Thermage Treatment Guide: Why It Sometimes Seems Ineffective (Mechanism, Effects, Longevity, Price, Side Effects, Differences from Ultherapy)
Thermage is a radiofrequency-based tightening device. Rather than directly lifting sagging areas like a traditional “lifting procedure,” it focuses on improving fine lines and pores, strengthening the skin, and preventing further sagging as an anti-aging treatment.
🔹 How Thermage Works
Thermage delivers heat to a wide area within the skin using RF(radiofrequency) energy.
The key is delivering heat deep into the dermis while keeping the epidermis cool.
If the epidermis overheats, the procedure becomes extremely painful and may cause burns.
Therefore, the target of the heat stimulus is strictly the dermis → improving elasticity and wrinkles.
🔹 Actual Effects of Thermage
(1) Immediate Effects
When the dermis heats up to about 60–65°C, collagen fibers contract and undergo instant structural changes, creating an immediate tightening effect.
(2) Long-Term Effects
To repair thermally damaged collagen, fibroblasts become activated and generate new collagen and elastin.
These changes progress slowly over about 3–6 months.
However, this type of tightening is not the same as treating sagging caused by subcutaneous fat or fascia, such as jowls, nasolabial folds, or double chin.
Therefore, lifting sagging contours requires a device like Ultherapy that targets deeper layers.
It’s important to clearly understand that Thermage does work—it simply has a different purpose.
It is an excellent anti-aging procedure for improving elasticity, wrinkles, and pores.
🔹 Why Some People Feel Thermage “Doesn’t Work”
(1) Misunderstanding About the Effect
If someone receives Thermage thinking it’s a “lifting” treatment, they may believe it didn’t work when their facial contour remains the same.
That’s why it’s important to choose a clinic where the doctor personally provides the consultation.
(2) Timing of Results
Thermage results develop very slowly over 6 months.
People who look in the mirror every day may not notice these gradual changes and misinterpret them as “no effect.”
Therefore, the most accurate way to assess results is with before-and-after images taken using a skin analysis device after enough time has passed.
As seen above, when evaluated with a skin analysis device, you can more clearly see improvements in fine lines, skin texture, and overall firmness.
This reflects enhanced skin elasticity.
🔹 How Long Thermage Lasts
Longevity varies by each person’s aging speed.
Once elasticity improves, results generally last at least one year.
However, since the treatment interval depends on age and personal aging rate, it’s more accurate to think of it as a “treatment cycle” rather than a permanence period.
Collagen production increases for six months after treatment → then maintains.
If you want to slow aging as much as possible, every 6 months is ideal.
Realistically, due to cost, once a year is typically recommended.
🔹 Thermage Pricing
Thermage is a premium RF device backed by numerous clinical studies.
For that reason, it is relatively expensive.
Thermage FLX 600 shots: 2.3 million KRW
(VAT not included, based on Gangnam ODE Clinic).
If the price feels burdensome, the Korean RF device “Density,” which uses a very similar RF principle, is a great alternative.
(The results are almost similar.)
🔹 Thermage 300 / 600 / 900 Shots
Many people ask, “Do I really need 600 shots?”
In truth, even 900 shots can be recommended.
The reason is cost-effectiveness.
Though it may surprise some people, RF treatments require a certain amount of energy buildup before achieving therapeutic temperatures.
Part of the shot count is inevitably used as a preheating phase.
Based on an estimated 100-shot preheating:
300 shots → ~200 effective shots
600 shots → ~500 effective shots
900 shots → ~800 effective shots
So the effectiveness doesn’t simply double or triple—it's more like 2.5x or 4x.
Meanwhile, the price increase is smaller than the increase in effective output.
Therefore, for noticeable results, 600–900 shots are recommended.
🔹 Thermage Side Effects
(1) Burns
Thermage typically has few side effects, but mild blistering or light burns can occasionally occur.
Most are mild and heal without scarring when treated properly.
(2) Volume Loss (Sunken Cheeks)
Lifting procedures that affect the subcutaneous fat layer, like Ultherapy, have a higher risk of volume loss.
Many people worry about this.
However, Thermage only delivers energy to the dermis, so the risk of volume loss is extremely low.
Still, for those with very thin skin or significant concerns, it's important to avoid high-risk areas through careful pre-treatment mapping.
🔹 How to Choose a Thermage Clinic
Many people decide based on price alone, but reviewing the below factors helps ensure a safer, more effective treatment.
(1) Doctor-Provided Consultation
Avoid clinics where only a consultant speaks with you and the procedure happens immediately.
It’s safer when the performing doctor examines the skin, fat, and contour directly and recommends the proper treatment.
(2) Clinics With Multiple Lifting Devices
Clinics equipped with a variety of devices—Ultherapy, Xerf, Density, Emface, Onda, etc.—can recommend the best combination for each patient.
(3) Before-and-After Comparison
Having a skin analysis device
and consistent photo management for all patients is essential.
(4) Use of Authentic Tips
Always check whether the clinic issues a certificate for genuine tips.
Counterfeit tips reduce results and increase side-effect risks.
🔹 Frequently Asked Questions (FAQ)
Q. How painful is Thermage?
A. It feels like “tolerable discomfort.”
Some consider sedation, but Thermage isn’t painful enough to require it.
Sedation may actually cause too much facial movement, reducing procedural accuracy, so it’s not recommended.
Q. What’s the difference between Thermage and Density?
A. Density is a Korean-made RF device that uses the same frequency (6.78 MHz) and the same output (400W).
Results are nearly identical, with differences mainly in brand recognition and length of clinical use.
If possible, it’s best to try both Thermage and Density and judge for yourself which offers better value for the cost.
Q. When can I resume normal daily activities?
A. Other than mild redness for a day or two, there’s virtually no downtime and no disruption to daily life.
Author: Dr. Dohoon Kim, Chief Director of ODE Clinic
Specialty: Anti-aging (Lifting, Volumizing, etc.)