Thermage FLX can reduce oiliness and inflammatory acne, but it is not a first-line acne treatment. Two small studies found fewer inflammatory spots and lower sebum after one or two sessions, and the effect lasted up to a year in the patients who were followed. I use Thermage mainly to tighten skin. For active acne, AviClear, AGNES and prescription treatment have stronger evidence. This guide covers how Thermage works on acne-prone skin, what the studies found, how it compares with other acne treatments, and what it costs in Singapore.
Key takeaways
- Thermage FLX heats the dermis with monopolar radiofrequency. The oil glands sit in this layer, and cooling protects the skin surface.
- In a 2024 study of 24 patients with moderate to severe acne, two Thermage FLX sessions four weeks apart reduced inflammatory spots by 46 per cent and sebum by 22 per cent at six months [2].
- In the 11 patients followed to one year, spot counts and sebum stayed lower than before treatment [3].
- The studies are small and had no comparison group, so Thermage does not replace AviClear, AGNES or isotretinoin for active acne.
- Thermage is not an acne scar treatment. Depressed scars need subcision, fractional laser or radiofrequency microneedling.
- A full-face Thermage FLX session costs $4,500 before GST at my clinic.
How Thermage Works on Acne-Prone Skin
Thermage FLX delivers monopolar radiofrequency through a treatment tip placed on the skin. The current heats the dermis and the fibrous layer beneath it, while bursts of cryogen spray cool the surface so the epidermis is protected. The sebaceous glands that produce the oil feeding acne sit in the dermis, inside the heated zone.
Heat has two effects that matter for acne-prone skin. It lowers the amount of sebum the glands produce, and it contracts and remodels dermal collagen, which is why Thermage is used for skin tightening. Pore volume also falls as the skin firms [2].
Numbing cream is applied before treatment, and most patients describe short pulses of heat. There is no wound, and most patients return to work the same day.
What the Studies Show for Thermage and Acne
The first study, published in 2003, treated 22 patients aged 16 to 28 with moderate to severe acne using the original Thermage device. Most had a single session. Eighteen of the 22 patients (82 per cent) had an excellent response on lesion counts and questionnaires, and no side effects were recorded [1].
A 2024 study from Siriraj Hospital in Bangkok treated 24 patients with moderate to severe acne with Thermage FLX, giving two sessions four weeks apart. Twenty completed the study. Six months after the second session, inflammatory lesions had fallen by 46 per cent, sebum output by 22 per cent and pore volume by 42 per cent. Quality-of-life scores improved by 80 per cent [2].
The same group reviewed 11 of those patients at one year. Inflammatory and non-inflammatory lesion counts remained significantly lower than before treatment, and sebum continued to fall [3].
The results are encouraging but limited. Each study is small, neither compared Thermage with an established acne treatment, and almost half of the patients were not seen at one year. AviClear, by comparison, was cleared by the FDA for acne on the strength of a 104-patient multicentre trial [5].
Thermage Compared With AviClear, AGNES and Isotretinoin for Acne
| Treatment | How it acts on acne | Evidence | Where it fits |
|---|---|---|---|
| Thermage FLX | Heats the whole dermis and lowers sebum output | Two small studies of 22 and 24 patients, no control group | Oily, acne-prone skin in a patient who also wants skin tightening |
| AviClear | 1726 nm laser that selectively heats the oil glands | FDA-cleared for acne, 104-patient multicentre trial [5] | Mild to severe acne in a patient who wants to avoid long-term medication |
| AGNES | Insulated microneedle radiofrequency that destroys individual oil glands | 63-patient randomised controlled trial [6] | Moderate to severe inflammatory acne |
| Isotretinoin | Oral medication that shrinks the oil glands across the whole skin | The strongest evidence of any acne treatment | Severe, nodular or scarring acne |
For active acne I start with AviClear, AGNES or prescription treatment. Thermage has a place when a patient with oily, acne-prone skin also wants the face tightened, because one treatment then addresses both. The differences between the acne treatments are set out in AviClear vs isotretinoin, AGNES vs AviClear vs Gold PTT and the acne treatment review.
Can Thermage Treat Acne Scars?
Thermage is not an acne scar treatment. Its heat spreads evenly through the dermis, whereas depressed scars are tethered by fibrous bands and need treatment directed at each scar. Tightening the skin can make shallow rolling scars look slightly softer, but it does not lift ice pick or boxcar scars.
Scars respond to subcision, which releases the bands, and to fractional CO2 laser and radiofrequency microneedling such as Infini and Secret RF, which remodel the scar. The acne scar treatment guide explains how each scar type is matched to a treatment.
