Thermage: how much can monopolar radiofrequency really tighten loose skin?

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Last updated: October 23, 2026

Thermage is a noninvasive, nonablative device that uses monopolar radiofrequency energy to heat the underlying skin while protecting the epidermis, with the aim of producing skin tightening[1]. Studies have shown that Thermage can impart mild tightening of periorbital, mid and lower facial laxity, and one review describes it as a nonsurgical alternative for treating mild skin laxity[1]. A 2005 review states that patients generally can expect a 5% to 20% improvement, but that results in any particular group are unpredictable[2].

What is Thermage and how does monopolar radiofrequency work?

One review describes the Thermage monopolar capacitive radiofrequency system as protecting the skin surface from injury while selectively heating the underlying dermis[3]. The same review states that preservation of epidermal integrity minimizes recovery and the risk of complications[3].

In medical radiofrequency, an oscillating electrical current forces collisions between charged molecules and ions, which are then transformed into heat[4]. Radiofrequency heating occurs irrespective of chromophore or skin type, according to the same review[4]. In monopolar configurations, the radiofrequency energy penetrates deeply and returns via a grounding electrode[4].

One review explains that radiofrequency passed through cooled epidermis causes thermal damage to the dermis and deep dermal collagen, and that remodeling of this collagen leads to clinically discernible improvement in sagging skin and skin quality[5]. Radiofrequency thermal stimulation is believed to result in a microinflammatory process that promotes new collagen[4].

A 2025 review of histological studies of noninvasive monopolar radiofrequency from 2000 to 2024 reported that dermal collagen content increases immediately and up to 6 months after treatment[6]. The same review reported changes in elastin content and increases in the thickness of the epidermis and dermis[6].

How well does Thermage tighten facial skin?

Reviews describe mild tightening of facial laxity with Thermage and measurable improvement in skin laxity of the face with monopolar and bipolar radiofrequency devices[1][7]. One 2007 review states that published clinical evidence supports the use of monopolar capacitive radiofrequency for mild to moderate facial skin laxity and rhytides[3]. A 2011 review states that monopolar capacitively coupled radiofrequency has the most clinical trials to date among aesthetic radiofrequency devices supporting its use to improve rhytids and tighten the skin[8].

A 2022 systematic review searched MEDLINE in September of 2020 and kept 23 articles, of which nine evaluated monopolar devices for the face and three evaluated monopolar devices for body areas[7]. The authors concluded that there is clinical evidence that monopolar and bipolar radiofrequency devices produce measurable improvement in skin laxity of the face and body with an acceptable complication profile[7].

Results from individual studies

  • In a pilot study of 32 patients with skin types III-V who had full-face monopolar radiofrequency treatment, with follow-ups over 24 weeks, 53.1% of patients reported over 50% improvement at 2 months[9].
  • That pilot study also observed significant improvements in jawline sagging and nasolabial folds in 2D and 3D images, and no severe adverse events occurred[9].
  • In a randomized study of 40 participants, a single treatment with a newer monopolar radiofrequency device was compared with a control group treated with Thermage CPT[10].
  • In that randomized study, nasolabial fold depression volume changed significantly from baseline at 1, 3 and 6 months, with no significant differences between the treatment and control groups and no severe adverse events reported[10].
  • In a study of 42 women with a mean age of 47.667 years who received a single Thermage treatment, skin hydration, elasticity, density, fine lines, texture and pores improved at 4 weeks after the procedure[11].
  • In that study of 42 women, improvement was significantly greater in the test group of 21 who also used repair and anti-aging cosmetic products[11].

What about the eyelids?

In a study of 14 Asian subjects who had a single session with a 0.25 cm² tip monopolar radiofrequency device on the upper eyelid and lateral orbital regions, 73% of patients reported more than 50% improvement in eyelid tightening at 2 months, increasing to 86% at 6 months[12]. No adverse events were observed in that study, in which a protective plastic contact lens was used during the procedure[12].

Can Thermage be used on the body, such as the thighs?

Reviews describe radiofrequency being used on lax body skin as well as on the face[4][5]. One review lists the most common current uses of radiofrequency devices as noninvasive tightening of lax skin, including sagging jowls, abdomen, thighs and arms, as well as wrinkle reduction, cellulite improvement and body contouring[4].

