The intense heat created by the radio frequency waves causes an immediate tightening of the collagen network, thereby tightening your skin while the effects of the thermal wound stimulates the fibroblasts to react and cause new collagen to form over the following weeks and months after treatment.  This collagen formation thickens the skin and lessens wrinkles, plus tightens the tissue over the following months creating a lifting effect. 

You may wonder how the intense heat does not cause damage, such as blistering and burning, to the surface of the skin.  There is a cooling, cryogen spray which is applied in bursts right before the radio frequency is emitted, and right after the pulse.  This action super-cools the skin, without causing any type of damage itself from the coolant, and prevents damage to the surface of the skin from the heat. 

On a personal note, I have had this procedure and went in not expecting much, and did receive benefits from just one treatment but it only lasted about 7 to 9 months.  And it hurt.  I am not going to kid you. It was very hot and felt pretty bad even with topical anesthesia and regional anesthesia administered halfway through the procedure.   Not everyone will feel as much pain as I did but at least you will not expect a cake walk.

What is it approved for?  "The ThermaCool TC System has an FDA clearance for the noninvasive treatment of periorbital rhytids and wrinkles*, and works by tightening tissue with an advanced form of radiofrequency. The Company is actively studying other aesthetic applications in its research programs.  *Also indicated for dermatological and general surgical procedures for electrocoagulation and hemostasis." (credit: Thermage Website)

The forehead treatment can give you a lift to the brows and a tightening of the forehead skin.  This may lessen wrinkles on the forehead through tightening and possible skin thickening.  The undereye treatment may give you thickened skin, tightening and lifting of the upper cheek skin.  The cheeks may assist in lifting them slightly and diminishing enlarged pores.  The mid and jaw line are treatment may diminish your jowling and sagging along the jaw line.  As with the jaw line treatment, a treatment on the neck may help tighten your skin and diminish wrinkling of the neck.  The procedure has also been said by our visitors to have helped them with their acne breakouts.

You will discuss what areas will be treated as sometimes only the forehead, temple and undereye area may be necessary.  You will discuss treatment protocol and discuss what to expect immediately post-op and over the following few days after treatment.  You should also discuss the procedure fees and pre-op/post-op medications, and topical creams, if necessary.  Your doctor may take before photos of the area to be treated, but usually this is reserved for the day of the procedure. 

If you don't discuss this with your doctor at your consultation after he knows you are going to book with him, he may provide this information over the phone, or at a pre-operative appointment.  If you are not told well in advance of any of the above before your procedure, please ask your doctor for specifics. 

Preparing For Your Treatment
There really isn't too much preparation, physically, unless your doctor specifically asks you to avoid certain medications, supplements, coffee, smoking, or alcohol beforehand.  Please determine this before your procedure.

Caffeine and Nicotine can also make some people more sensitive, plus it is a vasoconstrictor.  Vasoconstriction is when the bore of your blood vessels are narrowed, decreasing the amount of blood to the treatment area.  Obviously hemoglobin and oxygen are vital for proper healing -- so not smoking is especially helpful.  Vitamin E and alcohol consumption also may make some patients bruise more easily, especially if you are prone to such.  Inquire about the cessation of these two as well.

From experience, I was sure to book well before my menstrual cycle because my skin is far more sensitive right before and during.  So if you are a woman, you might want to take this into consideration.  

Vitamin C is considered helpful in collagen synthesis and health by some doctors so please ask your doctor if you may take this vitamin and what dosage.  Some doctors suggest that their patients take Arnica Montana or Bromelain to help with bruising and swelling.  However, it is very important to ask of your own doctor's approval before consuming any of the above.

I would make arrangements for someone to drive you to and from your procedure should you choose any type of sedative.  It can make you drowsy, thereby being very dangerous for you to drive.  If you will not be having any type of sedative, as I did not, you may be able to drive yourself home or back to work if you so wish, after your procedure.  personally, I would not have gone back to work after as I was swollen and had lumps from the thermal wound response.  I also felt as though I had a sunburn.  If I were you, I'd take off the rest of the day.  But, everyone is different.   I can gladly go back to work after Botox and Collagen, but Thermage?  No thanks.

As far as directly before your treatment, you may be given an oral sedative an hour in advance or be asked to take it before you arrive (have someone drive you!).  Once you are there, you may have your make up and surface oils removed and your skin cleansed to reduce surface bacteria.  You may also have a topical anesthetic cream applied and covered about an hour in advance.  If you are having the latter, you may be given the oral sedative and topical anesthetic cream upon arrival.  It usually takes about 30 minutes to an hour for full effect so you may be asked to come an hour ahead of time.

Your doctor will then apply a coupling fluid/gel right before beginning your treatment.  The single-use hand piece, which has a monopolar electrode, is placed flush to the treatment area.  Your doctor will then work across one side to the other until your treatment is complete.  After your procedure, a soothing gel or lotion is applied to your skin.

What Does It Feel Like?
Without adequate anesthesia, it feels like tiny, little pokes of a red hot needle, one...two...three...then onetwothreefourfivesixseveneightetc...all at once!  OUCH!  First, there is a blast of cryogen spray to cool the epidermis, thereby prohibiting damage to the upper layer of skin, while heating the first 2/3 of the dermis.  I did not feel the cryogen spray.  However, there was still pain and very intense, deep heat.  Even with regional anesthesia and topical, it was still very hot and it hurt.  

After the anesthesia wore off I noticed I started getting more numb late that night.  I noticed numbness on my forehead and temple -- and the knots/lumps started getting bigger, too.  I had numbness for about 2 weeks in certain areas as well.  You can see my photo journal and follow my recovery if you are interested.

You may be given soothing, healing lotions, creams or gels to lightly apply to your treatment area, and possibly a cool, moisturizing mist to apply as you feel necessary.  

You usually will not shower or wash your face that night, however some doctors suggest a cool water rinse and to reapply the moisturizers you were given.  You may notice more swelling before you go to sleep at night and also the very next day.

Your collagen will continue to form and network and cause a subtle (and sometimes considerable) lifting and tightening effect.  I also noticed lessened dark circles because in the areas treated the tissue became thicker.  I noticed brow lifting, more lid show and less fine lines on my forehead.  Please see my photo journal for my before and afters.  

Some visitors on our boards have confided they saw no improvement, others report subtle or even great improvement, still others... fat loss (see risks below).  Your own results may vary.

How Long Do The Effects Last?
Your effects may last anywhere from a couple of months to several years, depending upon the aging process, your habits as an individual, and your own body.  Some doctors advise that you have several treatments over a course of a year at first and then every year or two as a touch up.  Others believe that touch ups may only be necessary should you notice sagging over the years.  This procedure in generally new so the longevity is not greatly known.

Update: It lasted no more than 9 months for me and I feel as though I lost facial fat, especially on my forehead.  I personally would not choose to get this procedure again.

Like I said, I felt I had fat loss.  Fat loss in the cheeks is far easier to treat than fat loss in thin areas such as the forehead.