Why appropriate discomfort signals effective energy, why long sedation raises risk, and how nerve block sits between topical and sedation.
Hello. This is Dr. Lee Yumin of MeSOnBom Clinic.
In a Thermage consultation, one question comes before results or duration.
"Can I be sedated?"
Because that feeling is entirely natural, I do not brush the question aside.
To put the conclusion first: I do not use sedation for Thermage.
Today I want to explain the reason not as why it cannot be done, but as what it is meant to protect.
Thermage delivers heat to the dermis with monopolar RF to induce collagen regeneration.
Thermal stimulation and discomfort are in truth one and the same. Enough energy has to go in for the skin to respond — and that is what the collagen responds to as well.
Put differently, appropriate discomfort is also a sign that the treatment is going in properly.
I have checked this sensation myself, treating my own face at various intensities.
At level 3.0 there was discomfort and some swelling, but the result and its duration were incomparably better.
So I am cautious about the phrase painless Thermage.
If energy is lowered in the attempt to remove discomfort, you can spend considerable money and time and be left with a result that does not feel like a treatment at all. The discomfort lasts seconds; the satisfaction lasts months.
Many also worry that Thermage causes loss of cheek volume, but its heat is designed to reach only as far as the dermis, not the fat layer, so performed appropriately for your skin type it has nothing to do with losing cheek fat.
It is not that sedation is bad in itself. The issue is the conditions.
Performed together with Ulthera, treatment usually runs from an hour and a half to two hours — and the longer the time and the greater the accumulated dose, the more steeply the risk rises.
Even though propofol is a relatively safe agent, long duration combined with a large dose lowers the threshold for incidents such as respiratory failure.
So I ask myself a question.
"Would I ask to be put to sleep for two hours for an aesthetic treatment?" I cannot recommend to a patient something to which my own answer is no.
It is a question of safety, not of service.
Many people think of anaesthesia only as being asleep or awake.
In fact it divides into topical anaesthesia, local nerve block and sedation.
We choose the second: nerve block.
With accumulated experience of where and how much to block, you can tolerate high-energy Thermage perfectly well while awake.
Not one patient has yet stopped a treatment because of pain.
Thermage is an expensive treatment.
Rather than whether sedation is available or whether the price is low, look at whether the clinic explains which layer the heat reaches, whether it handles pain solely by putting you to sleep or manages the stages of anaesthesia carefully, and where it sets its line between results and safety.
A clinic that answers those questions honestly will look after both your safety and your result.
Please ask us anything. Thank you.
Our medical team will advise you based on your skin condition.