A 2009 review states that abdominal striae, loose upper arm skin, buttock sagging and the appearance of cellulite have become amenable to Thermage radiofrequency treatment[5]. The same review states that remodeling of deep dermal collagen allows modeling of contours and improvement of the cellulite appearance[5].

A 2008 review notes that Thermage has more recently been used for off-face applications[1]. The same review states that other radiofrequency devices have shown objective improvements in cellulite of the buttocks and thigh regions[1].

In the 2022 systematic review, three articles evaluated monopolar devices for body areas[7]. If you are considering Thermage for the inner thighs or another body area, ask your surgeon what results have been reported for that specific area.

What side effects and complications have been reported with Thermage?

Most reported complications of radiofrequency skin tightening are minor and transient, but major complication rates are higher with monopolar devices than with bipolar devices, according to a 2022 systematic review[7]. A 2011 review describes the Thermage CPT system as offering minimal downtime with a favorable side-effect profile[8].

Burns

One case report describes a 45-year-old man who received several facial burns from the Thermage CPT system due to failure of the dielectric membrane[13]. The authors of that report suggested that it may be contraindicated to treat male patients with this system[13].

If you notice blistering or a burn after any skin-tightening treatment, contact your surgeon right away.

Pain and short-term effects

In a survey of Korean dermatologists based on 52 surveys, 25.5% considered the newer Thermage FLX device more painful than Thermage CPT[14]. The same survey reported that the complication rate of Thermage was lower than the authors had reported in 2017 and 2011, which the authors said was likely due to the optimized energy delivery of Thermage FLX and gentle treatment[14].

In the study of 42 women who had a single Thermage treatment, post-procedure side effects were alleviated 1 day after the procedure[11]. In a retrospective study of 56 patients in Malaysia who had high-intensity focused ultrasound combined with monopolar radiofrequency, all patients reported transient mild erythema, with no serious adverse events such as burn, swelling, numbness or muscle weakness[15].

Who may be a good candidate for Thermage?

A 2005 review states that monopolar radiofrequency treatment may be appropriate for patients who desire skin tightening but will not tolerate surgery or downtime[2]. The same review stresses providing patients with detailed information to ensure that expectations are realistic[2].

A 2014 review lists patient age, degree of laxity, history of smoking, ethnicity, body mass index and individual pain threshold as factors that could possibly contribute to response to tightening devices[16]. That review also notes that the literature does not consistently clarify which variables are most important in predicting the best patient response[16].

In the Korean dermatologist survey, Asians in their 40s were considered to benefit most from Thermage FLX, and skin thickness was considered the most important determinant of response[14]. The interval between treatments reported in that survey was mainly 1 year, at 51.9%[14].

A Delphi panel of 8 international experts in aesthetic dermatology reached consensus on 19 recommendations for fourth-generation non-microneedling monopolar radiofrequency and developed explanatory guidance, including on patient selection and anticipated treatment outcomes[17]. The panel concluded that careful patient selection, pre-treatment counseling, treatment planning and good technique are all critical for success[17].

How does Thermage relate to liposuction and loose skin?

Radiofrequency is described as an option for patients who want skin tightening and an improvement in facial or body contour without an excisional surgical procedure[7]. One review notes that by manipulating skin cooling, radiofrequency can also be used for heating and reduction of fat[4].

A 2014 review states that radiofrequency energy can be applied to facial, neck and body skin to create tightening without surgical incisions and recovery time[18]. The same review found that the increasing number of nonablative systems all seem to be effective and safe when used in the recommended manner[18].

If you are worried about loose skin after liposuction, ask your surgeon whether a skin-tightening treatment is suitable for you and how its timing would fit with your surgery. You can also read our article on skin tightening after liposuction, our overview of non-surgical liposuction techniques and our page on liposuction and non-surgical treatments.

Talking to a surgeon

A consultation with a board-certified surgeon or dermatologist is a good place to decide whether Thermage, liposuction or another approach fits your goals. Questions you may want to ask include:

  • How much improvement do you expect for my skin, and how will we measure it?
  • What results have you seen when treating the area I am concerned about, such as the inner thighs, abdomen or jawline?
  • What risks apply to the device you plan to use, and how are they monitored during treatment?
  • How many sessions do you recommend, and how far apart?
  • Would liposuction, a skin-tightening treatment or a combination suit my goals better?
  • What should I do if I notice a problem after treatment?

