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Thermage and Fat Loss

June 11, 2008
Dear Dr Rivkin,

I have read many horror stories of facial fat loss from Thermage on this site. I had two Thermage treatments - one last year and one in March this year as I was quite happy with the result from the first. My PS explained that instead of doing one session, another method is do to a lower setting and space these out over 2-3 sessions over several months. I had no anaesthetic and it did not hurt at all - a very warm but actually pleasant feeling.

If fat loss were going to happen, would this have happened by now, 3 months later?

Thank you

yes, don't worry about fat loss.
this was a side effect from over aggressive settings on thermage back when people really didn't know what they were doing.
the company has reconfigured the settings on the device since then and it is much safer now.
it sounds like they used conservative settings - my treatments are more aggressive and they usually hurt. if you got results, that's great, and don't worry - you're not going to see fat loss.

4 thoughts on “Thermage and Fat Loss”

  1. linda ritchie says:

    I had facial thermage two weeks ago and noticed an immediate tightening of the skin. The following day I noticed a quarter moon depression on my cheek. I was assured that this would disappear as the settings had been very low. I am concerned that this is a permanent depression due to facial fat loss and the adherence of the dermis to the connective tissue.
    I have also noticed that my skin is in fact drier and the texture has become less refined.
    Please advise

    1. Dr. Rivkin says:

      I would give this kind of thing a bit of time. It is very unlikely that you have fat loss from thermage – the reports of this happening are limited to situations where the patient was under general anesthesia and extremely high settings were used. These settings would be much too painful to use on someone who is awake. I would agree with your doctor – the depression you are talking about is most likely temporary and should disappear within a couple of weeks. In the unlikely case that it does not, the depression can always be filled with an injectable filler. This usually triggers collagen growth in the area injected and you should only need one or two injection sessions. Skin texture changes are also temporary, although I have very rarely seen them after Thermage. If things persist after 2 more weeks, I would certainly return to your doctor and if you are not happy with his answer, I would get a few more opinions.

  2. linda says:

    Well it is now 8 months later and the half moon depression still exists. The doctor was adamant that it was not due to Thermage and blamed it on a loss of hylauronic acid. She reluctantly filled it at her own expense and it was reabsorbed after a month. I have now at 8 months, developed a noticeble depression in the middle of my right cheek when I smile. I have also developed a depression on my forehead.
    How much damage can be caused by this Thermage and for how long? Should I use fat fillers or the likes of Restylane or Perlane

    1. Dr. Rivkin says:

      i’m sorry – this sounds very frustrating.
      i think that, unfortunately, you have to get it filled with either filler or fat.
      it is unusual that filler would go away that quickly.
      i have never seen thermage cause this, by the way, so it is surprising to hear about it.
      i would suggest that you seek a second opinion about what is going on.
      having a fresh pair of eyes look at your situation would always be a good idea.
      good luck

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