Ultherapy vs XERF: Which is better?
With so many options for facial rejuvenation, choosing the right treatment can feel overwhelming. Ultherapy has been a familiar name in skin tightening for many years, while XERF is a newer approach to non-invasive lifting and tightening. The treatment goals for XERF and Ultherapy are similar, but there are key differences to consider. Let’s take a closer look at XERF vs Ultherapy and how each technology works.
Summary of how XERF and Ultherapy work:
STRUCTURAL SKIN TIGHTENING
XERF vs. Ultherapy
Two advanced technologies. Different approaches to non-surgical skin tightening.
XERF
Dual-Frequency Monopolar Radiofrequency
XERF uses dual-frequency monopolar radiofrequency technology to create broad, bulk heating across multiple tissue layers. AI-guided technology helps select depth and energy based on tissue response.
Ultherapy®
Micro-Focused Ultrasound
Ultherapy uses micro-focused ultrasound to create small, discrete thermal coagulation points at predetermined treatment depths for tissue contraction and collagen remodeling.
| Feature | XERF | Ultherapy® |
|---|---|---|
| Technology | Dual-frequency monopolar radiofrequency (6.78 MHz + 2 MHz) | Micro-focused ultrasound |
| How It Works | Uses AI-guided depth and energy selection with broad, bulk heating to treat multiple tissue layers for lifting, tightening and collagen remodeling. | Delivers focused ultrasound energy at specific, predetermined depths to create small thermal coagulation points that stimulate tissue contraction and collagen remodeling. |
| Target in Tissue | Radiofrequency preferentially heats water-containing tissue. Because adipose tissue has relatively low water content, RF energy interacts differently with fat than with more water-rich tissue. | Ultrasound does not rely on a specific chromophore such as water. Energy is mechanically focused at predetermined tissue depths. |
| Energy Delivery | Broad, bulk heating with energy distributed across multiple tissue layers. | Discrete, focal thermal coagulation points rather than continuous heating between treatment depths. |
| Treatment Depth | XERF does not rely on fixed millimeter treatment depths. AI-guided technology helps determine energy delivery and depth based on tissue response, allowing treatment of superficial, intermediate and deeper structural layers. | Uses predetermined treatment depths including 1.5 mm, 3.0 mm and 4.5 mm, depending on the treatment transducer. The 4.5 mm depth can target the SMAS. |
| Heating Pattern | Broad bulk heating across a larger volume of tissue. | Small focal thermal coagulation points at specific depths. |
| Tissue Effects | Designed to heat multiple tissue layers to stimulate collagen remodeling, tightening and structural support. | Produces focal thermal injury at selected depths to stimulate tissue contraction and collagen remodeling. |
| Customization | AI-guided energy and depth selection allows treatment to be customized according to individual anatomy and tissue response. | Treatment is performed using transducers designed to deliver ultrasound at predetermined focal depths. |
| Comfort | Integrated cooling is designed to improve comfort. No numbing is required. | Treatment may be uncomfortable for some patients. Topical numbing is typically required. |
| Downtime | Little to no expected procedural downtime. Temporary redness or tenderness may occur. | Little to no expected procedural downtime. Temporary redness, tenderness or swelling may occur. |
| Treatment Approach | Broad structural heating for patients seeking non-invasive skin tightening, lifting and collagen remodeling across multiple tissue layers. | Focused ultrasound treatment for patients seeking targeted tissue contraction and collagen remodeling at specific depths. |
XERF vs Ultherapy FAQ’S:
Is XERF BEtter than Ultherapy?
Variations in outcomes between XERF and Ultherapy may be influenced by numerous factors including the patient’s individual response to the treatment and collagen remodeling, lifestyle and environmental factors, genetics, age, skin quality, degree of laxity, as well as the experience and technique of the provider performing the treatment.
Which is more painful - XERF or Ultherapy?
Ultherapy is more uncomfortable than XERF, and typically requires topical numbing prior to the treatment. Because XERF has built-in cryogen (cooling for the skin surface), no numbing is needed and the treatment is generally comfortable with occasional hot sensations.
Which goes deeper - XERF or Ultherapy?
Ultherapy can penetrate as deep as 4.5 mm and has a focal heating zone, whereas XERF is not limited to a single specified depth in millimeters, and relies on bulk heating. XERF uses volumetric radiofrequency, so the thermal effect is influenced by frequency, tissue impedance, pulse structure, and the anatomy being treated. XERF also uses Wave Fit Pulse which divides the energy into multiple controlled pulses instead of delivering one continuous RF pulse. This creates a heating phase where the tissue temperature progressively rises, followed by a holding phase that helps maintain therapeutic heat within the deeper tissue while the surface is protected with cryogen cooling.
With XERF, the impedance affects depth because RF energy is influenced by the electrical properties of the tissue it passes through. Tissues with different water content, density, and composition conduct RF differently. As the tissue warms, its impedance can also change, which affects how the energy is distributed and how efficiently heat accumulates.
Can XERF or Ultherapy cause Facial Fat Loss or cheek hollowing?
When performed by a well-trained qualified medical professional who understands facial anatomy and energy/depth settings, XERF and Ultherapy can safely be performed with minimal risk for fat loss. However, any heat-based device that can penetrate to depth of the fat layer can potentially melt fat. Melting fat requires specific amount of energy or heat for a adequate amount of time.
Since XERF utilized radiofrequency which specifically targets water, and fat has very little water content, XERF is less likely to cause fat loss or facial hollowing. XERF has another safety feature: the built-in Cryogen helps to cool the skin surface and continuous surface temperature sensing and feedback which allows the provider to monitor the temperature and adjust the energy levels accordingly.
How quickly will I see results from XERF vs Ultherapy?
Onset of results of both XERF and Ultherapy really depends on various factors including age, genetics, biology, environmental influences, diet, health concerns, etc. With XERF, there is an immediate appearance of subtle tightening and lift related to bulk heating causing vasodilation and soft tissue swelling, but these results are temporary. Over, the next several weeks as new collagen forms, the the skin and underlying tissues will be firmer leading to improved skin texture, reduced pore size, and structural lift. The results will continue to improve over time for up to 6-12 months.
How Long do results from XERF vs Ultherapy Last?
How long results last from XERF or Ultherapy depends on various factors including the patient’s age, genetics, skin condition, degree of collagen and elastin integrity, extent of tissue laxity, diet, environmental and lifestyle. A younger patient with less skin laxity may only need to repeat XERF or Ultherapy once every 2-3 years whereas an older patient may benefit from repeat treatments every 6-12 months.
We are typically losing about 1% of collagen every year from the age of 25. Research suggests that biological aging may not occur at a steady/linear rate but rather, aging typically accelerates more dramatically at two stages in our life. A 2024 Stanford Medicine study identified substantial shifts in molecular markers associated with aging around the average ages of 44 and 60.
Can I have XERF if I’ve already had Ultherapy?
Yes, you can have XERF if you have already had Ultherapy, but it is best to wait at least 4-6 weeks or longer. Spacing treatments 4-6 weeks apart allows time for the tissue to recover and for the early stages of collagen remodeling to occur.
Can XERF and Ultherapy be combined?
XERF and Ultherapy should not be performed together on the same day since they both deliver thermal energy beneath the skin. Having excessive heat is both unnecessary and undiserable, potentially leading to complications such as prolonged tissue inflammation, hyperpigmentation, and unwanted fat loss.
Your body also has natural protective mechanisms that respond to thermal stress and help regulate tissue temperature to protect against excessive heat. For this reason, delivering more heat does not necessarily produce better results. When it comes to energy-based treatments, more is not always better.