Thermage, a non-invasive radiofrequency treatment for skin tightening, has evolved significantly since its inception in 2002. Early versions were notably painful, but advancements have made the procedure more comfortable. The introduction of Comfort Pulse Technology (CPT) in later models reduced discomfort by delivering energy in a series of pulses with cooling intervals. Additionally, techniques such as applying topical anesthetics or using cooling devices during treatment have further minimized pain.
The โวลนิวเมอร์ treatment utilizes a water cooling system to enhance patient comfort by reducing pain during the procedure. This system effectively cools the skin’s surface, minimizing discomfort associated with the treatment. Additionally, the device’s design includes curved, gold-plated tips that ensure even energy distribution, further enhancing the overall comfort and effectiveness of the treatment.
These innovations aim to provide effective skin tightening with minimal discomfort, addressing concerns of those hesitant due to pain.
So, can Thermage easily achieve a “comfortable and painless” experience? In fact, based on the working principle of Thermage, it is entirely possible—and not difficult at all.
There are a few key factors that make Thermage capable of achieving “comfortable and painless” results:
- Sufficient Treatment Passes: For most clients, the number of passes used in Thermage treatments is adequate. This means that there is no need to use extremely high energy (such as levels above 5) to achieve effective results.
- Unique Working Principle: Most radiofrequency beauty devices heat the “polar water molecules” in the skin by causing them to spin rapidly in an alternating electric field, creating friction and generating heat. This process helps to heat the dermis and fat layers, boosting fat metabolism. However, Thermage uses capacitive heating with monopolar radiofrequency. Its mechanism doesn’t rely on water molecules generating heat through friction; instead, it generates heat through electrical resistance as the current passes through tissues. This type of resistance-based heating is commonly used in various electric heating devices, such as electric blankets. Although Thermage uses much higher power than household appliances, we can effectively use the impedance and conductivity of different tissues to enhance efficacy and reduce pain—this is crucial.
- Pain Comes from High Temperature: Thermage typically heats tissues to 60°C-70°C to achieve therapeutic effects. However, this high temperature is also what causes the discomfort. While the advanced treatment head of Thermage blows cooling air onto the skin during treatment, this cooling effect becomes less effective as the heat accumulates and the skin temperature rises. Therefore, to avoid pain, we need to find a way to cool the skin. You might be wondering, “If we lower the skin temperature to a level where it’s not painful, wouldn’t that affect the treatment’s effectiveness?” Keep reading, and your doubts will be cleared!
- Pain-Sensing Nerve Endings are in the Epidermis: The main nerve trunks are located in the dermis, but the pain-sensing nerve endings are in the epidermis. If we can lower the temperature in the epidermis without reducing the temperature in the dermis and subcutaneous fat layers, we can reduce pain while still enhancing the treatment’s effectiveness!
Comfortable and Painless Thermage Methods and Techniques
- Impedance and Conductivity of Different Tissues
It’s important to note that radiofrequency (RF) belongs to the electromagnetic wave category, meaning it is an electrical current. Different tissues in the body have different electrical conductivities. Impedance is typically inversely proportional to conductivity.
- Impedance values: Bone > Fat > Skin (fibrous septa) > Tendons > กล้ามเนื้อ > Blood Vessels > Nerves
The image above is crucial because it demonstrates how we use the varying conductivity of different tissues to guide the electrical current effectively.
As seen, blood has the highest conductivity (though this isn’t directly related to the Thermage technique). Wet skin and fibrous septa follow, while bone, fat, and dry skin have much lower conductivity. In other words, dry skin has high impedance, which leads to high temperatures and pain.
- Understanding Conductivity
Many people have an incorrect understanding of conductivity and impedance. In reality, tissues with high conductivity will allow more current to pass through. The more current that flows through, the more energy accumulates, which leads to higher temperatures. The human body can be described as a parallel circuit. When the current encounters tissues with high impedance, it bypasses them and chooses tissues with lower impedance and higher conductivity.
- Increasing the Conductivity of the Epidermis
This is the most important point in this article. When the epidermis is dry, its conductivity is low, and impedance is high, which can result in high temperatures due to this impedance, leading to noticeable pain. Dry skin can also be more prone to burns due to high temperatures.
Based on the conductivity and impedance differences between dry and wet skin, we can increase the epidermis’ conductivity by moisturizing. This will lower the impedance and allow the current to penetrate deeper into the dermis and fat layers.
But can increasing the conductivity of the epidermis lead to excessive energy accumulation and burns because more current flows through it? No. The epidermis is much thinner than the dermis and fat layers, so it doesn’t accumulate much energy. Additionally, the cooling mechanism of the Thermage treatment head blows cold air onto the epidermis, further reducing the risk of burns.
