A well established and “incredibly successful part of our overall treatment strategy” for nearly two decades, Thermage has undergone an important new update with the release of Thermage FLX, says Michael Kaminer, MD. “We've used the FLX device as a way to both expand what Thermage can do and bring it potentially to a greater number of our patients so that more people will benefit from the results that we've seen with the previous generation.”
Thermage FLX is a non-invasive, radiofrequency (RF) system intended for tightening, with flexibility to treat a wide age range of patients and indications on the face, eyes, and body.
Courtesy of May Lupo, MD
Dr. Kaminer sees three primary reasons Thermage FLX eclipses earlier iterations of the Thermage device. “One is it's more comfortable for the patient because of the way the vibration has been enhanced. Two, it enhances comfort for the person who's doing the procedure, whether that's a physician or a nurse. The ergonomics of the system, the time to complete a treatment—they've all been improved,” Dr. Kaminer says.
Third, “which is probably where the rubber meets the road,” Dr. Kaminer says, “is the results we had already seen with Thermage are now improved—both better quality and faster in terms of time to onset.” Dr. Kaminer attributes the advancement to, “the way the technology's been improved, and the way that the radiofrequency energy is delivered. It's just a better system than the previous generations.”
Mary Lupo, MD agrees that FLX represents an improvement over older systems. “The new vibration decreases pain and the treatments go more quickly,” she observes. Dr. Lupo employs the FLX for a variety of approved uses, including face, neck, eyes, arms, and knees, where improvement in laxity and/or lines is desired.
A Focus on Eyes
“Thermage is the only device FDA approved for use inside the orbital rim and safe on all skin types,” Dr. Lupo points out. While the device can be used alone with favorable results, Dr. Lupo says that it also can be combined with other popular aesthetic treatments. “I like having options for patients,” she says.
For San Francisco's Vic Narurkar, MD, the eyes are the second most popular treatment area for Thermage. “I love using Thermage and Fraxel in combination,” he adds. “Thermage will improve eyelid laxity and then the Fraxel will be used for resurfacing the area around the eyes, especially that crepey skin.”
In most cases, Dr. Narurkar notes, the eyes are treated within a pan-facial rejuvenation approach. “We ultimately will do full-face Thermage and Fraxel combinations. And once the patient finishes that, then we look at volume loss and then use fillers,” he adds.
In the area around the eyes, where a patient's aesthetic concerns may be multi-faceted, combination approaches can provide the best results, Dr. Lupo agrees. In addition to Thermage FLX, “I do peels, toxin, Aquagold, Fraxel, and CO2 resurfacing,” she explains. “This way I can give the patient options and pick and choose to create best results for each patient/situation.”
In the periocular area and on other areas of the face, Thermage FLX treatment may confer benefits over injectables, Dr. Lupo says. These include a longer duration of effect and less maintenance. Plus, she points out, some patients are needle-phobic. Of course, she adds, a combination of Thermage and fillers can be ideal to create a home run. As she says, “The more I do, the better they look!”
“One of the things my patients like about Thermage is a natural brow lift that can be accomplished without a surgical forehead lift,” says New York City's Michele Green, MD. Using the facial handpiece to treat the forehead for about 20 minutes will produce a reduction is wrinkling and tightening that produces a natural lifting of the brow, she says. Of course some patients who are truly candidates for a surgical lift may see the best benefit with a more invasive procedure.
The Thermage forehead treatment can be paired with an injectable neuromodulator for even better results, Dr. Green adds, reminding injectors not to place neuromodulators too low, so as to avoid inducing eyebrow droop.
Worth a Look
Thermage FLX represents “An improvement on an already great system,” Dr. Lupo says. “It delivers better results in less time, with less discomfort.”
Dr. Narurkar echoes the assessment. “If you look at the literature and the long-term patient experience, it still is the go-to skin tightening device. So, the FLX just makes the gold standard even better by allowing faster treatments. It is also more accurate, having real time patient feedback.”
Dr. Green favors Thermage FLX for providing natural results. “What I like about the FLX is that obviously, like the traditional Thermage, you get natural results,” she says. “It's natural. It's over time. It's neocollagenesis—you're producing new collagen.”
For someone who does not have Thermage in practice, Dr. Kaminer says, “I think it's worthwhile to take another look at the technology, because the engineers at Thermage have really done a nice job of improving the way the radiofrequency energy is delivered. And I think people might be surprised at how much benefit Thermage can give to their patients, especially if they've looked at it five or 10 years ago. This is not your grandfather's Thermage.”
The technology is unique, he maintains. “If somebody doesn't have Thermage at their practice, it's not a waste of time to look at it again, and see whether it might be a good fit, because our patients are thrilled with it, and it's been a big, big part of our skin program's success.”
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