Thermage
Thermage heats the deeper layers with radiofrequency. The tip is stamped across the area.
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Dermapedia / CompareProcedures
Thermage vs Fraxel
Thermage firms. It heats a block of skin from the outside in a single visit, never breaks the surface, and is aimed at crepey texture and mild slackness. Fraxel resurfaces. It puts columns of controlled heat into the skin to treat texture, acne scars, sun damage and lines, and it costs you several days of peeling. They fix different complaints, so the choice is firmness against surface quality.
At a glance
| The difference | Thermage | Fraxel |
|---|---|---|
| What it does to your skin | Radiofrequency heat through the skin | Columns of controlled heat injury |
| What it is best at | Crepey texture and mild slackness | Texture, acne scars and sun damage |
| What it feels like | A hot flick, over and over | Hot snaps, then a sunburnt face |
| Downtime | None | About a week of redness and flaking |
| How long until it works | Two to six months | A week for glow, months for the rest |
Fraxel
Fraxel treats the skin in tiny columns and leaves the skin between them alone. Eye shields are worn.
Side by side
The differences that matter
What it does to your skin
Thermage
Radiofrequency heat through the skin
Current passes through the tissue to a pad on your back. The skin's own resistance to that current is what makes the heat.
Fraxel
Columns of controlled heat injury
The laser treats a fraction of the surface and leaves the skin in between untouched. That untouched skin heals the rest.
Does it break the surface
Thermage
No
A coolant spray protects the top of the skin while the heat builds underneath. Nothing is punctured or removed.
Fraxel
Yes, in thousands of tiny columns
That is the point. The healing is what lays down new collagen and remodels a scar.
What it is best at
Thermage
Crepey texture and mild slackness
Thin skin, fine wrinkles and skin that has lost its snap, including around the eyes.
Fraxel
Texture, acne scars and sun damage
Sunken acne scars, rough or crepey skin, fine lines, brown spots and surgical scars.
Conditions treated
Fraxel
Stretch Marks
The best-evidenced device for mature white marks, and useful on red ones too. It puts columns of controlled heat into the supportive layer to force a fresh round of collagen remodeling, over three to six sessions spaced weeks apart. Expect partial improvement in texture and how noticeable they are, not removal. On deeper skin tones it is used at conservative settings after a test patch, because of the pigment risk.
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Wrinkles and Fine Lines
Heats columns in the dermis without removing the surface, so it improves fine lines, texture and pigment with a few days of redness and swelling instead of a week of raw skin. It takes three to five sessions to match a fraction of what one ablative treatment does. It is the more sensible starting point on deeper skin tones.
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Sun Spots (Solar Lentigines)
Treats the sun-damaged skin as a whole rather than targeting individual spots, so it improves texture and fine lines alongside the pigment. That makes it a reasonable choice when the spots are only part of what is bothering you. For clearing spots alone it is slower, dearer and less precise than freezing or a pigment laser.
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Acne Scarring
Resurfaces without removing the surface, so recovery is a few days of redness and swelling rather than a week of raw skin. It gives less improvement per session than CO2 and needs more sessions to get there. It is the sensible middle option when the downtime of ablative laser is not workable.
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What it will not do
Thermage
It does nothing for scars or spots
The surface is never broken and no light is involved, so scarring and pigment are untouched.
Fraxel
It will not firm slack skin
Resurfacing changes the surface. Slackness sits deeper than it reaches.
Related topic illustrations
Fraxel
Microneedling
Moderate evidence. Aimed at the same acne scar and texture problems, without light or heat, so the pigment risk is lower, which matters on deeper skin tones. Generally cheaper per session and gentler, and generally slower to show the same amount of change.
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Chemical peel
Strong evidence for surface pigment and clogged pores. Much cheaper and available almost anywhere. It works on the surface, so it does not reach indented scars and does far less for texture.
←2 / 3→
Clear + Brilliant
Limited evidence, from the same manufacturer. A far gentler version of the same idea, with about a day of downtime and a much smaller result per session. A reasonable choice for early texture and dullness, not a substitute for a course of Fraxel on scars.
