Timing of Excel V (Genesis) Before Thermage Fraction
A two-week interval between Excel V laser treatment and Thermage radiofrequency is generally acceptable and safe, as this allows adequate time for initial healing of the epidermis and reduction of inflammation from the laser procedure.
Rationale for Two-Week Spacing
The two-week interval is based on standard dermatologic practice for sequential energy-based device treatments:
Skin healing timeline: Most laser-induced erythema and superficial inflammation resolve within 1-2 weeks, allowing the skin barrier to recover before subsequent thermal injury 1
Thermage mechanism: Thermage uses monopolar radiofrequency to heat deep dermal collagen while cooling the epidermis, making it less dependent on epidermal integrity than ablative procedures 2, 3
Excel V characteristics: Excel V is a non-ablative vascular laser that typically causes transient erythema and mild inflammation without significant epidermal disruption
Clinical Considerations
Factors Supporting the Two-Week Interval:
Reassessment standard: Dermatologic guidelines consistently recommend reassessing skin reactions after 2 weeks to determine if healing is adequate before proceeding with additional interventions 1
Non-overlapping mechanisms: Excel V targets vascular structures while Thermage targets deep dermal collagen and fibrous septae, minimizing cumulative thermal damage to the same tissue planes 2, 3
Important Caveats:
Individual healing variation: Patients with compromised healing, active inflammation, or grade 2-3 skin reactions at the 2-week mark should have treatments delayed until skin returns to baseline 1
Treatment intensity matters: If the Excel V treatment was aggressive (higher fluences, multiple passes), consider extending the interval to 3-4 weeks to ensure complete resolution of inflammation
Skin barrier assessment: Before proceeding with Thermage, confirm that erythema has resolved, there is no active inflammation, and skin barrier function has normalized 1, 4
Practical Algorithm
Pre-Thermage Assessment Checklist (at 2 weeks post-Excel V):
- Absence of erythema or only minimal residual pinkness
- No active inflammation, edema, or tenderness
- Intact skin barrier without dryness, scaling, or fissuring 1, 4
- Patient reports no ongoing sensitivity or discomfort
If any concerns present: Delay Thermage by 1-2 additional weeks and reassess 1
Common Pitfalls to Avoid
Proceeding with persistent inflammation: Performing Thermage on incompletely healed skin increases risk of prolonged erythema, hyperpigmentation, or excessive thermal injury 1
Ignoring patient-reported symptoms: Even if skin appears healed visually, patient complaints of sensitivity or discomfort warrant treatment delay 1
Inadequate skin preparation: Ensure proper moisturization and barrier support between treatments to optimize healing 4