Thermage FLX: A New Advancement for Tissue Tightening

The first thing, from a practical standpoint: it's a much faster device.” For New York City dermatologist Michele S. Green, MD, that's a key distinguishing feature of the new Thermage FLX. Thermage FLX is the latest generation of the popular Thermage radiofrequency (RF) device for tissue tightening.

“The old Thermage, which I obviously still have, would take at least an hour and a half. FLX completes the treatment in an hour,” Dr. Green continues. Patients appreciate the speed of treatment. “I tell them, ‘You need to be here for an hour or less,' and they love that.”

“There's a new four centimeter treatment tip that increases the surface area per tip by 25 percent. That means that the treatment time is reduced by about 25 percent,” explains San Francisco dermatologist Vic Narurkar, MD, a self-proclaimed Thermage devotee who says that faster treatments with Thermage FLX are a boon to patients and the practice.

Another key feature of Thermage FLX: “It's much more comfortable because of the new cryogen device,” Dr. Green notes. “Not that the other one hurt, because it really didn't, but this one's more comfortable than the other.”

Dr. Narurkar agrees that treatment with Thermage FLX is more comfortable than with earlier iterations of the system, especially when treating off the face. “Now the new body tip also has vibrations, so it increases the comfort even for the body, not just the face,” he notes.

For Chestnut Hill, MA dermatologist Michael Kaminer, MD, it's worth noting that the act of administering treatment using the Thermage FLX is more comfortable, as well. Ergonomics of the system have been improved, he says, leading to a better experience for the physician, nurse, or other operator.

What truly stands out with Thermage FLX, however, is the new AccuREP technology that is intended to optimize energy delivery for enhanced outcomes. “It automatically measures and tunes the amount of energy delivered to the patient in the treatment, so you know that you're getting the right amount each time,” Dr. Green explains.

With AccuREP, RF energy delivery is more precise, Dr. Narurkar says. Because each pulse receives automatic feedback, the device achieves more consistent results. “The results are better with FLX than even CPT [a previous Thermage update], so patients see more of that immediate tightening,” Dr. Narurkar says. Given the novelty of the device, it's not clear how long that tightening is sustained; patients reported long-lasting results with previous Thermage systems. Dr. Narurkar says one reason he's remained loyal to Thermage over other RF devices is that the device has always provided consistent results, which patients take note of.

Broad Application

Like its predecessor, Thermage FLX has broad application, making it a potential workhorse in the aesthetic practice. For Dr. Narurkar, face and neck treatments are the most common use for Thermage. “Then the second are the eyelids,” Dr. Narurkar says. He points out that Thermage is the only skin tightening device that is FDA cleared for use on the eyelids. “The third area is body, which includes the abdomen and the arms. Those are, in order, my most common areas of Thermage usage for skin tightening.” Dr. Green also uses FLX for the face, neck, and chin, as well as all body areas: “arms, legs, abdomens, buttocks.”

Using Thermage FLX to treat the neck and submental region yields good results, Dr. Green says, with or without the addition of deoxycholic acid (Kybella, Allergan). Do the RF procedure first, she says. Submental treatments are especially popular with male patients, who desire a more defined jawline.

Natural Results

Thermage RF treatments are shown to induce neocollagenesis that contributes to its clinically evident tightening effect. The results are natural, Dr. Green stresses. “What I like about the FLX is that obviously, like the traditional Thermage, you get natural results,” she says.

Jowls. For Dr. Green, the most common patient complaint tends to be jowls, but it's rare that laxity around the jawline is the only sign of skin aging. “If they have jowls, they usually have sun damage and usually have lost collagen,” she explains. “I find that if you do a Thermage/Fraxel combination where you're reducing pigmentation, sun damage, and fine lines with the Fraxel, the results are outstanding. That's because they've done the Thermage tightening and they've done the Fraxel to work on the epidermal changes. I pair that often with some kind of neuromodulator like Botox or Dysport and some kind of filler.”

Foreheads/Brows. Treating the forehead can produce lifting and tightening that results in a natural-looking “brow lift,” Dr. Green says. The effect can be augmented with judicious use of neuromodulators.

Submentum. Dr. Narurkar also favors combinations. “I've been a proponent of combination therapy. I was one of the first physicians to actually promote the use of combinations. I believe that for facial rejuvenation you need skin tightening, you need neuromodulators, you need fillers, and you need some sort of resurfacing and skin care.” Like Dr. Green, he says that treatment of the neck and submental area is very popular. “My favorite combination with Thermage, for example, is the submental area,” he says. “I'll often use Kybella and/or CoolSculpting for the actual submental fat. Then after they've finished that and gotten the desired result, I treat the entire base of the neck with Thermage. It's my signature, I call it the Lunchtime Lift.” Once the skin is tightened, additional treatments may be indicated. These may include Botox along the platysmal bands and fillers to recreate or define the jawline.

Periocular. Another popular treatment is Thermage for the periocular region. “I love using Thermage and Fraxel in combination. Thermage will improve eyelid laxity and then the Fraxel will be used for resurfacing the area around the eyes, especially that crepey skin,” Dr. Narurkar indicates. After focusing on the periocular region, patients ultimately undergo full-face treatment with Thermage and Fraxel. “Once they finish that, then we look at volume loss and then use fillers,” Dr. Narurkar adds.

Volume. In addition to a tightening effect, Thermage can produce some improvement in volume. “What I often find with Thermage is that there is an increase in volume after RF heating,” Dr. Narurkar says. Patients who have had Thermage treatment tend to need less filler injected than patients who have not had RF treatment, he observes.

A Go-To Device

For Dr. Narurkar, Thermage is the “go-to skin tightening device.” That's not just his opinion, he stresses. “If you look at the literature, if you look at the long-term patient experience, it still is the go-to skin tightening device. The FLX just makes the gold standard even better by allowing faster treatments and also more accurate having real time patient feedback.”

When it comes to treatment for laxity, “Thermage FLX is our absolute 100 percent go-to device,” Dr. Kaminer echoes. Like Dr. Green and Dr. Narurkar, he finds the device effective within a combination approach. “When you have textural changes, for the most part the Fraxel family of lasers is our go-to strategy there.”

Thermage FLX represents the latest step in the evolution of the well-established Thermage RF device. Dr. Kamimer urges practices to take a fresh look at the device. “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,” he says. “Our patients are thrilled with it, and it's been a big, big part of our skin program's success.”