Benefits and Risks of Face Lifts Without Surgery

Thermage and Titan Procedures

Plastic surgeon consulting female patient in doctors office
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Of the new crop of skin tightening ​procedures, the two that are best known are the proprietary procedures Thermage and Titan. While these two treatments utilize different proprietary technology, the idea is essentially the same, in that they both aim to heat the deeper layer of the skin (the dermis) in order to effect a “healing response.” This healing response encourages increased collagen production and remodeling of existing collagen. Supportive underlying tissues of the skin contract, resulting in a tighter, more uplifted appearance to the skin.


Both treatments have been used with success on the face and areas of the body. Some of the most dramatic results have been seen in the area of the neck and jawline. However, these treatments are also showing some promising results on sagging skin on the abdomen, upper arms, butt, and thighs, and seem to offer some help with diminishing the appearance of cellulite as well.


Unlike with ablative lasers or chemical peels, there is no peeling of the top layer of skin, and therefore the procedures are more suitable for patients with darker skin tones, because of the significantly lowered risk of pigmentation changes. The cost is also considerably less than a surgical facelift, and because the procedure is non-invasive (no cutting) there is usually no need to take time off from work.

Risks and Recovery

Pain management is hardly an issue, as some of these procedures require the use of local anesthetic or over-the-counter painkillers, while some use nothing at all. All incorporate some sort of means of cooling the skin during the treatment.

For most patients, there is no downtime, although a few people may have excessive swelling or redness, or even temporary skin blanching (whiteness) immediately following a treatment. More serious risks include bumps, blistering, permanent pigmentation changes, or skin depressions, although these are rare. Extremely rare incidents of scarring or infection have been reported.


Costs vary between $500 to $5,000, depending mostly on the size of the area being treated. Cost per treatment is generally higher with Thermage, although usually only one treatment is required. Titan requires one to three treatments, as recommended by your doctor to treat your specific concerns.


The basic difference between Thermage and Titan is the mechanism by which the dermis is heated. Thermage employs radiofrequency energy, while Titan uses infrared. The field has burgeoned since 2007 and now there are technologies that use a variety of radiofrequency, ultrasound, and infrared devices. All of them have the mechanism of heating the dermis and subdermal areas while not damaging the epidermis. Which technology is best for you will depend on the site being treated and individual factors. The good news is that reviews have found a high level of safety and minimal recovery time for radiofrequency treatments.

Realistic Expectations

Keep in mind that these procedures are not meant to deliver the same results as a surgical facelift. You cannot expect to erase 15 to 20 years with non-invasive tissue tightening. Also important to remember is that results vary from patient to patient due to differences in skin thickness and texture, healing response, and lifestyle variables. These procedures are probably best looked at as a way for younger patients to stave off more invasive procedures, or for those patients for whom surgery is not an option.

Good Candidates

Skin-tightening procedures seem to work best in patients who have thin faces who don’t quite yet need a facelift and want to put it off for a few years. In some cases, these procedures may have little or no discernible effect on those who are really ready for a facelift due to having very loose skin and, or those with a lot of excess facial fat. Although many patients do experience dramatic differences, there is no guarantee of a noticeable improvement.

Ensuring Best Results

Operator technique is of paramount importance to obtain a good result with these procedures, so make sure to do your research regarding the experience and training of the person who will be performing your procedure. And don’t forget to get and check references.

While you may be offered these technologies, with rapid developments in this field there may be superior devices and methods available. Discuss your options with your clinic to help determine which is best for you.

Keep in mind that since dermal collagen remodeling takes place over time, you cannot expect to see the final result until up to six months following your final session. This means that patients may be able to expect to see some immediate results, with improvements continuing for up to six months following the procedure.

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Article Sources

  • Beasley KL, Weiss RA. Radiofrequency in Cosmetic Dermatology. Dermatologic Clinics. 2014;32(1):79-90. doi:10.1016/j.det.2013.09.010.

  • Gold MH, ed. Update on Tissue TighteningThe Journal of Clinical and Aesthetic Dermatology. 2010;3(5):36-41.