I'm in Los Angeles. My email: ktd90211@yshoo.com

LH:
Are you coming to the Thermage Users Meeting in SF on April 19th??

Does anyone know if Titan can cause fatty necrosis? Would it have an ill effect on someone who has had fat grafts for their naso-labial folds ?Is this procedure actually a safe procedure? I gather that if ill effects were occuring, a patient would feel a burning sensation? To have an effect I understand that at least 45 to 50 joules are required.

pmdoc,

I am planning on Chicago April 26th.

Avmd,

No Titan will not cause fat necrosis. Only real risk is burns but they are rare when the procedure is done correctly.

I am an RN considering thermage to my arms, the practitioner i saw today said there is a 20% of it not working, i asked if she had done it to arms she said yes, but her receptionist said later that she hadnt seen any other body parts done in the office since she had been there.

this is the only office in my region that does thermage.

i am unable to find any data on this, only a few before/after pictures online that look very promising but dont want the pain and expense for nothing, can someone please advise or direct me to some evidence,
thank you

sonja:
By inferences, I assume you are of Asian Indian race and probably no older than 55, I would say you are actually a very good candidate for it. Besides, with the DC tip (4.3mm depth) for your thicker skin type, you could also get some "contouring" out of it besides the skin tightening benefit.

i am 100% caucasian (irish-welsh descent for many generations) and 53 yrs old.

Sorry for being half correct only. However, at your age, you should get a good outcome. I might just stick with the regular face tip type on your arms rather than the DC tip.

We have the Titan and results have been terrible.

We are looking into Thermage.

We are not interested in getting 20-30% tightening (at best and inconsistently) and having to manage expectations to the point where we have to tell patients that they probably won't SEE a difference. We also don't want to have to "properly select" patients to the point that 90% of patients will not be good candidates. We also don't want to have to "expertly" read our before and after pictures because you really can't see much difference unless you focus really hard,use your imaginate and pretend.

Will the Thermage get us "clinically significant results"? Will our patients be happy? Will we really be able to see results?

We have been burned before and don't want to waste any more money and time on systems that don't work and create bad word of mouth in the community.

Thanks for your help. .

CHMD:
As with any technology, it is paramount to the MD to know it very well. This means WAYYYYY beyond what the sales rep told you. This is why this site is so helpful. I do Thermage and know a lot about it. I would be happy to share my knowledge with you. At the end of the day, it is up to you to decide on its merits. My email is pmhdoc@gmail.com

I had the titan and it can really hurt. No results and still waiting 7months now. Actually it looks worse.

followup from my april posting, i had the thermage, i have lost 1 1/2 inch per arm at the biggest spot, but also lost weight some weight, arms are quite wrinkly now in the front, but i always ketp them covered anyway, the practitioner said it is good to repeat in 6 months for optimum results, what is your opinion? thank you, sonja

To Cheyenne and all of you who use the Titan laser: I too have been badly burned by the Tital laser. I am now in my 36th day since the burns occurred. I have had this procedure before with good results, nothing material has changed since my laste titan treatment, last year. Same operator, same dermatologist. I have this treatment in my Dermatologists office , the operator is a nurse. She has been doing them for 5 years with no problems. I have deep second and third degree burns on my face. I have oozing wounds, which are not healing at the rate you would expect. I am in excellent health. I am now being treated by a burn specialist and the dermatologoist . We have been aware of this problem since the day after it occurred. At first , they thought it was just major swelling and redness--the treatment was not completed. It was aborted in the first minue or two due to pain-- but that afternoon I saw that I was blistering and called the office. They have been treating it since then ,and Cutera could not be less helpful. They took the mackine back and "checked it". They found nothing wrong. Then, after some discussion, they took back the handpiece. They are still "looking at it". We are now debriding the wounds to encourage healing and have stitched one. I would like to hear from anyone who has had experience with these kinds of wounds.

PMDOC,

I am truly impressed by both your knowledge and your well balanced interactions. If you are in Southern California, how I can get in contact with you/r office

Please check out our cosmetic laser equipment rating and reviews site:

http://www.bingmed.com/reviews/cosmetic/all

Thanks.

