Updated Insights from an Expanded Survey on Monopolar Radiofrequency Treatment

Thermage® FLX, a fourth-generation monopolar radiofrequency (RF) device, is widely used for non-invasive facial and periorbital rejuvenation. This study provides updated insights into clinical usage patterns, perceived efficacy, and complications across the Asia-Pacific region, building upon findings from previous surveys. A 29-item ques-tionnaire was completed by 204 physicians (90 Korean dermatologists and 114 from seven other countries) with over one year of experience using Thermage® FLX. Pa-tients in their 40s were viewed as the most responsive, with skin thickness identified as the key factor influencing efficacy. The 600 REP and 900 REP 4 cm² tips were com-monly used for facial areas, while the 450 REP 0.25 cm² tip was preferred for periorbital treatments. Many practitioners used both facial and eye tips, often combining treat-ment with injectables administered after RF. Annual sessions were the most common treatment frequency. Korean physicians generally favored lower energy settings (≤3.5) to reduce complications, whereas higher energies were more common elsewhere. Most respondents had personally undergone treatment and expressed high satisfaction. Common side effects included transient erythema, edema, and post-inflammatory hy-perpigmentation. Thermage® FLX is broadly adopted across Asia-Pacific, with high satisfaction and relatively mild adverse effects. Patient selection, conservative settings, and counseling are essential for optimization.