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XERF vs Thermage: Skin Tightening Results and Key Differences
Key points
- XERF is a monopolar RF treatment that uses two frequencies and selectable depth settings to support area-specific treatment planning.
- Early research has reported encouraging changes in firmness, lower-face contours and some measures of skin texture.
- Current evidence cannot establish whether facial hollowing occurs or whether XERF is superior to Thermage; skin thickness and facial fat should guide treatment selection.
INEE INSIGHT · LIFTING
XERF Skin Tightening:
Results, Facial Volume and Thermage
Meaningful results. Without overdoing it.
What patients want from skin tightening today—and why XERF is attracting attention
During consultations about skin tightening, I find that patients are much more specific about what they want than they used to be.
They are not looking for a treatment with only a subtle effect.
They want a noticeable improvement in sagging and a more defined jawline, but they do not want their face to look excessively hollow, obviously treated or unnatural.
Recent large surveys of aesthetic-treatment consumers also show a clear preference for natural-looking results and personalized care. Concern about looking overtreated is also common.[1][2]
Ultimately, what patients want today is simple.
They want to see a meaningful difference while preserving the features they like about their face and looking naturally better.
I believe this also helps explain the recent interest in XERF.
What makes XERF different?
This diagram shows settings selected according to facial anatomy and treatment goals. It does not assign each frequency to a specific skin layer or show actual anatomical depths.
XERF is a noninvasive monopolar radiofrequency treatment that delivers RF energy from the skin surface to generate heat within tissue.
Appropriate thermal stimulation from monopolar RF can produce immediate collagen contraction and encourage collagen remodeling over the following months.
A study using tissue biopsies also found improvements in dermal collagen density and fiber organization after monopolar RF treatment.[5]
One of XERF’s key distinguishing features is its use of two frequencies: 6.78 MHz and 2 MHz.
It also offers shallow, middle and deep settings that can be selected according to the treatment goal and facial area.
This matters because facial anatomy is not the same everywhere.
Preserving volume may be particularly important in areas such as the temples and front of the cheeks, while firmness and contour may be a greater priority in the lower face and jawline.
In my view, XERF’s value lies not simply in treating more deeply, but in the ability to plan depth and energy more precisely for different facial areas and conditions.
Patients want less sagging and a clearer jawline
This timeline summarizes the assessment periods discussed in the article. It does not guarantee identical results or a fixed rate of change.
Early clinical findings for XERF are encouraging in this respect.
A prospective multicenter study observed significant improvements in facial laxity and lower-face sagging after two treatment sessions.[3]
Interestingly, later assessments showed better results than those immediately after treatment.
This is consistent with earlier research suggesting that RF effects extend beyond the initial thermal response, with collagen remodeling continuing afterward.
For this reason, I believe it is more appropriate to assess XERF over approximately one to three months rather than judge it only by the mirror immediately after treatment.
What if my face becomes too hollow?
Preserve existing volume
as much as possible
Consider improvements
in firmness and contour
This is a concept illustration of considerations for different facial areas. It does not specify treatment boundaries or energy levels.
This is a common concern among people considering skin-tightening treatments.
Many want a more defined jawline without losing so much volume in the front of the cheeks or temples that their face looks thin and tired.
This is another reason XERF’s depth settings may be useful.
Rather than treating the entire face at the same depth and intensity, they allow consideration of areas where volume should be preserved and areas where improved firmness is the priority.
A recent small study observed regional redistribution of facial volume rather than simply a reduction in overall facial volume.[4]
However, the study population was small and follow-up was limited.
The current evidence therefore cannot establish that XERF does not cause facial fat loss. Equally, it would be inappropriate to describe it as a fat-reduction device.
For people who already have little facial fat, careful selection of treatment areas, depth and energy is particularly important.
Can skin texture improve alongside tightening?
These are observations from early research; the same improvements will not occur in everyone. [4]
Recent findings in this area are interesting.
A study following patients for several months after one XERF treatment found positive changes in wrinkles, skin evenness, pore size and oiliness.[4]
In contrast, no clear change in pigmentation was demonstrated.
Based on the available evidence, it may be more appropriate to view XERF as an RF treatment that could improve fine lines and some aspects of skin texture alongside firmness and facial contours, rather than as a device solely for the jawline.
However, if pigmentation or redness is the main concern, separate treatment such as laser or light-based therapy may be needed.
