Thermage and Re2O
Thermage FLX uses radiofrequency energy to heat the skin evenly and firm it over the following months. Re2O is an injectable skin booster developed in Korea that is aimed at skin quality rather than tightening. Dr. Kim combines the two for people whose concern is both looser skin and thinner, tired-looking skin.
- Thermage FLX
- Monopolar radiofrequency. It heats a broad volume of the dermis and the fibrous strands beneath it, while the skin surface is cooled.
- Re2O
- An injectable based on extracellular matrix (ECM) from processed donated human skin, developed by the Korean company L&C Bio and used as a skin booster.
- Treatment time
- Typically about 1 hour or more for Thermage, depending on the areas and tips; Re2O injections add time.
- Downtime
- Thermage: usually minimal redness for hours. Re2O: small bumps, swelling or bruising at injection points for a few days.
- When do results show?
- Gradually. Firming from Thermage usually develops over about 2–6 months. Changes in skin quality from a booster also take weeks to show and vary between people.
Why Dr. Kim for Thermage and Re2O
When the change is in the skin itself, the treatment has to reach the dermis. He pairs energy that firms it with a booster that rebuilds its structure.
Energy matched to the layer
He explains that radiofrequency such as Thermage suits fine wrinkles and elasticity better than focused ultrasound, and combines the two when both layers need it.
Re2O in his own words
He has written on Elravie Re2O, a human acellular dermal matrix booster, and how to combine it with Ulthera or radiofrequency.
Combination is what he teaches
His 2026 DEEP Symposium lecture to about 100 clinicians covered stepwise combination treatment for skin quality.
Clear timelines
He describes Thermage as typically lasting around ten months to a year, and plans sessions accordingly.
A surgeon's judgement
Trained in facial surgery, he can tell when the skin needs firming and when tissue has descended too far for any device.
Layer by layer
Skin by Thermage and Re2O, deeper support by Ulthera, volume by Sculptra: each tool for the layer it suits.
Why These Two Are Combined
Tightening
Thermage heats the deeper part of the skin and the fibrous strands under it. The collagen contracts and, over months, remodels. The aim is firmer, smoother skin, especially on the lower face, jawline and around the eyes.
Skin quality
Firmness is only one part of how skin looks. Thin, dull or crepey skin is a separate issue. A skin booster such as Re2O is injected into the skin to support its texture and thickness, rather than to tighten or lift.
Dr. Kim’s approach
Thermage combined with Re2O is one of the non-surgical treatments Dr. Kim focuses on. He uses it where the main problem is in the skin itself, and as a surgeon he will also tell you when the problem is descended tissue that a device and booster cannot move.
Limits
Neither treatment lifts heavy jowls, removes excess skin or corrects a low brow. Results are gradual and modest, and some people notice little change. Evidence for Re2O is still limited compared with established treatments.
Glossary
- Monopolar radiofrequency (RF)
- Electrical energy that flows from a treatment tip on the skin to a return pad elsewhere on the body. The tissue’s resistance to the current produces heat.
- Fibrous septae
- Strands of connective tissue that run through the fat under the skin and anchor the skin to deeper structures.
- Extracellular matrix (ECM)
- The framework between cells, made mainly of collagen, elastin and other proteins. It gives skin its structure.
- Acellular dermal matrix
- Donated skin (dermis) that has been processed to remove cells, leaving the matrix framework.
- Skin booster
- A general term for injectables placed in the skin to improve hydration, texture or quality rather than to add shape.
How Thermage FLX Works
Thermage FLX, made by Solta Medical, is a monopolar radiofrequency device. A disposable treatment tip with a thin membrane is placed on the skin, and a return pad is attached elsewhere on the body. With each pulse, energy passes through the skin, and the tissue’s natural resistance turns it into heat. Unlike focused ultrasound, which creates tiny separate points, radiofrequency warms a broad zone of the dermis and the fibrous septae below it at once.
Heat makes existing collagen fibers contract and starts a healing response that builds new collagen over the following months. To protect the skin surface, the device sprays a cooling agent onto the back of the membrane before, during and after each pulse, and adds vibration to make the sensation more tolerable. The system also adjusts its energy delivery pulse by pulse. You will be asked about the heat you feel, and energy is set from that feedback and the area treated.
| Step | What happens |
|---|---|
| Before | Cleansing, marking a grid on the skin to guide even coverage, and usually numbing cream. |
| During | The tip is placed square by square. Each pulse gives a brief deep heat, followed by a cool feeling from the spray. |
| Passes | Several passes over the face, with extra passes along areas of concern if appropriate. |
| After | Mild redness and warmth that usually settle within hours. Makeup can generally be used the next day unless advised otherwise. |
Thermage sessions are often described by the number of pulses. As with Ulthera shots, the total says little without knowing which areas received how many passes and at what energy.
