Among the most popular reality TV shows these days are graphic ones featuring extreme makeovers. Personally, I can't bear to watch them... and I believe that many people would never go under the knife just to improve their appearance. But now along comes what is theoretically a kinder, gentler solution to the traditional face-lift: Thermage. Last year, the US Food and Drug Administration (FDA) approved this "non-invasive plastic surgery" for the face. Instead of making incisions, Thermage uses deep heat to tighten and contour the skin and its underlying tissues. It reminds me a little of those commercials for "vacuum" machines that tighten your tummy. Is Thermage for real? Is it safe? To get the facts about Thermage, I spoke with Barney Kenet, MD, a dermatologist at New York-Presbyterian Hospital Cornell Medical Center in New York City and coauthor of Saving Your Skin (Four Walls, Eight Windows). He told me that Thermage is a safe and effective way to obtain tighter, younger-looking skin without resorting to surgery. The results are more subtle and natural than those of a conventional face-lift... recovery time is nil... and in experienced hands, the procedure poses little risk. Thermage works by using radio frequency (RF) technology to apply deep, uniform and powerful heating to the inner layer of skin, or dermis, while the outer layer (the epidermis) is protected with a cooling spray. This promotes the contraction of collagen, which is the building block in the skin that gives it structure and firmness. Some contraction is immediate, but even more takes place over time. Although improvement usually can be seen after just one treatment, there is even more improvement over time, because the skin continues to tighten for three to six months while the technology stimulates the production of new collagen fibers. It lasts for at least 12 months and may last 24 months or longer. Thermage usually requires only one or two treatment sessions (with at least six months between the two). During the procedure, the dermatologist lightly touches the desired areas of the face and neck with a small device called a ThermaTip, which delivers a controlled amount of RF energy to the skin. Treatment continues for approximately one to one-and-a half hours, as the dermatologist slowly conducts five to 10 passes over the skin at a low heat setting. As far as discomfort goes, Dr. Kenet says that the experience is comparable to a visit to the dentist. There is some pain -- a pinching and sensation of heat. Oral or injected medications can take the edge off this discomfort. In contrast, surgery requires four to six weeks of recuperation. Best of all, there is no cutting, bleeding or bruising, and no recovery time with Thermage. Afterward, you simply can head back to the office or go out to dinner. Dr. Kenet also notes that when performed correctly by an experienced practitioner at a low heat setting, the risk of side effects is very modest. In 1% to 2% of cases, Thermage does not work on someone's skin. This is most likely to happen in heavy smokers or people who have received excessive sun exposure, whose skin has lost much of its elasticity. There are no special maintenance strategies after treatment. Just follow your regular skin-care routine. Research is under way to determine if this technique can be used on other skin areas that could benefit from tissue tightening and contouring. Dr. Kenet says that many doctors already use it to tauten loose skin on saggy underarms and tummies. Thermage will never replace a surgical face-lift. It is a subtle technique geared toward those with mild aging issues who require minor -- not major -- facial intervention. Thermage -- at about half the price of plastic surgery -- is an excellent alternative for people who don't have the time, money or interest in plastic surgery, and want a safer and less-invasive alternative, explains Dr. Kenet. While it's not going to do the trick for those who want major changes, he says Thermage can benefit virtually anyone who wants to obtain a delicate lift to droopy cheeks and sagging jaw lines. Moreover, it does not leave patients with the mask-like, expressionless faces of aging divas who have indulged in one cosmetic surgery too many. Dr. Kenet stresses that for the best results and the highest degree of safety, you must see an experienced, knowledgeable practitioner who is prepared to do multiple passes over the skin at a low heat setting. This yields the safest, most effective and consistent results. Before undergoing the procedure, make certain that this is your dermatologist's approach. If it is not, go elsewhere. An inexperienced practitioner who uses a high heat setting and rushes through just one or two passes is less likely to significantly improve the skin, and a high heat setting can cause complications such as burning or scarring. To learn if Thermage is available in your area, click on the "Locate a Doctor" feature at the Web site of Thermage, Inc., www.thermage.com. Keep in mind that this is a cosmetic procedure that insurance will not cover. The cost varies dramatically, but in general ranges from $3,000 to $5,000.