Hi, i'm 44, with large open pores, which I've had since I was a teenager. Now they look like needle pricks.I now also have hyperpigmentation face/ legs
also depletion of collagen has left me with fine lines and hollowed eyes with noticable bags underneath .
My confidence is zero, I'm looking at facelift or thermage. Myconcern is I scar easily with my brown skin. What treatment would you suggest could work effectively for me?
Thanks

The dates on this blog do not include the year, so I don't know the age of the discussion, but will chime in for Cheyenne just in case. I am 46 years old with a history of acne and minor scarring. I had CO2 resurfacing 1.5 years ago. The results are amazing - you would never know I had acne in the past. I was fortunate that I aged well based on genetics; however, instead of being assumed to be 5 - 6 years younger, it is 10 - 15 years younger. I always had large pores (oily skin be damned) and am constantly complimented on my skin now. HOWEVER, you need to understand the process of going from waking up in recovery to this point. The first week is extremely uncomfortable; my entire face swelled beyond being recognizable and it was very painful. (Take your pain meds and stay ahead of the pain.) By day 2, I could squeeze Cheerio's and plain M&Ms through my lips. Day 3 was the first day I recognized mysef; but the oozing was disgusting. The cleansing and ointment application process can be painful initially, until the scabbing stage. DO NOT PICK THE SCABS AT ALL. Get used to having what I called "corn flake face" for about 10 - 14 days. Be diligent about your post operative instructions (this is surgery!). At 3 weeks, you will see your new skin, but expect to remain very red for another 3 weeks (you are around week 6 now). I didn't go out of the house for 4 weeks. After that, there are many low-end and high-end cosmetics that will cover the redness. The process takes about 2 years to complete, so I haven't seen the final results yet, but would do it again even knowing the pain. I had mild milia that Tazorac took care of and no hyperpigmentation, which is a discussed risk. I am fair skinned but tan easily; rarely burn. I recently had some odd surface issue that I feel is related to the resurfacing; Finacea took care of that. I paid $4500, including the plastic surgeon's fee, hospital surgical suite and anesthesiologist fees. I got on this blog to decide between Thermage v. Titan for another area of my body (vanity runs deep). Thanks for all of the input. Sorry for the length of this post.

Hi, I just received a complimentary Refirme Trinity session. I have to comment that since August I have been having light box treatments for a rash. So when I went for this treatment I did notice that only the firming device was painful and has left a red swollen mark on my jaw line, looks like a welt. I am having these treatments at a Medical Spa and the light box from my dermatologist. My derm. dr. says it is ok to have the lazer but to cover my face with something. I want to know is this swollen mark something that will happen all the time as many people have comment in other posts that they do have marks and that it is painful. The other lazer part of spots and wrinkles that were done on my checks and nose were fine with no marks and no pain.

I am getting great results with Titan and I also own a Lumenis Fractional CO2 for Active and Deep FX. As with any laser proceedure the results are based on patient selection and expectation. The second factor is to always go back to the science. With both Titan and Thermage the goal is bulk dermal heat without causing blisters or burns in the skin. So technique matters. Therefore rather you use Titan or Thermage the goal is the same. We never use just the Titan by itself. We first pre-treat with a radio frequency machine called Lipotron. We do this because it is not only getting the temp of the skin to 38C but how long you keep it there. To reduce the cost of the shots of our Titan we use this device to get the skin to tempture, then we follow with the Titan. We pre-treat one-half of the face with the RF the pulse through with the Titan at 50j with a moving pulse (200 pulses), post heat with the RF, follow with the Genesis, Follow with IPL (Limelight). Great results. We charge $2500 for full face and neck. I would not use this on a patient that is a heavy smoker and has a lot of lip lines and solar elastosis.
My laser center is located in Los Cabos and many of my patients come in for timeshare and don't want to have downtime for there vacation. Husband plays golf for two hours and wife does Titan 3D.
On the other hand I have snowbirds, they stay for 6 months and have a lot of sun damage. For these patients I would use CO2 fractional Active and Deep FX. If they don't mind 3-7 days of downtime. You are never going to remove heavy lip lines with Titan, but you can have beautiful results with the Lumenis Fractional CO2. We charge $3500 for full face and neck. Hope this helps.
One more thing customer satisfaction is key, I never nickle and dime my patients, I treat their hands for spot with IPL I remove their veins. So don't price yourself that you have to upsale everything patients don't like this. We have over 6,000 clients in our database and around 3,000 followers on facebook. Keep them happy.

Hi. I had CO2 Laser resurfacing to my face back in '97 to correct scarring caused by electrolysis. It was a disaster! Not only did it take MONTHS to heal; I was left with worse scarring than before, with the treated area paler than my natural complexion. My surgeon simply shrugged and referred to his 'success rate' with other clients. I had read previously two separate articles reporting that Vegetarians had a tendency to scar with Laser. Has anyone else heard the same? With so many options available now what do you propose I do?

Hi pmdoc-
You have really given me hope. I sustained a small indentation at the hands of a dermatologist who was too aggressive while zapping (with a hyfrecator) an almost imperceptible spider vein about an inch below my right eye. I would like to have Active/Total Fx done on this one spot only (the rest of my face doesn't need it.) However since I've (LITERALLY) been burned before, I want to be sure that the settings are correct so that I don't suffer further scarring. How do I know if I have a doctor I can trust?