Does Thermage hurt? What it feels like and how we manage it

Thermage had a reputation for pain in its early years. With the current device, Thermage FLX, reviews describe heat rather than sharp pain. "Hot" and "warm but bearable" are common descriptions, and some people report that the cheekbone or chin felt hotter. This article covers what Thermage FLX pain feels like and how we manage it.

Heating of the dermis causes the pain

Thermage heats the whole dermis beneath the contact surface of the tip. The pre-cooled tip touches the skin, and once the pulse begins, radiofrequency and cooling alternate so that the surface is cooled and protected while the dermis heats (U.S. FDA 510(k) K170758). The hot sensation comes toward the end of the pulse, when heating of the dermis peaks.

Bony areas such as the jawline hurt more

In our experience, the jawline and the sides of the face, where the soft tissue is thin, are more often reported as painful than the cheeks. A report on Thermage under nerve block likewise judged that topical anesthesia alone could not control pain in the jaw and neck (Chen 2024, PMID 37878546). No study, however, has compared Thermage pain across areas using pain scores.

Treatment with no anesthesia at all is unrealistic

The manufacturer states that Thermage can be performed with no anesthesia at all, numbing cream included (Solta Medical Korea 2026). That is not realistic. In 46 people who had 2% lidocaine cream for 30 minutes before Thermage FLX, pain immediately after treatment averaged 6.62 and 7.12 out of 10 for the two sides of the face (Wang 2026, PMID 41924292). In the same study, those aged 42 or younger scored higher than older participants.

Numbing cream reaches deeper the longer it stays on. In a study in which numbing cream was applied to the thigh under a film dressing, needle insertion was tolerable to an average depth of 2.9 mm after 60 minutes and 4.5 mm after 120 minutes (Wahlgren 2000, PMID 10727302). Because Thermage heats a shallower layer than Ultherapy, leaving the cream on longer may reduce pain further. No study, however, has compared Thermage pain by the duration of cream application.

We recommend nerve blocks along with numbing cream

Waiting an hour or two with the cream on is not practical, and as noted above, cream does little for the jaw and neck. We therefore usually recommend nerve blocks for the whole face. A nerve block places local anesthetic around the sensory nerves of the face and numbs the area each nerve supplies for a few hours. One report describes blocking the buccal nerve and the superficial cervical plexus together to cover the jaw and neck, but it did not compare pain scores with and without the block (Chen 2024, PMID 37878546).

Whatever the anesthesia, you need to be able to tell us how hot it feels during treatment. The manufacturer also recommends keeping to a level that is "slightly hot but tolerable" and adjusting the energy in consultation with the clinician (Solta Medical Korea 2026). For that reason we generally do not recommend intravenous sedation, in which you sleep but keep breathing on your own and cannot give that feedback. If you prefer it, we can proceed carefully with conservative energy settings.

Instead, if you are sensitive to pain, you may take a pain reliever before your visit. If the pain is still severe, we can add nitrous oxide inhalation, commonly known as laughing gas. You remain awake and can still give that feedback.

For how Thermage delivers heat, see How Thermage FLX tightens skin: broad heat below a cooled surface. For pain with other devices, see Does Ultherapy hurt? What it feels like and how we manage it and Does Sofwave hurt? What it feels like and how we reduce it.

References

1. U.S. Food and Drug Administration (2017). 510(k) Summary K170758: Thermage FLX System. accessdata.fda.gov.
2. Chen X, et al. (2024). Achieving the minimum pain experience by buccal nerve and superficial cervical plexus blocks in radiofrequency treatment. J Cosmet Dermatol. PMID 37878546 (opens in new window).
3. Solta Medical Korea (2026). Thermage FLX official website FAQ: Does Thermage hurt? Is anesthesia required?; Is aftercare needed right after Thermage? thermage.co.kr (accessed 2026-10-04).
4. Wang Y, et al. (2026). Evaluation of the effect of laterality and age on pain perception in monopolar radiofrequency facial therapy. Clin Cosmet Investig Dermatol. PMID 41924292 (opens in new window).
5. Wahlgren CF, Quiding H (2000). Depth of cutaneous analgesia after application of a eutectic mixture of the local anesthetics lidocaine and prilocaine (EMLA cream). J Am Acad Dermatol. PMID 10727302 (opens in new window).