Structural Skin Tightening with XERF: A New Era in Non-Invasive Lifting

XERF is the world’s first multifrequency monopolar RF structural skin tightening treatment, that uses AI-guided precision to lift, firm, and rejuvenate the skin from within. Its intelligent cooling and multi-depth technology deliver powerful, comfortable, and natural-appearing results—without needles, pain, or downtime.

What is XERF and How does IT Work?

Utilizing dual monopolar radiofrequencies of 6.78 MHz and 2 MHz, XERF generates controlled thermal energy to target the superficial, mid, and deep dermal layers. This precise thermal energy activates the skin’s natural repair response, stimulating the production of fresh collagen and elastin. Over time, the treated area appears lifted and the skin becomes visibly firmer, smoother, and more refined, with softened lines and improved elasticity. The XERF system combines Wave Fit™ pulse and Advanced Integrated Cryogen Delivery cooling technology to control energy delivery while maintaining surface temperature.

Summary of Xerf benefits:

• Deep structural skin tightening and increased collagen levels

• Improved skin texture

• Dual Radiofrequency: The XERF system delivers the world’s first multifrequency monopolar RF treatment, combining 6.78 MHz and 2 MHz frequencies to target energy precisely where it’s needed

• Multiple depths: Histological analyses from multiple clinical studies confirm that the XERF system effectively delivers RF energy to the SMAS (Superficial Musculoaponeurotic System), a key tissue layer beneath the skin that supports lifting, tightening, and reducing the appearance of jowls. In vivo porcine studies demonstrate that XERF stimulates thickening and tightening of collagen bundles across multiple tissue depths, while producing a measurable upward lift of the fascia.

• Artificial Intelligence: XERF uses AI technology to provide a personalized, consistent, and safe approach to skin tightening and contouring by precisely controlling radiofrequency energy delivery.

  • Intelligent treatment parameters: Using advanced AI, XERF precisely analyzes the skin’s depth to customize the ideal treatment depth and energy settings for every patient.

  • Real-time monitoring and feedback: A built-in temperature monitoring system provides instant feedback to maintain effective heating while preventing overheating or discomfort.

  • Smart cooling: The AI-regulated ICD system cools the skin surface in real time, protecting the epidermis and improving comfort during treatment.

  • Predictive performance: XERF uses a "Wave Fit™ pulse" technology that automatically adjusts the energy output based on the treatment conditions, optimizing performance. 

• Customizable: Depth and energy settings can be adjusted to target the skin precisely, allowing the treatment to be tailored to each individual’s unique needs.

• No downtime: There is no associated redness or appearance of external skin injury so patients can immediately return to normal daily activities after the procedure. 

• No numbing: Integrated cooling technology ensures patient comfort, allowing the treatment to be performed without anesthesia or topical numbing.

• Fast and convenient: Each session takes only about 60 minutes, depending on the area(s) treated.

• Versatile: Can be used to tighten skin on face or body.

• Quick results: Although true remodeling after new collagen/elastin formation takes a 3-6 months, the effects of the skin tightening are apparent immediately after the treatment. The initial tightening with wane over time and slowly build back up over the next 3-6 months.

• All skin types: XERF uses radiofrequency energy, safely reaching deeper layers to stimulate collagen and elastin without affecting the surface pigment (melanocytes). While XERF is generally safe for darker skin tones, patients with melasma may experience worsening of their pigment, as their skin is sensitive to heat.

What to Expect After Your XERF Treatment:

Following your XERF session, you may notice mild redness or a gentle tightening sensation—both normal signs that the treatment is stimulating your skin. These effects are temporary and typically fade within a few hours. Unlike more invasive procedures, XERF requires no downtime, allowing you to leave with refreshed, radiant skin and resume your day right away. To support optimal results, we recommend avoiding direct sun exposure and keeping your skin hydrated with a gentle moisturizer in the days after treatment.

What Results Can I Expect From XERF?

One of the most exciting features of XERF is the immediate visual improvement, which offers an encouraging preview of your skin’s transformation. This initial effect may soften after a few days. The full effects of skin tightening and texture improvement appears around three months post-treatment, when collagen stimulation produces more noticeable, long-lasting improvements.

This combination of instant and progressive results makes the XERF journey both exciting and rewarding, with the delayed peak delivering more substantial and enduring changes in skin firmness and texture.

Before and After Photos:

How does XERF compare to other skin tightening devices?

After nearly seven years of dedicated research and development in South Korea, XERF made its clinical debut there. Just over a year later, it received FDA clearance for use in the United States — bringing this advanced dual-frequency RF technology to a broader audience. Below is a brief summary of the nonsurgical skin tightening devices currently on the market based on their mechanism of action. The key difference with XERF compared to all the other devices is it’s depth of penetration and the amount of heat that it can comfortably transfer. No other device on the market besides XERF is able to utilize Artificial Intelligence to measure the skin's depth and accordingly set the optimal treatment depth and energy level for the individual patient.

Ultrasound: Ultherapy, Sofwave, HIFU (High Intensity Focused Ultrasound)

RF (Radiofrequency): Thermage, Ultherapy, XERF

RF Microneedling (micro needling plus radiofrequency): Genius, Potenza, Morpheus 8, Secret RF, Vivace, SylfirmX, etc.)