Thermage Side Effects and Who Should Not Have It
Redness and mild swelling are common and temporary. Blisters, small burns and dents from fat loss are uncommon and are linked to high energy and overlapping pulses. In a review of 757 sessions using an older Thermage protocol, second-degree burns occurred in 2.7 per cent of sessions and persistent redness in 1.2 per cent [4]. Neither acne study recorded significant side effects [1, 2].
Thermage is not used in a patient with a pacemaker, defibrillator or other implanted electronic device, during pregnancy, or over skin with an active infection.
Thermage Cost in Singapore for Acne-Prone Skin
A full-face Thermage FLX session costs $4,500 before GST at my clinic. The acne studies used one or two sessions, and the number of sessions is agreed at consultation. Costs for AviClear, AGNES and the other acne treatments are listed on the acne treatment cost page, and HIFU and Thermage prices are compared on the HIFU price page.
Dr Gerard Ee, Aesthetic Doctor in Singapore
Dr Gerard Ee is an aesthetic doctor in Singapore and the Medical Director of his practice at 50 Raffles Place. He graduated from St George’s, University of London, trained in surgery at Singapore General Hospital and the National University Hospital, and holds the MRCS (Edinburgh) and a postgraduate diploma in practical dermatology from Cardiff University.
He has practised aesthetic medicine since 2012, is the author of sixteen peer-reviewed papers, and writes and medically reviews every article on this site. Read more about Dr Gerard Ee.
Book a Thermage or acne consultation with Dr Gerard Ee
Dr Gerard Ee consults and performs Thermage and acne treatments at The Clifford Clinic, 50 Raffles Place, Singapore. Consultations are by appointment. Message the clinic on WhatsApp, or call 6532 2048.
Thermage for acne questions
Can Thermage treat acne?
Thermage FLX can reduce inflammatory acne and oiliness. In a 2024 study, two sessions four weeks apart reduced inflammatory spots by 46 per cent and sebum by 22 per cent at six months. The studies are small, so Thermage is an option for oily, acne-prone skin in a patient who also wants tightening, rather than a first-line acne treatment.
Is Thermage FDA-cleared for acne?
No. Thermage is FDA-cleared for the non-invasive treatment of wrinkles, including around the eyes. Its use for acne rests on the published studies described on this page.
Does Thermage help acne scars?
Thermage does not treat depressed acne scars. Tightening can soften shallow rolling scars slightly, but ice pick and boxcar scars need subcision, fractional CO2 laser or radiofrequency microneedling.
How many Thermage sessions are needed for acne?
The acne studies used one or two sessions, with two sessions given four weeks apart in the most recent study. The number of sessions is agreed at consultation.
How much does Thermage cost in Singapore?
A full-face Thermage FLX session costs $4,500 before GST at my clinic.
Selected References
Show the references (6)
- Nonablative radiofrequency for active acne vulgaris, the use of deep dermal heat in the treatment of moderate to severe active acne vulgaris (thermotherapy), a report of 22 patients. Dermatol Surg. 2003;29(4):333-339. PMID 12656809
- Long-term efficacy and safety of nonablative monopolar radiofrequency in the treatment of moderate to severe acne vulgaris. Lasers Surg Med. 2024;56(2):133-141. PMID 38221810
- One-year follow-up of acne vulgaris patients treated with nonablative monopolar radiofrequency, efficacy and safety assessment. Lasers Surg Med. 2025;57(5):397-404. PMID 40371601
- Adverse reactions after nonablative radiofrequency, follow-up of 290 patients. J Cosmet Dermatol. 2007;6(3):163-166. PMID 17760693
- Novel 1726 nm laser demonstrates durable therapeutic outcomes and tolerability for moderate-to-severe acne across skin types. J Am Acad Dermatol. 2023;89(4):703-710. PMID 37328000
- Selective sebaceous gland electrothermolysis using a single microneedle radiofrequency device for acne patients, a prospective randomized controlled study. Lasers Surg Med. 2020;52(5):396-401. PMID 31502662
Dr Gerard Ee consults and performs this treatment at The Clifford Clinic, 50 Raffles Place, Singapore.
This page is written from published research and from clinical experience in Singapore since 2012. It is for general education, not medical advice. Whether a treatment suits you, what it may achieve and what it may risk can only be established at a consultation. Dr Gerard Ee is the Medical Director of The Clifford Clinic, a private clinic in Singapore, and treatments discussed on this site are provided commercially.