Frequently asked questions

What is Thermage?

Thermage is a noninvasive, nonablative device that uses monopolar radiofrequency energy to heat the underlying skin while protecting the epidermis, with the aim of skin tightening[1].

How much improvement can Thermage give?

A 2005 review states that patients generally can expect a 5% to 20% improvement, but that results in any particular group are unpredictable[2]. Studies have shown that Thermage can impart mild tightening of periorbital, mid and lower facial laxity[1].

Can Thermage cause burns?

One case report describes a 45-year-old man who received several facial burns from the Thermage CPT system due to failure of the dielectric membrane[13]. A 2022 systematic review found that major complication rates are higher with monopolar devices than with bipolar devices[7].

Can Thermage be used on the thighs or abdomen?

One review lists noninvasive tightening of lax skin, including the abdomen, thighs and arms, among the most common current uses of radiofrequency devices[4]. A 2022 systematic review found three articles evaluating monopolar devices for body areas[7].

Is Thermage a replacement for liposuction?

Radiofrequency is described as an option for patients who want skin tightening and an improvement in facial or body contour without an excisional surgical procedure[7]. Ask a board-certified surgeon which approach suits your goals.

References

  1. Thermage: the nonablative radiofrequency for rejuvenation. Clinics in dermatology. 2008. PubMed 18940540
  2. Thermage: monopolar radiofrequency. Aesthetic surgery journal. 2005. PubMed 19338872
  3. Monopolar radiofrequency skin tightening. Facial plastic surgery clinics of North America. 2007. PubMed 17544932
  4. Noninvasive radio frequency for skin tightening and body contouring. Seminars in cutaneous medicine and surgery. 2013. PubMed 24049924
  5. Clinical applications of radiofrequency: nonsurgical skin tightening (thermage). Clinics in plastic surgery. 2009. PubMed 19309652
  6. Monopolar Radiofrequency-Induced Fibroblast Stimulation for the Prevention and Improvement of Skin Laxity. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2025. PubMed 40864850
  7. Minimally Invasive Approach to Skin Tightening of the Face and Body: Systematic Review of Monopolar and Bipolar Radiofrequency Devices. Plastic and reconstructive surgery. 2022. PubMed 35877937
  8. Radiofrequency: Thermage. Facial plastic surgery clinics of North America. 2011. PubMed 21763995
  9. Evaluation of Improvement in Skin Laxity and Oiliness After Monopolar Radiofrequency Treatment: A Pilot Study Utilizing Multiple Assessment Tools. Journal of cosmetic dermatology. 2025. PubMed 41014039
  10. Long-Term Efficacy and Safety of a Novel Monopolar Radiofrequency Device for Skin Tightening: A Prospective Randomized Controlled Study. Lasers in surgery and medicine. 2025. PubMed 39957006
  11. Short- and Long-Term Effects of Adding Topical Cosmetics to a Dermatological Procedure (Thermage): A Randomized Controlled Comparative Study Exploring the Synergistic Effects. Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI). 2025. PubMed 40320875
  12. Tightening of the eyelids with monopolar radiofrequency in Asians. Lasers in medical science. 2025. PubMed 41402632
  13. Multiple facial burns with the new Thermage CPT system. Journal of drugs in dermatology : JDD. 2011. PubMed 22052316
  14. A survey on monopolar radiofrequency treatment: The latest update. Dermatologic therapy. 2020. PubMed 32902088
  15. Safety and Efficacy of High-Intensity Focused Ultrasound and Monopolar Radiofrequency Combination Therapy for Skin Tightening: A Retrospective Study in Malaysia. The Malaysian journal of medical sciences : MJMS. 2024. PubMed 38456105
  16. Patient selection for skin-tightening procedures. Journal of cosmetic dermatology. 2014. PubMed 25196688
  17. Consensus Recommendations for 4th Generation Non-Microneedling Monopolar Radiofrequency for Skin Tightening: A Delphi Consensus Panel. Journal of drugs in dermatology : JDD. 2020. PubMed 31985194
  18. Monopolar radiofrequency for skin tightening: our experience and a review of the literature. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2014. PubMed 25417570