Safety and discomfort matter as well as results
Safety, discomfort and recovery are common concerns when patients consider an aesthetic procedure.
XERF studies have generally reported mild to moderate discomfort.[3][4]
It would therefore be inaccurate to describe the treatment as completely painless.
RF treatment uses thermal energy, so greater intensity does not automatically make a treatment better.
Achieving a meaningful effect while minimizing unnecessary tissue injury.
In my view, this is the foundation of a well-planned energy-based treatment.
Which is better: Thermage or XERF?
| Aspect | Thermage | XERF |
|---|---|---|
| Evidence and experience | A long history of clinical use and research | Encouraging early studies Limited long-term data |
| Key point | An established evidence base | Two frequencies and selectable depth settings |
| Selection factors | Skin thickness · Facial fat · Sagging · Desired changes | |
Current evidence does not establish that XERF is better than Thermage.
Thermage has been used for many years, with a substantial body of clinical experience and research behind it.
XERF is relatively new, and the available clinical studies still involve limited patient numbers and follow-up periods.[3][4]
At present, there is no basis for stating that XERF is better than Thermage.
At the same time, having less evidence does not mean its potential should be dismissed.
XERF builds on the established scientific principles of monopolar RF, adding two frequencies and depth settings as further treatment options.
Early clinical studies have also reported encouraging findings for facial firmness, lower-face contours, wrinkles and skin texture.
The most reasonable view at this stage is that Thermage’s strength lies in its established evidence base, while XERF is a newer monopolar RF option with interesting potential for more detailed treatment planning.
What INEE values in XERF treatment
An individualized treatment plan
What we hope to achieve with XERF is not simply stronger tightening.
It is to create a meaningful change in line with the patient’s goals while preserving their existing facial volume and natural appearance as much as possible.
Even within one face, some areas need volume preservation, others need more firmness, some have thin skin and others may be considered for deeper treatment.
That is why I believe the more important question is not “How many shots?” but “Where, at what depth and why was the treatment delivered?”
XERF is an RF device with promising potential because it offers scope for more detailed, individualized treatment planning.
What does good skin tightening ultimately mean?
Patients are not looking for a treatment with weak results.
They want meaningful change without excess: better firmness and contours that look natural, while preserving the features they like about their face. This is the improvement patients are seeking.
Based on the evidence available so far, XERF is a newer RF treatment that merits interest in this context.
Although it does not yet have the long-term evidence accumulated for Thermage, it builds on established monopolar RF principles, adds two frequencies and depth settings, and has shown encouraging early clinical findings.
As more long-term research becomes available, I expect XERF’s strengths and the patients best suited to it to become clearer.
References
- American Society for Dermatologic Surgery. 2025 Consumer Survey on Cosmetic Dermatologic Procedures. View source ↗
- Allergan Aesthetics. Layered Beauty Report. View source ↗
- Weiss R, et al. Clinical Outcomes Following Dual-Frequency Noninvasive Monopolar Radiofrequency Treatment for Facial Laxity and Lower Face Lifting: A Prospective Multicenter Study. View source ↗
- Erlich G, et al. Objective and subjective retrospective evaluation of XERF, a novel single-shot dual-frequency non-invasive monopolar radiofrequency. View source ↗
- Suh DH, et al. Monopolar radiofrequency treatment for facial laxity: Histometric analysis. J Cosmet Dermatol. 2020;19:2317-2324. View source ↗
FAQ
- Who might consider XERF?
- XERF may be considered by people concerned about reduced skin firmness or less defined lower-face contours and jawlines who want natural-looking improvement that takes their facial features into account. Early research has also reported encouraging findings for those concerned about fine lines and skin texture.
- Does XERF reduce facial fat?
- Current research does not establish that XERF causes clinically meaningful facial fat loss. However, because it can deliver thermal energy to deeper tissue, careful selection of treatment areas, depth and intensity is particularly important for people with little facial fa
- When can I expect to see changes?
- Some changes may be noticeable immediately after treatment, but it is difficult to judge the final result at that point. Collagen remodeling can continue for several months after monopolar RF treatment, so it is helpful to assess changes over approximately one to three months.
- Can XERF help with skin texture and pores?
- Current evidence does not show that either option is better for every patient. Thermage’s strength lies in its long-established clinical experience, while XERF offers detailed treatment planning using two frequencies and selectable depth settings. A reasonable choice considers skin thickness, facial fat, the location and degree of sagging, facial shape and the changes you want to achieve.