RF + HIFEM (High Intensity Focused Electromagnetic Energy): EMFACE

Depth of Treatment

XERF vs RF Microneedling:

Radiofrequency microneedling combines the microneedling with Radiofrequency heat to treat multiple depths of the skin to induce collagen and elastin formation. RF Microneedling offers customizable depth settings for surface level concerns, but doesn't penetrate as deeply as XERF to provide the same level of structural tightening. RF microneedling requires topical numbing and can be painful. Different RF microneedling devices have advantages and disadvantages, but that is a topic for discussion on it’s own. There is downtime associated with RF microneedling such as redness, swelling, risks of hyperpigmentation; whereas ZERF is more comfortable and has no associated downtime. With the added topical numbing required, RF microneedling sessions can take longer to perform. RF microneedling delivers energy more precisely to the deeper layers of the skin, while XERF works through bulk heating to treat broader tissue areas. Although XERF can help refine pores and improve the appearance of scars, RF microneedling may offer more targeted results for these specific concerns.

XERF vs Thermage:

Thermage is an older RF technology that uses a single 6.78 MHz frequency to stimulate collagen, primarily targeting skin layers by using pulsed RF energy with fixed cooling cycles and manual impedance monitoring. In contrast, the XERF system is the world’s first multifrequency monopolar RF treatment, combining 6.78 MHz and 2 MHz to reach multiple depths of the skin—surface, mid, and deep—for more effective results. Unlike Thermage, which can be painful and lacks customization, XERF features adjustable settings, continuous controlled RF energy with AI impedance feedback and real-time thermal monitoring, and built-in cooling - providing a safer, more comfortable, and tailored treatment.

XERF vs Exilis:

Both Exilis and Thermage use monopolar radiofrequency (RF), which delivers energy through a single electrode to create a closed-loop circuit that penetrates deeply into the dermis, but does not reach the deeper structures (SMAS level). Unlike Thermage which relies solely on Radiofrequency, Exilis is able to cool the skin for a more comfortable experience and also incorporates ultrasound to control the depth of penetration. Exilis requires multiple sessions to obtain the results of a single session of XERF. Exilis treatments are also lengthy - a full face/neck treatment could take up to 2.5 hours to perform, while XERF treatments takes 60-90 minutes. Both Exilis and XERF do not require topical numbing, and have no associated recovery time.

XERF vs Ultherapy:

Ultherapy uses micro-focused ultrasound energy to heat the tissue to a precise temperature at three specific depths. Ultherapy is difficult to perform and requires an experiences/skilled practitioner to achieve optimal result. The treatment is painful and can unintentionally cause fat loss or nerve damage. Ultrasound also heats everything in it’s path because it does not target a specific chromophore.

• 1.5 mm - mid dermis (skin layer)

• 3 mm - deep dermis (fat layer)

• 4.5 mm - SMAS (Superficial Musculoaponeurotic System)- A network of collagen and elastic fibers, fat, and muscle that lies underneath the skin for lifting effect.

XERF can also penetrate all three depths, but with radiofrequency - not ultrasound. Radiofrequency has the benefit of targeting water as a specific chromophore. So rather than targeting everything in its path like Ultherapy, XERF can specifically target the retaining ligaments which contains high water content while sparing fat and nerves which have low water content. While Ultherapy relies on smaller coagulation zones, XERF relies on bulk heating and can therefore have a broader effect. In addition XERF can emit more energy (higher peak temperature 55-72 degrees Celsius) without being painful because of its surface cooling technology.

XERF vs SofWave:

Sofwave delivers synchronized ultrasound energy into the mid-dermis (1.5 mm) to induce collagen and elastin formation. Although more comfortable than Ultherapy, topical numbing is still recommended for Sofwave. The results from Sofwave develop gradually over time, while XERF produces visible tightening sooner thanks to its bulk heating technology, which targets the skin’s deeper structural layers. With it’s dual monopolar radiofrequencies, XERF can treat multiple depths (surface, mid, deep, whereas Sofwave only treats at the 1.5 mm depth producing superficial skin tightening, rather than the deeper structural tightening seen with XERF.

Comparison Chart:

Feature / Device	XERF	Ultherapy	Thermage	Exilis	RF Microneedling
Technology Type	Dual-frequency RF (6.78 & 2 MHz)	Micro-Focused Ultrasound	Single-frequency RF (6.78 MHz)	Monopolar RF + Ultrasound	Microneedling + RF
Depth of Penetration	Superficial, mid, and deep dermis including SMAS	1.5 mm, 3 mm, 4.5 mm (SMAS)	Mid to deep dermis	Mid to deep dermis	Surface to mid-dermis
Mechanism	Bulk heating with AI-controlled precision	Focused ultrasound coagulation points	Pulsed RF energy with fixed cooling cycles	RF heating with controlled ultrasound depth	RF energy delivered via microneedles
AI Customization	✅ Adjusts energy & depth per patient	❌	❌	❌	❌
Cooling Technology	✅ Advanced Integrated Cryogen Delivery	❌ None	⚠ Fixed cooling cycles	✅ Surface cooling	❌ None
Comfort Level	✅ Comfortable	❌ Painful; numbing required	❌ Painful	✅ Comfortable	❌ Painful; numbing required
Downtime	⚠ Brief mild redness	⚠ Mild redness/swelling	⚠ Mild redness	✅ None	❌ Redness, swelling, hyperpigmentation
Target Layers	Dermis, SMAS, retaining ligaments	Dermis, SMAS	Dermis	Dermis	Dermis (superficial)
Selectivity / Safety	Targets water-rich collagen & ligaments, spares fat & nerves	Non-selective; heats all tissue in path	Non-selective	Limited targeting	Risk of PIH in darker skin tones
Results	Immediate + progressive collagen remodeling	Gradual; results over 3–6 months	Gradual	Gradual	Gradual with downtime
Best For	Structural lifting, tightening, and contouring	Lifting (SMAS level)	Surface tightening	Mild skin tightening	Texture, scars, fine lines