Gwyneth Paltrow’s says Botox: No, Thermage: Yes

It’s no secret that women look to celebrities for fashion and beauty tips.

So when women get a chance to hear from celebrities like Gwyneth Paltrow, who at 40 looks as bright faced as she did in her 20’s, they listen.

In an interview in this month’s Harper’s Bazaar, Paltrow talks about the dichotomy of her health and beauty choices:

I think it’s a mix….You know, I use organic products, but I get lasers. It’s what makes life interesting, finding the balance between cigarettes and tofu.”Paltrow admitted to trying many non-surgical cosmetic procedures, saying “I would be scared to go under the knife, but you know, talk to me when I’m 50. I’ll try anything. Except I won’t do Botox again, because I looked crazy. I looked like Joan Rivers!

Joan Rivers‘s response?  “She should see what I look like without Botox – That’s really scary!”

But Gwyneth did approve of the treatment she got from her dermatologist in Los Angeles:

[My dermatologist] gave me this amazing laser the last time I was there. It’s called Thermage. It’s not invasive. I went out to dinner right afterward and I didn’t look crazy, but it’s quite painful. It feels like someone’s smacking your face with a rubber band that has an electric shock in it. But I would do it again, because I feel like it took five years off my face.

What is Thermage?

Thermage is the brand name for one of several non-invasive cosmetic procedures which uses radiofrequency technology.

A few words about skin aging: As we age, our skin becomes subject to damage from the sun, called photodamage or solar elastosis. Clinically, this is seen as fine lines,  wrinkles,  skin looseness, skin discolorations and the formation of those tiny spider veins, called telangiectasias .


Normal skin layers

At the microscopic level, one sees an accumulation of elastic fibers in the dermis- the deepest layer of the skin (see diagram, right). Collagen fibers, which act as a scaffold, becomes increasingly disorganized. The collagen is prone to breakdown and there is less ability to make new collagen.

The traditional method of surgical repair using procedures such as eye lid lifts (blepharoplasty), and  brow or chin lifts are being replaced by less invasive procedures as the demand for cosmetic procedures has increased.

One kind of procedure called ablative laser resurfacing uses intense pulsed light to treat and remove wrinkles arising from photo-aging. The process induces controlled wounds on the skin, prompting it to heal itself by creating new cells. The main disadvantages include downtime that can last 4 to 6 weeks and complications that include oozing, bleeding, and infection.

Non-ablative lasers were developed to address these problems.  They create less heat to the lower layers and are better suited for mild to moderate photo-aging. They typically require more treatments (typically 4-6) to get the desired effects. Recovery time is decreased- only about 3 days after each session.

Radiofrequency Technology

Radiofrequency technology (RF) also produces thermal (heat) damage to the dermis, however it does it by using an electric current rather than light. The technology has been around since the 1920’s, when it was used in electrocautery devices. Since 2002, when it was approved by the U.S. Food and Drug Administration (FDA), it has been used for non-ablative skin rejuvenation.

RF devices produce an electric current using electromagnetic radiation. The characteristics of  a particular tissue determines the amount of heat produced by this current. Subcutaneous fat is a high impedance tissue which generates greater energy and heat effects.

During the procedure, a cooling spray is applied to the skin which protects the epidermis. Heat produced by the device causes partial unwinding of  dermal collagen. This has been shown to lead to  the collagen contracting (tightening) and thickening. Some of this tightening is seen immediately after the procedure. Further contraction occurs over the next few weeks, when a natural inflammatory response leads to wound healing and new collagen synthesis.


There are three forms of RF, monopolar, bipolar, and fractional. The main difference between mono- and bi- polar devices is the configuration of the electrodes. The difference between these and fractional devices is that the newer fractional approach creates areas of affected skin adjacent to unaffected areas.

Many studies have shown that RF works in the treatment of wrinkles around the eyes, skin looseness,  severe acne and scarring, cellulite and skin rejuvenation.

Side effects are generally mild and may include redness, swelling and mild/moderate pain during treatment. Potential risks include itching, blanching, blisters, bumps, burns, scabbing, scarring, bruising pigment changes, altered sensations, surface irregularities and herpes reactivation.

Although the results of RF may not work as well as surgery, it has fewer side effects and shorter recovery times.  These factors make RF a good choice for many people who may be considering a cosmetic procedure.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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