I’m excited to be offering XERF here in Beverly Hills, a treatment I believe is a game-changer for patients who want a subtle lift and stronger skin support without going straight to surgery. XERF comes to us via the aesthetic hubs of South Korea, where it has been used extensively in clinics, popularized in the K-beauty world for its ability to tighten early laxity and enhance structure. In fact, the device has recently received U.S. regulatory clearance and is now entering practices here in the States.
Here’s what makes XERF unique:
- It uses dual-frequency monopolar radiofrequency energy (6.78 MHz + 2 MHz) so that energy can be delivered at different depths in the skin and underlying connective tissue.
- It heats the dermis, fibrous septa/fascia and the underlying support layers (including the superficial musculoaponeurotic system, or SMAS) in a controlled way. The histological work shows thickening of collagen bundles and upward pulling of fascial layers.
- It does not melt fat. The goal here is structural tightening, meaning we’re reinforcing your skin’s internal scaffolding rather than removing volume. That’s an important distinction if you’re concerned about loss of fullness or over-hollowing.
- It is designed for comfort: no needles, no numbing, minimal downtime. Integrated cooling and real-time impedance feedback help protect the epidermis while delivering energy deeper down.
- Because this technology has been refined in Korea, where aesthetics clinics have embraced non-surgical lift modalities early, it brings the benefit of mature global usage into the U.S. space now.
In office, I see XERF as the sweet spot in our multi-modal armamentarium: when someone has early to moderate sagging, some loss of skin support or definition, but isn’t quite ready (or doesn’t want) surgery, and when tightening only isn’t enough (i.e., fillers + neurotoxins alone won’t address the structural deficiency). XERF becomes the tool that sits between “just skin quality/tightening” and “full surgical lift.”
How It Works: The Science Behind the Lift
When skin and tissue begin to sag, it’s not just about surface wrinkles or crepey texture, much of aging means the deeper connective tissue and fibrous networks lose their structural integrity. The collagen fibers become thinner, the elastin weaker, the fibrous septa relax, and the fascia (the support membrane beneath the skin) slackens. A treatment that only addresses the superficial layer often falls short.
XERF delivers biphasic RF energy: the higher frequency (6.78 MHz) targets more superficial dermal components, while the lower frequency (2 MHz) penetrates deeper into the connective tissue and fibrous septa. In histologic studies (porcine and human) of devices of this type, immediate changes were noted in the collagen bundles (thickening, shortening) and in the fascial layers (thickening, upward pull) after treatment.
By creating that controlled thermal injury (not burning, but enough heat to induce contraction and remodeling), the device triggers the body’s natural wound-healing cascade: fibroblasts become active, new collagen and elastin are laid down, and over the next 8-12 weeks and beyond, tissue gradually becomes firmer, tighter, and better supported. Because XERF can reach the SMAS/fascial layers (confirmed in histologic work) it has more “structural lift” potential than devices confined to the dermis. Imagine the skin as a tent with poles and ropes. With age the poles loosen, the fabric sags, and the ropes slacken. XERF tightens the ropes, stabilizes the poles, and refirms the tent, not just pulling the fabric downward but reinforcing the whole internal frame. That’s why we say it’s “structural skin tightening.”
What to Expect: Treatment, Results, and Recovery
We’ll do a detailed consultation: assess your skin laxity, volume status (fillers/neurotoxins), anatomy, goals, and tailor a plan. For many patients, a series of 2 XERF treatments spaced 4 weeks apart may be recommended, with maintenance treatments annually or as clinically indicated. The treatment session itself is typically 45-60 minutes for the face/neck, depending on area. Many patients describe a warm sensation, and due to the advanced cooling technology you’ll find it much more tolerable than older devices. We’ll arrange for photos and track your progress.
Results: You’ll often notice an immediate tightening effect (often called the “first peak”). Over the next 8-12 weeks you’ll see the “second peak” as collagen remodeling progresses and the structural changes settle in. Many studies report effects lasting 12-18 months, depending on skin quality, lifestyle, and other treatments used.
Downtime is minimal: you can typically resume daily activities right away, maybe slight redness or warmth, but no injections, no numbing, no significant downtime. We’ll discuss after-care: sun protection, routine skincare, avoiding aggressive exfoliants for a short period.
Where XERF Fits Into Your Aesthetic Plan
Your skin ageing is multifactorial: muscle dynamics (neurotoxins help here), volume loss (fillers/biostimulators help here), skin quality/texture (lasers, peels, RF, microneedling help here) and structural support/laxity (this is where XERF and surgery come in).
- If you mainly have fine lines, good skin support, mild laxity → you might lean toward Sofwave or other skin-quality devices.
- If you have moderate laxity but want non-surgical options → this is where XERF stands out: better structural reach, minimal downtime.
- If you have severe tissue sagging, loss of definition, heavy jowling or require repositioning of tissue → surgery is still the gold standard.
- In all cases, we might combine XERF with neurotoxins (for muscle pull), fillers (to restore volume), and tailored skincare/lifestyle support.
And because XERF doesn’t remove fat or volume, you’ll avoid the hollowing that sometimes occurs with older modalities, especially important if you’ve had weight loss or GLP-1 use and are concerned about losing fullness.
Putting It in Context: How XERF Differs from Historical Devices
To help you understand how far non-surgical lifting has come, here’s a comparison with legacy technologies:
- Thermage (monopolar RF): Long-standing device that heats dermal/subdermal layers to contract collagen. Single-frequency (6.78 MHz), smaller tip sizes, known comfort issues and higher cost per session in many cases.
- Ultherapy (micro-focused ultrasound): Uses ultrasound energy to reach precise depths (1.5mm, 3.0mm, 4.5mm) including the SMAS. Very effective for lift, but more discomfort and a steeper treatment curve for patients.
- Sofwave (superficial ultrasound planar): Targets mid-dermis (approx ~1.5mm) and is excellent for texture/firming and mild tightening—but less “lift” capability than deeper technologies.
- XERF now adds a new dimension—dual-frequency RF, better depth reach, larger tip, improved comfort/cooling, and structural support. Because of the histology showing fascial involvement, XERF may close the gap between superficial tightening and surgical lift in appropriate patients.
In essence:
- Sofwave → skin quality & mild tightening.
- Thermage → global dermal tightening for moderate laxity.
- Ultherapy → lift via deep focus including SMAS.
- XERF → structural skin support and mild-mod lift via multi-layer RF, needle-free, minimal downtime.
Why I’m Using XERF
Here in Beverly Hills we cater to patients who want natural, refined, structural improvement but without the downtime or tell-tale signs of overdone. XERF fits that mindset perfectly. It allows us to offer a solution for those who are not ready for surgery, but want more than just a topical refresh. I’m excited to integrate it as a core component of our aesthetic rotation. What I appreciate most is that XERF doesn’t rely on volume removal but focuses on support and reinforcement. For patients who have done fillers, neurotoxins, skincare diligently but still see sagging or looseness, XERF offers that missing structural step.
If you’re noticing early sagging, soft jowls, loosening of the jaw-line definition, or just want to strengthen your skin’s internal support as part of your anti-aging regimen, XERF is an option. We’ll map your face: evaluate muscles, volume, skin quality, and support tissue. Then together we’ll decide whether XERF is the right next step, and how it complements skin health.
Let’s talk about your goals and how adding in XERF can be another layer of precision and boost to your journey.