For many people, aesthetic treatments are something to consider only after wrinkles deepen or facial contours begin to change.

But a growing approach to skin ageing takes the opposite view: maintaining collagen before those changes become more obvious.

According to aesthetic doctor Dr Gerard Ee, medical director and co-founder of The Clifford Clinic, conversations about early facial maintenance often begin with patients in their early 30s onwards, when collagen production begins to decline and early skin laxity may first appear.

These subtle changes can include a softer jawline, smile lines that linger a little longer and facial contours that appear less defined.

“Preventive care is about maintaining collagen strength before laxity becomes more obvious,” says Ee. He explains: “Think of the skin like a bedsheet, and collagen as the elastic fibres underneath that keep the ‘sheet’ smooth, firm and well supported. As we age, collagen becomes weaker and less organised, so the ‘sheet’ starts to look loose, thinner and less taut.”

Treatments that stimulate collagen aim to support this underlying structure rather than simply treating visible wrinkles. One option for maintaining facial firmness before more pronounced sagging develops is Thermage FLX.

The Clifford Clinic has been offering Thermage treatments since 2014, first with Thermage CPT and now with the latest fifth-generation Thermage FLX system. Compared with the earlier system, it uses a larger treatment tip that covers more skin with each pulse, helping to shorten treatment time.

Thermage FLX uses monopolar radiofrequency energy to gently heat the deeper, collagen-rich layers of the skin. According to Ee, this is useful for areas such as the upper eyelids, jawline, lower face and neck, where early skin laxity can make the face look less defined.

“It is non-invasive, requires little to no downtime for most patients, and is typically done as a once-yearly collagen stimulation together with lifting, tightening and contouring treatment,” he says.

“For patients who are not ready for surgery but want natural-looking improvement, it may be considered as one option for addressing mild to moderate skin laxity.”

What happens during a Thermage FLX treatment

A Thermage FLX session at The Clifford Clinic begins with a consultation, where the doctor will assess the patient’s face shape, skin laxity, areas of concern, medical history, previous treatments and expectations.

“Since the treatment can be used as preventive care for younger patients, the consultation is very important as we look at skin quality, facial structure, lifestyle factors and whether there is any genuine early laxity,” Ee says.

Thermage FLX uses radiofrequency energy to support the skin’s natural collagen remodelling as part of a non-invasive approach to maintaining skin firmness.

PHOTO: THE CLIFFORD CLINIC

First, numbing cream is applied and left on for about 30 minutes. After that, the skin is cleansed.

During treatment, patients typically experience repeated pulses of heat, together with cooling and vibration that help improve comfort. According to Ee, the level of discomfort depends on the patient’s sensitivity, the treatment area, the energy settings and, most importantly, the operator’s technique.

He notes: “Thermage can be uncomfortable, but communication during treatment is important because we can adjust both the energy settings and the treatment technique according to the patient’s comfort.

“At our clinic, we use a customised contour-based technique rather than rigidly treating every face in fixed grids. By spreading the energy according to the facial contours, patients often find the treatment much more tolerable.”

Depending on the treatment area, the doctor selects one of three device tips designed specifically for the face, eyes or body.

What results can you expect from Thermage FLX?

Says Ee: “One of the capabilities of Thermage FLX is treating the eye area. It can be used on wrinkles around the eyes, including the upper and lower eyelids, which requires very careful and controlled treatment. Clinically, tightening the eyelid skin may create a subtle lifting or opening effect around the eyes in suitable patients.”

When administering treatment close to the eye area, proper protection like plastic eye shields are used.

A full-face Thermage FLX treatment typically takes around 30 minutes to complete (excluding numbing), so it can be scheduled as a lunchtime treatment, says Ee.

There is usually little to no downtime, and most patients can apply make-up, exercise and resume their normal activities. However, in some patients, there may be mild redness or swelling that usually resolves on its own, he says.

Most importantly, Ee emphasises that Thermage FLX works with the body’s own collagen response, so patience is needed.

“Some patients may see early tightening, but the more meaningful improvement usually develops gradually as collagen remodels over the next few months. The gradual onset also contributes to natural-looking results, because the skin’s natural rebuilding process takes time.”

According to Ee, results may last one to two years for suitable patients. He notes that it is also not suitable for patients with certain electrical implants such as pacemakers, defibrillators or other implantable electrical devices, as well as pregnant patients.

Thermage FLX vs HIFU: What’s the difference?

Thermage FLX can be used on its own, or it can also form part of a broader treatment plan.

Ee says one complementary treatment option is High-Intensity Focused Ultrasound (HIFU), which sends focused ultrasound energy deep into the skin. It targets deeper tissue layers than Thermage FLX, and in suitable patients, may help contour the face and reduce fat deposits in areas such as the cheeks, jowls, neck and under the chin.

Like Thermage FLX, HIFU is non-invasive and typically requires no downtime, says Ee.

However, he notes that although HIFU targets deeper tissue layers, patients with severe sagging may want to consider aesthetic surgery to address the underlying structures responsible for more serious facial laxity.

Ee will also assess those who have undergone recent aesthetic treatments before deciding the best plan for them.

He notes: “For those who have had eye-bag surgery or double-eyelid surgery, Thermage can still be considered once the eye area has fully healed and there are no active issues such as swelling, infection or abnormal scarring.

“The most important thing is choosing the right treatment, or combination of treatments, for the patient’s face, age, anatomy and goals.”

Find out more about Thermage FLX and HIFU at The Clifford Clinic.