INTRODUCTION
Thermage® FLX is an advanced, non-invasive monopolar radiofrequency (RF) device used in aesthetic dermatology to address skin laxity and signs of aging. Building on the success of earlier Thermage models, it delivers RF energy to stimulate collagen production, enhancing skin firmness and texture.1,2 The FLX model represents the latest advancement in the Thermage platform, offering faster treatment times, improved precision, and greater patient comfort. It uses a single RF electrode in a monopolar configuration to deliver controlled heat into the dermis, creating thermal injury that triggers the body’s natural wound-healing response and collagen regeneration.3-5
Following our previous investigations,6-9 the 2024 survey provides updated insights into expert perceptions of Thermage FLX regarding its efficacy, complications, and usage patterns. This cross-sectional survey was conducted across eight countries in the Asia-Pacific region.
Following our previous investigations,6-9 the 2024 survey provides updated insights into expert perceptions of Thermage FLX regarding its efficacy, complications, and usage patterns. This cross-sectional survey was conducted across eight countries in the Asia-Pacific region.
MATERIALS AND METHODS
A 29-item questionnaire on Thermage FLX was distributed to physicians across the Asia-Pacific region who had at least one year of experience using the device. Participants were recruited from attendees of the 2024 annual Thermage user meetings in their respective countries. Eligible physicians were invited to complete an online survey. All questions were multiple-choice, with the option to select multiple responses. The study was approved by the Institutional Review Board (IRB) of Incheon St. Mary's Hospital, The Catholic University of Korea (IRB number: OC25QISI0019).
A total of 204 physicians participated (90 from Korea and 114 from Taiwan, China [including Hong Kong], Thailand, Vietnam, Singapore, Malaysia, and Australia). The respondents had an average of 7.8 years (range: 1-23) of experience with Thermage and 3.2 years (range: 1-6) with Thermage FLX (Figure 1). The questionnaire addressed three main areas: (a) perceived effectiveness, (b) complications encountered, and (c) practice patterns. Compared to prior surveys, this edition included expanded questions on Eye Thermage and physicians' personal use of the FLX platform.
A total of 204 physicians participated (90 from Korea and 114 from Taiwan, China [including Hong Kong], Thailand, Vietnam, Singapore, Malaysia, and Australia). The respondents had an average of 7.8 years (range: 1-23) of experience with Thermage and 3.2 years (range: 1-6) with Thermage FLX (Figure 1). The questionnaire addressed three main areas: (a) perceived effectiveness, (b) complications encountered, and (c) practice patterns. Compared to prior surveys, this edition included expanded questions on Eye Thermage and physicians' personal use of the FLX platform.
RESULTS AND DISCUSSION
Consistent with our 2020 survey 9, individuals in their 40s remained the most frequently identified ideal candidates for Thermage FLX using the total tip. Skin thickness, in conjunction with age-related changes (e.g., laxity, wrinkling), continued to be the key predictor of treatment response. In addition to tightening, the total tip was reported effective for improving pores (80.9%), rosacea (30.4%), and acne (28.9%) as reported in previous studies (Figure 2A).6-13
The 2024 survey indicated an improved non-responder rate compared to 2011,6 with 69.1% of physicians reporting fewer than 20% non-responders. However, 30.9% still experienced higher non-responder rates, underscoring the need to manage patient expectations, which are often heightened due to online media. Physicians emphasized the importance of counseling and suggested adjusting treatment parameters or combining Thermage with injectables to improve results.14 Notably, 75.5% reported performing both treatments on the same day, with 93.5% starting with RF (Figure 2A).
The Thermage Eye Tip, a specialized tool for non-invasive eyelid rejuvenation, has become a popular choice due to its ability to tighten upper eyelids with no downtime.15,16 As the only treatment option for upper eyelid tightening with no downtime, Eye Thermage has gained significant popularity. As with the total tip, individuals in their 40s were considered ideal candidates. Thin periorbital skin was cited as a predictor of successful outcomes. Eye Thermage was frequently paired with injectables (80.6%), and in 94.6% of such cases, physicians treated the eye area first when crow's feet were present (Figure 2B).
Topical EMLA (2.5% lidocaine/2.5% prilocaine) remained the preferred anesthetic (Figure 3A), while ~30% of respondents reported using sedation. With growing concern over propofol-related risks, nitrous oxide ("laughing gas") is increasingly used as a safer alternative that maintains patient communication during treatment.14
The preferred treatment interval for the total tip was one year (67.2%), followed by 6–11 months (31.9%) (Figure 3A). The 600 REP 4 cm² and 900 REP 4 cm² tips were similarly popular
The 2024 survey indicated an improved non-responder rate compared to 2011,6 with 69.1% of physicians reporting fewer than 20% non-responders. However, 30.9% still experienced higher non-responder rates, underscoring the need to manage patient expectations, which are often heightened due to online media. Physicians emphasized the importance of counseling and suggested adjusting treatment parameters or combining Thermage with injectables to improve results.14 Notably, 75.5% reported performing both treatments on the same day, with 93.5% starting with RF (Figure 2A).
The Thermage Eye Tip, a specialized tool for non-invasive eyelid rejuvenation, has become a popular choice due to its ability to tighten upper eyelids with no downtime.15,16 As the only treatment option for upper eyelid tightening with no downtime, Eye Thermage has gained significant popularity. As with the total tip, individuals in their 40s were considered ideal candidates. Thin periorbital skin was cited as a predictor of successful outcomes. Eye Thermage was frequently paired with injectables (80.6%), and in 94.6% of such cases, physicians treated the eye area first when crow's feet were present (Figure 2B).
Topical EMLA (2.5% lidocaine/2.5% prilocaine) remained the preferred anesthetic (Figure 3A), while ~30% of respondents reported using sedation. With growing concern over propofol-related risks, nitrous oxide ("laughing gas") is increasingly used as a safer alternative that maintains patient communication during treatment.14
The preferred treatment interval for the total tip was one year (67.2%), followed by 6–11 months (31.9%) (Figure 3A). The 600 REP 4 cm² and 900 REP 4 cm² tips were similarly popular