Tips and Treatment Areas
Thermage FLX uses different single-use tips for different areas. In the United States, the system is cleared for non-invasive treatment of wrinkles, including those around the eyes and on the upper and lower eyelids, and for temporary improvement in the appearance of cellulite.
- Total Tip 4.0 cm² A larger tip for the face, jawline and neck.
- Total Tip 3.0 cm² A smaller tip for smaller or curved areas.
- Eye Tip 0.25 cm² A small tip for the eyelids and the area around the eyes, giving shallower heating.
- Body Tip A large tip for body areas such as the abdomen.
Treating around the eyes
For eyelid treatment, numbing drops are placed in the eyes and protective plastic shields are placed over the eyes before the Eye Tip is used. The larger tips are not used over the eye itself.
Thermage around the eyes can make the upper eyelid skin look slightly firmer and soften fine lines. It does not remove excess eyelid skin or lift a brow that has dropped. When the eyelid skin rests on the lashes or the brow has descended, upper eyelid surgery or a forehead lift is usually the more effective answer; see Heavy upper eyelids: upper blepharoplasty or forehead lift?
How Thermage Differs From Ulthera
Both devices use heat to stimulate collagen, but they deliver it differently. Ulthera focuses ultrasound into small, separate points at a fixed depth, reaching down to the SMAS layer, and uses an on-screen image to see the layers. Thermage warms a broader zone of the skin and the tissue just beneath it, without imaging. They are sometimes used together to address different layers.
| Thermage FLX | Ulthera | |
|---|---|---|
| Energy | Monopolar radiofrequency | Microfocused ultrasound |
| Heating pattern | Bulk heating of a broad volume | Separate small points in rows |
| Main layer | Dermis and fibrous septae just below | SMAS and dermis, depending on the transducer |
| Imaging | No | Yes, real-time ultrasound image |
| Main aim | Firmer, smoother skin; eyelid skin | Lift of the deeper layer plus skin firming |
| Sensation | Brief heat with cooling | Deeper, sharper heat, strongest over bone |
What Re2O Is
Re2O is an injectable developed in Korea by L&C Bio, a company that works with human tissue products. It is made from donated human skin (dermis) that is processed to remove cells, leaving the extracellular matrix: the collagen- and elastin-rich framework of the skin. The matrix is then broken into very fine particles so it can be injected. The maker describes it as a particulated human acellular dermal matrix.
The idea behind it differs from hyaluronic acid boosters, which mainly hold water, and from collagen stimulators such as Sculptra, which trigger a reaction to a synthetic material. Re2O supplies matrix components directly into the skin, with the aim of supporting the skin’s own repair and improving texture and thickness. How much it does this, and for how long, is still being studied.
What patients should know
- It is derived from donated human tissue. Donors are screened and the tissue is processed to remove cells, which is intended to reduce the risk of reactions and transmitted disease.
- In Korea it is supplied under the regulations for human tissue products. It is not approved by the US FDA.
- Published long-term data are limited, and most information so far comes from short studies and clinical experience.
- It is a newer product than Thermage, Ulthera or Sculptra.
How it is given
Re2O is injected into the skin with fine needles or a cannula across the treatment area. Numbing cream is usually applied first. Small raised bumps at injection points are common for a day or two. A course may involve more than one session, with spacing decided by how the skin responds.
If you prefer not to receive a product made from human tissue, tell the clinic; other skin treatments can be discussed.
Dr. Kim on Re2O
In his column for the clinic, Dr. Kim describes Elravie Re2O as a different kind of skin booster: rather than adding a single ingredient, it supplies finely processed human acellular dermal matrix (hADM), the same structural material that makes up the skin's own support, made largely of collagen, elastin and hyaluronic acid.
Why he combines it with energy devices
He notes that Re2O can be used alone, but that it is often paired with focused ultrasound such as Ulthera or with radiofrequency such as Thermage: the device works on lifting and firmness, while Re2O works on the quality and structure of the dermis itself.
How he describes the course
According to his column, a session takes roughly ten minutes with numbing cream, one session can already help, and around three sessions spaced three to four weeks apart give a fuller effect. Small raised bumps and redness usually settle within the day. Alcohol, saunas and smoking are best avoided for about a week.
Who it suits
People with fine lines and general loss of elasticity, enlarged pores or rough texture, dry skin, and those bothered by hollowing under the eyes or around the mouth who would rather avoid surgery or filler.
The injector still matters
As with any injectable, he stresses that the result depends on who injects it and how. The skin's condition is assessed first, and Re2O is chosen only when it is the most suitable booster for that skin.
