga for one month. Protect yourself from the sun.

Q5: How long after a Thermage treatment can I resume normal skincare and makeup?

After a Thermage treatment, if there are no signs of redness, blisters, or other discomfort on the skin, you can begin basic skincare such as moisturizing. Avoid rubbing or patting your face vigorously. If you experience no discomfort, you can apply makeup 2-3 days after the treatment.

Q6: When is the best time to see the results of Thermage?

For most people, the effects are visible immediately after treatment, but the results are more pronounced 2-6 months later. Depending on the patient’s skin condition, age, lifestyle, and aging process, the skin-tightening effect can generally last for 1-2 years.

Conclusion

1. By adjusting the conductivity and impedance of the epidermis, allowing more Thermage current to be delivered into the deep dermis and fat fibrous septa, pain can be significantly reduced, and the therapeutic effect can be improved.

2. Studies have shown that dry skin has low conductivity and high impedance, while moist skin has high conductivity and low impedance.

Since pain is mainly perceived by nerve endings in the epidermis, we can try to increase the water content of the epidermis, thereby increasing its conductivity and decreasing its impedance, thus preventing the radiofrequency current from accumulating and generating heat in the epidermis.

3. Methods to increase the water content of the epidermis include:

• Applying a highly moisturizing occlusive agent with good water-locking properties one month in advance, with Vaseline being the first choice.
• Applying a facial mask for 5-10 minutes immediately before the procedure to quickly increase the water content of the epidermis.
• Repeatedly applying a large amount of water-containing coupling agent during the procedure.

4. The fat layer covering most bony areas is thinner than that covering other areas.

At this point, repeated manipulation, even with high epidermal moisture content, will lead to increased current accumulation in the epidermis due to reduced downward current penetration, resulting in significant pain. Therefore, when manipulating the cheekbone area, we can lift and accumulate the underlying skin tissue above the cheekbone to thicken the tissue layer before proceeding with the manipulation. This can greatly reduce pain in the cheekbone area.

5. Additional Tips.

If unbearable pain occurs during treatment due to high skin temperature, a handheld fan can be used to blow air onto the facial skin for 30-60 seconds to cool the skin surface.