Downtime after monopolar radiofrequency:
redness, the grid and what is not normal

What happens on the day of Thermage?

On the day, the treated zones look pink and feel warm once the return pad and the tip are removed. Thermage FLX delivers monopolar radiofrequency that heats the deep dermis as a layer while cryogen spray cools the surface before, during and after each pulse, so the colour is from blood flow in warmed skin rather than from a surface injury. Some people see a faint grid or the square outline of the tip where the treatment paper's marks and the tip's contact pattern show briefly; it fades with the pinkness. The Thermage Singapore page explains how the energy is delivered and which tip is used where.

Mild swelling follows the heat. On the cheeks and jawline it is usually slight. After the eye tip the lids are the exception: the skin there is thin and loose, so they can look puffy and feel tight straight afterwards, and the puffiness is more obvious the following morning. Tenderness on pressure over the treated zones is usual, and the skin can feel tight or slightly firmer immediately, which is the tissue's response to heat rather than the result.

Because the surface is intact there is no wound to dress, and most people return to ordinary activity straight away with a gentle cleanser, a plain moisturiser and sunscreen. During treatment Dr Sin Yong sets the energy per zone and adjusts it to your feedback on heat, which is also the reason the problems listed further down are uncommon. The Thermage aftercare page sets out the routine in full.

What do the following days look like?

Over the following days the pinkness fades, the grid pattern goes with it, and the mild swelling eases on its own. Lid puffiness after the eye tip settles a little more slowly than cheek swelling, and cool compresses help; it can look more marked first thing in the morning and ease through the day as you are upright. Tenderness on pressure or on chewing over the jawline fades over the same period.

A small raised welt or a bruise where a pulse crossed a vessel is less common and settles. A patch of tingling or altered sensation is uncommon, usually temporary, and reviewed if it persists. Some people notice the skin feels firmer early on; that early firmness is swelling and immediate collagen contraction, not the remodelling the treatment is planned for, which builds gradually over the following months as new collagen forms. The Thermage side effects page lists what is common and what is not.

What to avoid while the skin is pink

• Saunas, steam rooms, hot yoga, very hot showers and heat-based facials, which add heat to skin that has just been heated
• Strenuous exercise, which flushes the face and can prolong the pinkness and swelling
• Retinoids, exfoliating acids and other strong actives until the colour has gone and the skin feels ordinary
• Rubbing, massage or pressure on the treated zones, including a facial

“Pink skin that fades is heat doing its job in the dermis. A dent or a blister is heat in the wrong place. That is why I set the energy zone by zone rather than at one preset for every face.”

Dr Sin YongOn what the skin looks like after Thermage

What is not normal after Thermage, and when should you call?

Not normal: a blister, a burn mark or a line of raised welts along a treated zone; a crust or open area; a dent, hollow or step forming in the skin, usually over the cheek or jawline; swelling that is marked, one-sided or increasing; numbness that persists rather than fades; or pain that worsens rather than settles. Each has a mechanism, and each is photographed and sent rather than watched.

A blister or burn points to a pulse where cooling or tip contact was incomplete, or where the energy was too high for that zone; it is managed like any superficial burn, with wound care and sun avoidance, and reviewed until healed, because a crust that is picked or exposed to sun can leave a mark. A dent points to heat affecting the fat beneath the skin, which is more of a concern in a lean face with little tissue above bone, and the reason energy is planned zone by zone rather than run at one setting for everyone. Persistent numbness or weakness of a facial movement points to heat near a nerve branch and needs prompt review. Contact the clinic during clinic hours with a photograph; the complication care page lists what goes to an emergency department the same day, wherever you are.

A face that looks heavy or puffy long after the swelling should have gone is a different problem from swelling, and is usually not Thermage at all: it is assessed separately, often with ultrasound, where earlier filler is involved; the pillow face page explains why.

Can I wear make-up, exercise and go in the sun after Thermage?

Make-up can usually go on once the pinkness has calmed, since the surface is intact, applied gently and without rubbing; if a welt, blister or crust has formed, that area is left bare until it is reviewed. Sunscreen follows the same rule and goes on before you leave. Exercise is better left until the warmth and swelling have settled, because exertion flushes the face and prolongs both; the same applies to saunas, hot showers and alcohol. Gentle walking is fine straight away.

Sun protection applies throughout, as it does for any heated skin, with shade, a hat and a broad-spectrum sunscreen in Singapore's year-round sun. Paracetamol is usually enough for tenderness. Any combination with injectables, Volnewmer or other devices is spaced as set out in your plan rather than booked on the same skin straight away. Flying is not usually restricted once the skin is comfortable; the flying after treatment page covers what to carry and when to message.

How should you plan Thermage around work and events?

Thermage is among the energy treatments that can usually be fitted around a working day, because the pinkness is short, the surface is intact and nothing is open. Plan instead around two things: the eyelids, which can look puffy the morning after the eye tip and are better not treated just before a photograph; and heat, since saunas, hot yoga and a tropical afternoon outdoors are the things most likely to prolong the colour. A face that bruises easily should allow for a small bruise to fade before an event.

The change the treatment is planned for comes from collagen remodelling over the following months, so review is timed to allow for it rather than booked straight away, and how much change follows varies with age, skin quality, the degree of laxity at the outset and sun exposure. Whether monopolar radiofrequency is the right tool for your laxity, or whether focused ultrasound or VF Lift – Vertical Facelift on Volnewmer suits the face better, is decided at consultation; the Thermage vs Volnewmer comparison sets out the differences.