Source: Dr. Young Jun Kim's column on Elravie Re2O, Violacell Plastic Surgery (2026). Individual results vary.
Sequencing: Same Day or Separate
Thermage and Re2O can be done on the same day or on separate visits. When done on the same day, the device treatment is commonly performed first and the injections afterwards, so that the injected material is not heated or pressed by the treatment tip and the injection bumps do not interfere with even contact.
Separate visits may be preferred if you want to see how your skin reacts to each treatment on its own, if your skin is sensitive, or if you have an event soon and want to limit visible bumps. The choice is made at consultation based on your skin and your schedule.
Who this combination may suit
- Mild skin laxity together with thin, crepey or dull skin
- Fine lines and looseness around the eyes, without excess eyelid skin
- People who want gradual improvement with little downtime
When another option fits better
- Heavy jowls and descended tissue: mini facelift or facelift; see Mini facelift or full facelift: which one fits your face?
- Lift of the deeper SMAS layer: Ulthera
- Hollow temples or cheeks: Sculptra
- Localized fat under the chin: liposuction
Downtime and Results
| Timing | Typical course |
|---|---|
| Same day | Redness and warmth after Thermage, usually settling within hours. Raised bumps and possible pinpoint bleeding at Re2O injection points. |
| First 1–3 days | Injection bumps flatten. Mild swelling, more noticeable around the eyes. Avoid saunas, intense exercise and alcohol for a short period, as advised. |
| First week | Any bruising fades. Mild tenderness can persist briefly. |
| About 2–6 months | Gradual firming from Thermage. Changes in skin texture from Re2O develop over weeks and vary. |
| Afterward | Aging continues. Thermage is commonly reassessed about once a year or longer; booster sessions depend on response. |
Courses vary with skin type, the areas treated and individual healing. Results cannot be guaranteed.
Risks: Thermage
- Discomfort Brief heat with each pulse; energy is adjusted to feedback.
- Redness and swelling Common and usually short-lived.
- Temporary marks or bumps Occasionally in a grid pattern; usually fade within days.
- Altered sensation Temporary numbness or tingling, rarely.
- Blisters or burns Rare; can leave marks or color change.
- Dents Rare reports of small surface irregularities from fat changes, mostly associated with older, higher-energy approaches.
Thermage is generally not used if you have a pacemaker or other implanted electronic device. Tell the clinic about metal implants, pregnancy, skin conditions and recent treatments in the area.
Risks: Re2O
- Bumps, redness and swelling Common at injection points for a day or two.
- Bruising Possible, especially with blood thinners.
- Infection Rare with any injection; signs include increasing pain, warmth and redness.
- Allergic or immune reaction Possible with any injected material, including tissue-derived products.
- Lumps or uneven texture Possible; usually temporary.
- Uncertain long-term profile Long-term data are limited because the product is relatively new.
Injections are generally avoided during pregnancy or breastfeeding and with active skin infection in the area.
Frequently Asked Questions
What is the difference between Thermage and Ulthera?
Thermage uses radiofrequency to warm a broad zone of the skin and the fibrous strands beneath it. Ulthera uses focused ultrasound to create small heated points at set depths, reaching the deeper SMAS layer, with an on-screen image. Thermage mainly firms the skin; Ulthera aims more at lifting the deeper layer.
What is Re2O made from?
Re2O is made from donated human skin that has been processed to remove cells, leaving the extracellular matrix of collagen and elastin. It is broken into fine particles for injection. It was developed in Korea by L&C Bio.
Why combine Thermage with a skin booster?
They address different problems. Thermage aims at firmness through heating, while a skin booster aims at skin quality such as texture and thickness. Someone with both looser skin and thin, dull skin may benefit from addressing both.
Are Thermage and Re2O done on the same day?
They can be. On the same day, the device treatment is commonly done first and the injections afterwards. Separate visits may be preferred for sensitive skin or to limit visible bumps before an event.
Can Thermage treat my eyelids?
Yes, with the small Eye Tip and protective eye shields. It can firm the eyelid skin slightly and soften fine lines, but it does not remove excess eyelid skin or lift a dropped brow. Those need eyelid surgery or a forehead lift.
Is Thermage painful?
Each pulse gives a brief deep heat, eased by cooling and vibration. Numbing cream is usually used, and the energy is adjusted based on what you feel.
Is Re2O approved?
In Korea it is supplied under the regulations for human tissue products. It is not approved by the US FDA, and long-term published data are limited. Ask about its status and evidence at consultation.
Can these treatments replace a facelift?
No. They can improve skin firmness and quality, but they cannot reposition descended tissue or remove excess skin. When sagging is marked, a mini facelift or facelift is usually the more effective option.