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What it feels like
Thermage
A hot flick, over and over
The tip is stamped across the area with a spray of coolant before and after each pulse. Uncomfortable rather than dreaded.
Fraxel
Hot snaps, then a sunburnt face
Numbing cream first. The heat lingers for hours afterwards.
Downtime
Thermage
None
Redness and slight swelling for a few hours. Make-up the same day is normal.
Fraxel
About a week of redness and flaking
Swelling and a bronzed, rough look for five to seven days. The strongest version removes surface skin and needs one to two weeks of wound care.
How many sessions
Thermage
Usually one
Repeated after a year or two if you liked it.
Fraxel
One strong, or three to five gentle
The gentler setting is a course, four to six weeks apart.
How long until it works
Thermage
Two to six months
Collagen contracts a little on the day, then rebuilds slowly.
Fraxel
A week for glow, months for the rest
Skin looks brighter once the peeling ends. Scars and texture keep improving for months.
How it works, illustrated
Fraxel
How long it lasts
Thermage
About one to two years
These are the usual clinic figures rather than measured ones.
Fraxel
Years, for texture and scars
New collagen is real change. Sun exposure brings new pigment back sooner.
Skin tone
Thermage
No light, so no pigment target
Radiofrequency heats tissue rather than aiming at colour, so it is reasonable across skin tones.
Fraxel
Light and heat both raise the risk
Any laser can leave a patch that heals darker. That is more likely on deeper skin tones, and it is managed with lower energy and longer gaps.
Cost
Thermage
Priced by treatment tip and area
One visit, so the total is easier to pin down. Ask how many pulses are included.
Fraxel
Priced per session, often a course
Ask what a full plan costs rather than one visit.
The at-home or drugstore version
Thermage
Home radiofrequency wands are far weaker
They warm the top of the skin a little. The clinic device drives current through the full thickness of the skin with a return pad, which is a different scale of heating.
Fraxel
A retinoid cream is the honest version
Home fractional wands reach only the very top of the skin at a fraction of the power. A nightly retinoid is slower than resurfacing and it genuinely works on texture and fine lines.
Who each suits
Thermage
- Best for — Crepey, thin skin that has lost its firmness.
- The trade — A modest, slow result, in exchange for no recovery.
Fraxel
- Best for — Acne scars, rough texture, sun damage and lines.
- The trade — Real time off for a visible change in the skin.
Firmness or surface
Thermage
Thermage is aimed at the quality of the skin, not its finish. Heating the full thickness makes collagen contract and then rebuild, and the result is skin that feels tighter and looks less crepey.
Fraxel
Fraxel is aimed at the finish. It remodels the layers where scars, roughness and brown spots live, by injuring them in a controlled way.
The risks worth knowing
Thermage
Thermage's rare problems come from heat concentrating in one spot. Burns and blistering are uncommon. So is loss of fat under the skin, which leaves a small dent.
Fraxel
Fraxel's common problem is a dark mark left behind. Post-inflammatory hyperpigmentation, the brown staining after skin is inflamed, is the usual complaint and is more likely on deeper skin tones.
Common questions
Questions Patients Ask
What is the difference between Thermage and Fraxel?
Thermage heats skin from the outside to firm it, and never breaks the surface. Fraxel makes tiny columns of controlled damage in the skin to resurface texture, scars and sun damage.
Which one has downtime?
Fraxel. Expect about a week of redness and flaking, and one to two weeks if the strongest, surface-removing version is used. Thermage leaves you red for a few hours and nothing more.
Which is better for acne scars?
Fraxel. Scars need the skin remodelled at the level the scar sits, and Thermage never breaks the surface, so it does nothing for them.
Which is better for loose or crepey skin?
Thermage. It heats the full thickness of the skin so collagen contracts and rebuilds. Fraxel works on the finish of the skin, not its firmness.
Can I have both?
Yes, at different times. They treat different complaints, so they are not really rivals. Leave weeks between them rather than asking the skin to heal from two things at once.
How long does each one last?
Thermage is usually quoted at one to two years, though those are clinic figures rather than measured ones. Fraxel's change to texture and scars is collagen, so it lasts years, with sun exposure bringing pigment back sooner.