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07 Aug 2008

Thermage v Syneron v Ellipse
I am currently looking into an effective skin tightening procedure, Thermage is extremely pricey, Syneron less so and Ellipse even less... all appear to be safe and from all accounts effective. Thermage seems to stand out as the best but for the price is it really worth it. Which is the best route to take? Please advise!
Answer 1,191 views
Anti-ageing expert
Anti-ageing expert

01 Jan 0001

Hi Nikki, thank you for the question.

The Ellipse is an IPL (intense pulse light) skin rejuvenation machine that may produce some skin tightening effect due to collagen and elastin stimulation but this is not your first choice when one is considering skin tightening specifically.

Only the following are considered skin tightening technologies:
Syneron Refirme: Infrared and Bi-Polar Radiofrequency
Thermage: Monopolar Radiofrequency
Titan: Infrared

When one is deciding which technology to choose for skin tightening my advice is never to look at before and after photographs but rather at independent medical studies that indicate not only results but side effects as well. These are not always easy to find but I will list the results of the studies I know of for the two skin tightening technologies you have listed: (More information on these studies and more can be found on my web page at: and use the search function for either Thermage, Syneron, or Titan.)


Peri Orbital (around the eye) Lasers Surg Med. 2003;33(4):232-42.
RESULTS: Independent scoring of blinded photographs resulted in Fitzpatrick wrinkle score improvements of at least 1 point in 83.2% (99/119) of treated periorbital areas. Treating physicians, without reference to pre-treatment photographs, noted improvements in 28.9% (48/166) of treatment areas. Fifty percent (41/82) of subjects reported being satisfied or very satisfied with periorbital wrinkle reductions. Objective photographic analysis showed that 61.5% (40/65) of eyebrows were lifted by at least 0.5 mm. Rates and duration of edema/erythema were very low (e.g., vs. ablative procedures). Overall 2nd-degree burn incidence was 0.36% (21 per 5,858 RF applications). Three patients had small areas of residual scarring at 6 months.

Thermage Study: Radiofrequency Treatment for Middle and Lower Face Laxity
Arch Facial Plast Surg. 2004 Nov-Dec;6(6):370-3.
RESULTS: Eleven patients received a single RF treatment, and 9 patients underwent 2 treatments. All subjects experienced mild edema and mild to moderate erythema as an acute clinical response; no patients experienced burns, skin breakdown, or scarring. At 4-month follow-up, patients in the 2-treatment group received higher scores in all categories of photographic analysis; the difference in improvement in the nasolabial folds was statistically significant (P = .04). In self-assessment ratings, individuals receiving 2 treatments reported more improvement than subjects in the single-treatment group 4 months after treatment (P = .03). In both treatment groups, physician photographic assessment demonstrated continued improvement in all subsites between the 1-month and 4-month assessments (P<.05). Although the overall change noted by both patients and physicians was modest in most patients, 75% of subjects (n = 15) stated they would consider paying for additional treatments.

Syneron Refirme:

Skin Tightening and Treatment of Facial Rhytides With Combined Infrared Light and Bipolar Radiofrequency Technology
Robert Sleightholm, M.D. Director of Surgery, Brampton Cosmetic Surgery and Laser Clinic
Hugh Bartholomeusz, M.D. Greenslope Plastic Surgery
Objective: To evaluate the efficacy and safety of the ReFirmeā„¢ ST Applicator (Syneron Medical Ltd., Yokneam, Israel), a novel combination of broadband IR light (700-2000 nm) and bipolar RF (electro-optical synergy [ELOS]) for the non-ablative treatment of skin laxity and mild to moderate rhytides.
Patients graded post-treatment satisfaction on the following scale: 1-2 not satisfied; 3-4 slightly satisfied; 5-6 moderately satisfied; 7-8 satisfied; and 9-10 exceptionally satisfied.
RESULTS: The overall median wrinkle clearance rate for the 3 blinded evaluators was 50% (40.0-50.0 [97.1% CI]). The three median clearance rates did not differ significantly from one another (p=0.1666). The median patient satisfaction rate was 7.0 (6.0-8.0 [97.1% CI]) with 20 patients reporting 7 or greater. A Spearman
rank correlation coefficient of 0.74 (0.53-0.87 [95% CI]) indicated a strong correlation (p<0.0001) between clearance rates and patient satisfaction levels. Adverse effects other than mild transient erythema or edema were not observed 1 to 2 days after treatment or 1 month after the final treatment.
Conclusion: The combination of broadband IR (700-2000 nm) and bipolar RF energies is a safe and effective treatment modality for improving the appearance of rhytides, skin texture, and laxity of the face.
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