Many people looking into Thermage get stuck on one question: "Do I have to be sedated for this?" Quite a few hesitate about the treatment itself out of fear of the pain. This article walks through how Thermage changes the skin, why performing it without IV sedation is the recommended approach, and what each stage of an actual session looks like.
How Thermage works on the skin
Thermage is a lifting device that delivers monopolar radiofrequency energy down into the dermis to apply heat to collagen. Heated collagen fibers contract immediately, and the fibrous septae between the dermis and the subcutaneous fat are drawn in along with them. Over the following months a remodeling process replaces the denatured collagen with newly formed collagen, and skin density gradually fills back in.
The change arrives in stages rather than all at once. Immediately after the session there is tightening and a shift in skin texture from collagen contraction; at 2-4 months, firmness and wrinkles improve as new collagen forms; and around the 6-month mark the process settles and the condition holds. How much improvement appears and how long it lasts vary from person to person.
Why IV sedation is not necessary
To put the conclusion first, Thermage is a treatment you are better off receiving awake than under sedation. The fourth-generation FLX platform in wide use today has improved pain-reduction technology compared with the earlier CPT, so while there is a stinging, hot sensation, most people find it manageable.
The more important reason is the feedback during the session. With Thermage the core of the work is listening to the heat the patient feels and adjusting the energy level to find the "hot but bearable" point, and sedation makes that exchange impossible. Contrary to the common assumption that a higher setting is always better, energy the skin cannot handle can become the cause of side effects such as burns and blisters.
A treatment approach that reduces side effects
The side effects most commonly reported with Thermage are burns and blisters, and less frequently some people feel their skin has turned sensitive or that fine lines look more noticeable. These problems usually arise when high energy and a uniform shot count are applied without regard for the condition of the face. Skin thickness, and how fast and how far the heat rises, differ from person to person, so checking each area and changing the level partway through is what protects safety and results at the same time.
The Thermage 600-shot sequence at Skinique Clinic
At Skinique Clinic, the Thermage 600-shot treatment is built with steps before and after the main session that ease discomfort and support the skin's recovery. The actual order is as follows.
First, a consultation confirms the direction you are hoping for and whether Thermage is a suitable option to begin with.
Once treatment is decided, cleansing is followed by needle-free ultrasound anesthesia. Numbing cream is applied and then worked in with the sono device, so the cream penetrates more deeply, the numbing effect lasts longer, and the skin's moisture level rises to a state in which radiofrequency energy works well.
After the numbing cream is wiped off, a grid is drawn on the face. It is a guide that keeps heat from overlapping in one spot and helps cover the whole face evenly. The genuine 600-shot tip is then opened in front of you so you can see it for yourself before it is loaded into the device.
During the main session, as described above, we exchange feedback about the heat and adjust the energy level area by area.
When all 600 shots on the genuine tip have been used, the device screen displays it and further treatment is blocked automatically, so you can verify the shot count with your own eyes.
After the session the grid is wiped away and a salmon regenerating ampoule step follows. It replenishes moisture and nutrients in skin that has absorbed heat energy to support recovery; hydration care before and after a radiofrequency treatment plays an important part in lifting the result.
The LED light therapy that follows encourages cellular metabolism so the skin settles more quickly.
Finally, a Rejuran pack is laid on to supply moisture and nutrients one more time, and the whole process is complete. From consultation through the finishing care the session is not short, so it is a good idea to leave room in your schedule when you book.
Wrapping Up
Thermage is not a treatment where energy is simply pushed as high as it will go; it is one that searches for the optimal level your own skin can take. That is why proceeding without sedation, in conversation with the doctor, works in favor of both results and safety. Detailed costs can be found on the price guide. If you are wondering whether Thermage is the right choice for your skin, try asking by chat about the direction that suits your skin.
This article was written by Dr. Park Tae-hyung, Chief Director. He is the chief director of Skinique Clinic and serves as academic director of the Korean Society for Laser Dermatology and Trichology.
First published January 21, 2025 · Last reviewed August 23, 2026
This text is general medical information. Skin condition and response to treatment can vary from person to person. Please decide whether and how to be treated through an in-person consultation.