Thermage Procedure Reference Guide[1]

Thermage: Face Procedure
Tip Selection
Thermage CPT System: TT3.00C3
Average starting level is 3.5
Thermage NXT & TC3 Systems: TT3.00C2, TT3.00C1
TT3.00C2 : Average starting range between 362.0 and 363.0
TT3.00C1 : Average starting range between 352.0 and 353.0
AREA TREATED
Lower Face
Lower Face & Neck
Full Face
FACE TIP
REPs SUGGESTED
600 REPs
900 REPs
900 REPs
FULL PASSES
2 passes
4-5 vector passes
2-3 passes
4-5 vector passes
2-3 passes
4-5 vector passes
PROCEDURE TIME
45-60 minutes
60-90 minutes
60-90 minutes
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Treatment Settings
Thermage CPT
Thermage NXT & TC3
TT3.00C2
Treatment Levels
Estimated J/cm
For face procedures
360.5
360.5 361.0
361.0 361.5 362.0 362.5 363.0 363.5 364.0 364.5 365.0 365.5 366.0 366.5 367.0 367.5 368.0 368.5
2
9
12
15
20
27
33
38
44
50
56
61
67
73
79
85
90
96
Thermage NXT & TC3
TT3.00C1
For face procedures : Thermage TC Tip 3.0cm2
350.5 351.0 351.5 352.0 352.5 353.0 353.5 354.0 354.5 355.0 355.5 356.0 356.5 357.0 357.5 358.0 358.5
9
14
12
15
20
27
33
38
44
50
56
61
67
73
79
85
90
96
Procedure Preparation
Supply List
Lighting/Photo Set-up
U 70% Isopropyl Alcohol
U Gauze
U Gloves
U Skin marking paper
U Skin marking pen
U Coupling fluid
U Return pad
U Thermage Face Tip
U Cryogen canister
Return Pad Placement
U Place return pad horizontally on either side of the upper back
U Return pad cable connection pointing away from the center of the body
and cable pointing away from the treatment area
Lights
U Diffused with soft box or umbrella
U Equidistant from subject
U Equally bright
U Placed above the subject
U Tilted down
U Use a black background
Camera
U Mounted on tripod
U Vertical position
U Level with patient treatment area
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Photography Recommendations & Pointers
Patient
45 degrees - left and right sides
U Head band
U Shoulders aligned with direction of gaze
U Cape to cover clothing
U Check vertical tilt and horizontal rotation of head
U No make-up or jewelry
U Align tip of nose with edge of cheek for 45 degree angle
U Gaze is eye level
Photo Positions
U Take pictures at five different angles
Full front
U Head should be level and vertically straight
U Shoulder aligned with direction of gaze
U Gaze is eye level
90 degrees - left and right sides
U Check vertical tilt and horizontal rotation of head
U Gaze is eye level
16
Procedure Guidelines
Step 1 Pre-treatment assessment and planning
U Ask patient to identify areas of concern and treatment goals
U Identify areas of treatment for optimal tightening and contouring
U Mark vectors (linear patterns of applications) for multiple passes for
incremental tightening and contouring
- Palpate skin/tissue for mobility, firmness and thickness
- Palpate and manipulate to determine the best treatment plan
U Mark problem areas for additional passes
- Example areas: jowls, submentum, nasolabial folds
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Procedure Guidelines
Optional Vectors
Step 2 Use moderate treatment levels
U Treat to a level 2.0-2.5 feedback “Hot, but tolerable”
- Adjust treatment levels according to patient feedback
- Thermage CPT: To determine patient’s heat tolerance, deliver
5-10 pulses without vibration
Brow lifting vectors capture
skin just below eyebrow.
Must have minimum of 5
pulses before returning to
first pulse.
U Monitor tissue during treatment for excessive erythema (redness)
and/or edema (swelling)
U Common areas of patient sensitivity shown below
Curved swoosh from
corner of nose to top
of ear.
Nasolabial &
mesolabial lines
Jowl lifting vector
cross mesolabial line
to zygomatic arch.
Jawline vector crosses
mesolabial line along
mandible to ear.
Neck lifting vectors
U Apply grid to area being treated
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Neck vectors
midline to just
behind angle
of jaw.
Sensitive
Sensitive
Areas Areas
Sensitive Areas
Sensitive
Areas
Sensitive
Areas
U Penorial region: with dental fillings or crown, it may be more
comfortable to place gauze under the lips, over the gums and
teeth while treating
Procedure Guidelines
Step 3 Deliver passes to entire treatment area
(see Basics section for pass technique options)
Handpiece Technique
U Keep the treatment tip perpendicular to the skin ensuring full
tip-to-skin contact
U Use enough downward pressure to maintain full contact, but not
so much as to impede vibration
U Pre-position skin when placing pulses by pulling in the direction of
desired contraction
Tune Treatment Tip
Vibration with Thermage CPT
U Select the level of vibration that is most comfortable for the patient
U Start with setting 1, then monitor patient feedback regarding vibration
intensity and adjust accordingly
U In thin skin areas, a lower vibration setting may be preferred by the patient
Choose Treatment Technique (see Basics section)
U Two single passes over the entire grid of squares and circles
- Penorial region: deliver five single passes across entire grid — treat
area superior to the vermillion border, extending approximately
1.0 cm laterally to the buccal commissures
U Use proper handpiece technique
U One Super pass: combined pass of circles and squares, alternating rows
U Use a generous amount of coupling fluid
U One Staggered pass: combined pass of circles and squares, staggered
U Tune on the cheek, avoiding bony areas
- Not suitable for treatment with Thermage CPT
Coupling Fluid
U Repeat chosen technique 2-3 times
U Regularly apply generous amounts of coupling fluid
U During the treatment, inspect the treatment tip for irregularities on
the tip surface, every 50 pulses
U Use approximately one 60 mL bottle for a 900 pulse treatment
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Procedure Guidelines
Step 4 Treat vectors and problem areas
Step 5 Goal: Treat to a clinical endpoint
U Apply additional passes to the vectors and problem areas identified
in the pre-treatment assessment
U Visual tightening over entire area of treatment
U Visual lifting and tightening of selected target areas
U Achieve incremental skin tightening adjacent to and over each area of
correction with 2-4 additional passes
- Softening of the nasolabial and mesolabial fold
U Maximize lifting and contouring over each vector with at least
5 additional passes
- Accentuating or defining of the jaw line
U Use all pulses available
- Reduction/narrowing of the jowls
- Renewed contour/lift (and/or reduction of submental fullness)
U Palpable change
U Utilize half-time assessment to identify clinical endpoint
Visual Change
Untreated Side
Palpable Change
Treated Side
Treated Side Untreated Side
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