- How to Moisturize the Epidermis
A paper published in 1975 titled “Skin Impedance and Moisturization” mentioned that “an increase in environmental humidity leads to an increase in the water content of the stratum corneum, which results in reduced impedance. If dry skin is not moisturized, reduced environmental humidity will cause impedance to increase. Barrier moisturizers can correct dry skin, thus lowering the impedance of the stratum corneum.”
From this early paper, we learn that moisturizers with water-retaining functions can increase the water content in the epidermis, thereby lowering impedance and increasing conductivity.
Therefore, using a highly moisturizing occlusive cream (preferably) for 2-4 weeks before a Thermage treatment can significantly enhance the skin’s hydration.
However, I recommend a simpler and faster method for increasing the water content in the epidermis. In skincare routines, we often use masks to hydrate the skin. Although I don’t recommend frequent masking, using a mask before Thermage is a great way to quickly hydrate the skin. Studies have found that just 5-10 minutes of hydration can significantly change skin impedance.
Thus, applying a mask for 10 minutes before a Thermage session can rapidly increase the skin’s water content, enhancing conductivity and lowering impedance (which is key).
This technique is referred to by Thermage manufacturers as the “Impedance Reduction Method.”
However, during the procedure, the high temperatures from Thermage will cause the skin’s moisture to evaporate. To maintain the epidermis’ high water content, doctors should frequently apply hydrating coupling agents during the procedure. The coupling agent mainly consists of gel and water, providing excellent hydration and heat conduction. This allows heat to be better transferred to the air while keeping the epidermis hydrated. Frequent application of the coupling agent during the procedure is a critical method to maintain skin hydration.
As a rule of thumb, avoid waiting until the coupling agent visibly decreases before reapplying. Regular reapplication is essential.
- Moisturization Alone Isn’t Enough!
- The cheekbones, a primary area for Thermage treatment, have a thinner fat layer compared to other areas. If Thermage is repeatedly applied to the cheekbone area, even with adequate skin hydration, the current may not penetrate deeply enough, leading to energy accumulation in the epidermis. This can increase pain in the area. Therefore, when performing Thermage on the cheekbone, it is advisable to gently lift the skin below the cheekbone, increasing tissue thickness before proceeding. This technique can significantly reduce pain and also help reposition the skin, lifting sagging fat tissue.
- Since the Thermage treatment lasts for a relatively long time and heat is gradually accumulated to achieve high temperatures, skin moisture will evaporate over time. Although the coupling agent helps retain moisture, it’s not as fast-acting as a mask. During the procedure, it’s impractical to stop the treatment and apply a mask due to the patient’s pain. Here’s an exclusive tip: When pain becomes unbearable due to high skin temperature, use a handheld fan to blow air onto the skin for 30-60 seconds. The fan’s low power and short duration won’t affect the deeper layers of the skin, but it will cool the epidermis and relieve pain.
During the treatment, if a client feels significant pain, they should immediately inform the doctor. The doctor can repeatedly use the fan to cool the skin, which has proven to be highly effective.
With these methods, you can achieve a comfortable and painless Thermage experience without significantly lowering energy levels.
สรุป:
- By adjusting the conductivity and impedance of the epidermis, more Thermage current can be directed into the dermis and fat fiber layers, which can significantly reduce pain and improve treatment effectiveness.
- Research shows that dry skin has low conductivity and high impedance, while moist skin has high conductivity and low impedance. Since pain is primarily perceived by the nerve endings in the epidermis, we can increase the moisture content of the epidermis to raise its conductivity and lower its impedance, thus preventing the RF current from accumulating and generating heat in the epidermis.
- Methods to increase the moisture content of the epidermis include:
- (1) Applying a water-locking, occlusive moisturizer such as petroleum jelly a month before the procedure.
- (2) Immediately before the procedure, applying a mask for 5-10 minutes to quickly increase the moisture content of the epidermis.
- (3) Repeatedly applying a moisture-rich coupling gel during the procedure.
- Most bony areas have thinner fat layers compared to other regions. If repeated operations are performed in these areas, even if the epidermis has a high moisture content, the reduced penetration of the current into deeper layers will lead to an increase in current accumulation in the epidermis, causing more pain. Therefore, when working on the cheekbone area, it helps to lift and pile the skin tissue below the cheekbones to thicken the layer before proceeding, which can significantly reduce pain in this area.
- Exclusive Tip: When unbearable pain occurs due to high skin temperature during treatment, using a handheld fan to blow cool air onto the face for 30-60 seconds can help reduce the skin’s surface temperature. This method can effectively relieve pain without significantly affecting the temperature of the deeper dermis layers. Have you learned this trick?
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