Notes from Dr. Seiler: Thermage Supported by Dr. Kaminer

Thermage supported by Dr. Kaminer from SkinCare Physicians in Chesnut Hill, Massachusetts

 

I watched a great webinar by a very well-known cosmetic physician who was actually the first one to ever use Thermage when it was in clinical trials in 1999.  It got its first FDA approval in 2002.  This webinar discussed why new Thermage CPT is so much better than the older versions of Thermage.  Thermage has been performed over 600,000 times by over 2,500 physicians and practitioners in over 100 countries.  The newest version of Thermage, which we have at Seiler Skin, has three new features that make the result and the comfort much better than before.  1.  It uses pulsed RF (radiofrequency) energy with pulsed cryogen cooling.  2.  It uses vibration.  3.  It has framed treatment tips.  I will try to simply explain how these three features make the procedure offer a better result with much less discomfort (as it is now very tolerable and I have not had a patient have more than mild discomfort, and not a single patient has said he or she would not do it again). 

First of all, because of the pulsed delivery of the energy and the cooling, there is a uniform heat distribution.  Therefore the entire pulse is tolerable.  Now, all my patients know that I am always very blunt and honest and so I will say that there is some discomfort.  Remember I always say that, “if it doesn’t hurt some, it probably doesn’t work”?  But even I've had it done and it's really not that bad.  In addition, because of it's technology, it is actually able to confuse the nerves into not sensing as much heat.  The heat is more consistent and predictable, therefore not shocking to the patient.  Finally, the vibration also masks the heat by what is called the “gate theory” which basically means that the vibration stimulates other nerves so there is less sensitivity in the “pain sensing” nerves.  All of these features lead to a very tolerable procedure.  And because it is more tolerable with more heat being able to be delivered, the result is also much better. 

Dr. Kaminer recently did a study with paying patients in his practice, with the new Thermage CPT.  Twenty patients were treated with a mean age of 53 years old (38-71).  He was one of the patients.  The patients rated the discomfort from 0-4 (4 being “I want to kill you (the treating practitioner)”).  Only 6 rated it a 2 and the other 14 said it was a 1 out of 4.  So, everyone tolerated it well.  ALL PATIENTS SAID THEY WOULD DO IT AGAIN, that the maximum pain they felt would not keep them from doing it again. 

I also found out that his treatment heat settings are very mild to moderate, and he gets great results.  I have always told my patients that, to receive the best result, it should be “hot but tolerable.”   Patients always ask, when I sometimes have to turn it down a little, if it is still going to work.  I always say yes, but I was really happy to see that he actually treats patients with a little less energy/heat that I get my patients to tolerate!  Take home message is that you will be able to tolerate plenty of heat to get a great result. 

Some of the listeners of the webinar were able to ask questions, so I will touch on a couple of extra interesting points. 

He commented:  Pain and dermal skin temperature are correlated.  If you feel even mild discomfort, you are getting therapeutic heat, the target temp!  “Settings mean nothing.”  Temperature is what’s important.  Mild to moderate pain equals therapeutic temp.  So don’t worry about the settings being too low.  If it causes some discomfort, then it works!

Thermage is great for prevention.   He has two patients who have done it every two years for ten years and they have great looking skin.  He comments that they are even two people who didn’t need major skin tightening to begin with.  So even younger people and/or those with just the beginning of aged/lax skin will benefit from Thermage.     Both think their skin is tighter and as soon as they felt a little lax they do it again.  So. . . do it early as soon as you see laxity!!!!   THERMAGE SIGNIFICANTLY SLOWS THE AGING PROCESS.  Start mid- to late-30s and beyond. 

Someone asked him what was the single most compelling characteristic that makes him confident in the procedure.  He has seen it work in many patients for a long time!  As the technology has improved, Thermage has been able to marry results with comfort.  No device gives facelift results. So patients have to be reasonable.  His patients do see results and are happy.  He has greater than 98% happiness in his patients. 

It was also discussed that Thermage is a great procedure to combine with other treatments, especially skincare, Botox, dermal fillers, and laser skin tightening.  This supports my philosophy of maintenance treatments and utilizing multiple modalities to treat the patient and not just depending on one “miracle, catch-all” treatment.  He, like me, will typically perform a laser procedure (like Fraxel or CO2) the day after Thermage if the patient is going to do both. 

It was also commented that sometimes younger patients with healthier skin will benefit more from Thermage.  This supports my entire practice’s philosophy of helping the patient achieve better skin (remember I always say “don’t just ask me for Botox, and not do other things like SkinMedica to insure the result”).  And healthy skin, in turn, will allow for a better result from procedures like Thermage because the skin is better able to do what the procedure is stimulating it to do. . . build collagen, and look better!  Healthier equals better looking!

Treatment spacing:  don’t do before 6 months.  If you do it too early, you shut off the wound healing process and new collagen production.  WAIT FOR IT!  It isn’t additive then, its just replacement of the first.  In his practice, some of his patients usually do it once per two years.  But his biggest population of patients do it every 4-5 years!

Finally, as to recovery, he says “there is no recovery.  There just isn’t.”  He had it done and immediately after, he attended a very important business dinner.  He started to see results by the end of the first month after the procedure.  The only after effect he has ever seen is in someone who is a “flusher”, they may have pink skin for up to an hour.  But “that’s rare.”

So, all of the above info should make you very confident in Thermage CPT, if its performed on the right patient by the right practitioner!