Thermage FLX in Practice: What 52 Dermatologists Report

This is an English adaptation of a clinical article Dr. SangYoul Yun — board-certified dermatologist and Medical Director of Delight Dermatology in Gangnam, Seoul — originally published in Korean. Read the Korean original on Naver. It has been restructured and translated for international readers; all references are the author's own.

Thermage FLX is a device developed by Solta Medical that uses radiofrequency current to coagulate tissue, for the non-invasive treatment of wrinkles around the eyes and on the face. Below is a review of how experienced dermatologists actually use it, drawn from a published survey.

How Thermage works

Thermage cools the epidermis while generating heat in the dermal tissue, delivering radiofrequency energy that denatures and contracts collagen fibers — producing collagen regeneration and wrinkle improvement. Collagen that has lost elasticity and stretched is denatured and then regenerated by the RF heat. Thermage received FDA approval in 2002 and has been steadily improved since.

A survey of dermatologists using Thermage

According to a 2020 survey on monopolar radiofrequency treatment (represented by Thermage FLX), 52 dermatologists who had used Thermage consistently for more than a year were asked a 23-item questionnaire, with multiple answers allowed. The questions fell into three groups: (1) effect, (2) experience of side effects, and (3) recent treatment patterns.

Key findings:

• Best effect in the 40s–50s.
• The 4th-generation Thermage FLX, compared with the previous CPT version, was reported by many to be faster — reducing treatment time — and improved in effect.
• Beyond age, the most influential factor was skin thickness. Thin-to-medium skin gave the best effect, though thick skin also did well with the 4th-generation device.
• It was frequently reported to work well for pore treatment and acne.

Because the neck and eyelids are areas of thin skin, they are typically treated at lower settings — which is also why the eye area is treated as its own Eye Thermage protocol.

Side effects

The most common answer was that side effects occurred in fewer than 5% of cases — in practice, few side effects. The main ones are 1–2 days of facial edema or small blisters, which can be managed with appropriate early detection and treatment. Because these tend to arise from energy that is too strong, treating at excessively high energy is not advisable. As for fat loss (volume loss), the prevailing opinion was that it does not occur.

The bigger picture

As interest in anti-aging has grown, so has interest in monopolar RF procedures — Thermage, Oligio, Tenserma, and others. Among these, the FDA-approved Thermage device gives good results for skin texture, pores, fine wrinkles, and elasticity. These monopolar RF procedures can be received by most people — with some exceptions — and show good effect; here we have looked more specifically at the effect, side effects, and candidates.

For the biopsy-level view of what changes inside the skin after treatment, see our companion article, what really changes inside your skin after Thermage.

Reference

1. Suh DH, Hong ES, Kim HJ, Lee SJ, Kim HS. A survey on monopolar radiofrequency treatment: The latest update. Dermatologic Therapy. 2020.

Medical disclaimer. This article is general information and does not replace individual consultation. Whether Thermage suits you, and the appropriate settings and intervals, should be decided after an in-person consultation with a dermatologist. Treating at excessively high energy is not advisable and should be judged by an experienced physician.