What Is XERF? | A Doctor Explains Its Effects, Costs, Downtime, and How It Differs from HIFU

Do any of these concerns about sagging treatments sound familiar?

Hello, this is Smart Skin Clinic, an aesthetic dermatology clinic.

In this article, we take a detailed, medically grounded look at XERF, a radiofrequency device drawing attention for sagging treatment — how it works, the effects you can expect, how it differs from other treatments, what the procedure involves, and what downtime to expect.

*If there's something specific you'd like to know, you can jump straight to it using the table of contents below.

Supervisor Information

Group Chief Director, Smart Skin Clinic Group

IshiiIshii KotaKota

Career

Graduated from Juntendo University School of Medicine

Worked at Tokyo Women's Medical University Hospital and affiliated facilities

Worked at a major aesthetic clinic in Tokyo

Affiliations / Qualifications

Board-certified specialist, Japan Surgical Society

Board-certified specialist, Japanese Society of Anti-Aging Medicine

What Is XERF?

XERF was developed by LUTRONIC, a South Korean manufacturer, as amonopolar RF (radiofrequency) treatment device.

It received certification in 2024 from Korea's MFDS (Ministry of Food and Drug Safety), the Korean equivalent of Japan's Ministry of Health, Labour and Welfare.

XERF's defining feature is its ability todeliver thermal energy "three-dimensionally," from the dermis down through the subcutaneous fat layer.

As a result,address multiple skin concerns at once — including a double chin, sagging along the jawline, nasolabial folds and marionette lines, and skin firmness, radiance, and pore tighteningcan be expected.

Who XERF Is Recommended For

Three Key Features of XERF

①Monopolar RF and the Mechanism Behind Sagging Improvement

Radiofrequency (RF) generates heat by vibrating water molecules within the skin tissue.
The mechanism by which this heat improves sagging works as follows.

RF treatments are also categorized as "monopolar," "bipolar," or "multipolar" depending on the number of electrodes used, and XERF employs monopolar RF.

With monopolar RF, radiofrequency energy flows between an electrode applied to the treatment area and a return electrode attached to the body, forming a closed circuit within the body that heats the target area.Because the energy reaches a broad area, this approach is well suited to mild-to-moderate sagging.

[Types and Characteristics of RF]

RF type	Monopolar RF	Bipolar RF	Multipolar RF	Microneedle RF
Frequency	6.78MHz / 2MHz	1 MHz	1 MHz	2 MHz
Benefits	Heat penetrates broadly and deeply	Treatment depth can be specified	Energy concentrates centrally	Treatment depth can be specified
Drawbacks	Treatment depth cannot be specified	Treatment depth is shallow	Treatment depth cannot be specified	Downtime occurs due to skin puncture
Effect	Tightening · Promotes skin regeneration	Contour correction	Contour correction	Promotes skin regeneration

2. A World First: What Is the "Dual Frequency" of 6.78MHz + 2MHz?

XERF's second defining feature isits ability to deliver two different frequencies — 6.78MHz and 2MHz — simultaneouslya world-first technology.

Conventional RF devices (such as Thermage and Volnewmer) typically use a single 6.78MHz frequency.

Why combine two frequencies? The answer lies in controlling treatment depth.

ThisBy combining the two, thermal energy can be delivered "three-dimensionally,"from shallow to deep layers.

This makes it possible to achieve something that was difficult with conventional RF treatment:treating "deep sagging" and improving skin quality at the same timeThe first is that

In a preclinical study comparing 6.78MHz and 2MHz radiofrequency (i.e., XERF) in pigs, 2MHz was found to warm deeper tissue more readily, while 6.78MHz acted more effectively along the skin's fibrous structure. Combining the two produced more pronounced changes in components such as the collagen fibers that support skin firmness, with no fat cell damage observed. (Preclinical study)

Ko, K., Ryu, H. G., Park, J., Kim, W., Kim, S., Ko, J., & Cho, S. B. (2025). Computational modeling and histologic analysis of 6.78- and 2-MHz monopolar radiofrequency-induced thermal reactions. Lasers in Medical Science, 40 (1), 501. doi:10.1007/s10103-025-04746-8

3. Three Irradiation Modes and the "Three-Layer" Concept

XERF's third defining feature isthe ability to switch between three irradiation modes depending on skin depth.
As a result,enabling "customized irradiation" tailored to each patient's bone structure, fat distribution, and type of saggingwill apply.

Mode	Deep	Middle	Shallow
Frequency	6.78MHz + 2MHz (dual frequency)	6.78MHz	6.78MHz
Target	Deep fat layer	Deep dermis to superficial fat layer	Superficial dermis
Effect	Reduces fat volume Lift-up effect from the deeper layers	Dermal collagen Promotes elastin remodeling Natural lift-up effect	Immediate improvement in skin quality
Indications	Double chin Deep sagging along the jawline Jowls beside the mouth	Nasolabial folds marionette lines Golgo lines Mild-to-moderate sagging	Fine lines Lack of skin firmness and radiance Enlarged pores Facial redness

What Effects Can You Expect From XERF?

By combining the characteristics of monopolar RF with its three irradiation modes, XERF delivers a range of aesthetic benefits.

Jawline tightening, a slimmer-looking face, and V-line definition

A loose, sagging jawline makes the face look larger and can add years to your appearance.

The Deep mode's three-dimensional approach to the deep fat layer can be expected to tighten a jawline blurred by aging, define the V-line, and create a slimmer-looking face.

Many patients notice a sharper contour right after treatment.

Reduced jowls beside the mouth and double-chin fat

Jowls beside the mouth and a double chin are mainly caused by fat accumulation. This is especially common from the late 30s onward, when a slower metabolism makes fat more likely to build up under the chin.

By concentrating heat in the deep fat layer, Deep mode can improve mild-to-moderate concerns around the chin and mouth without surgery.

Improvement of nasolabial folds, marionette lines, and Golgo lines

Nasolabial folds and marionette lines tend to form in areas prone to sagging, involving not only the dermis but also the subcutaneous tissue and the ligaments that anchor the skin to it.

Applying thermal stimulation to the deep dermis promotes medium-to-long-term collagen remodeling, which can be expected to improve skin elasticity and reduce wrinkles and sagging.

Improved Skin Firmness, Radiance, and Texture | Skin Quality Benefits (Shallow Mode)

What sets XERF apart from other RF treatments is thatit can also improve skin quality alongside saggingat the same time.

Promoting collagen production in the superficial dermis supports skin turnover and circulation, leading to improved firmness, radiance, and texture.

Many patients notice their skin feels "tighter" or that "makeup goes on more smoothly" immediately after treatment.

Long-term rejuvenating effects through increased collagen and elastin production

XERF's greatest appeal is that it deliversnot only an "immediate effect right after treatment" but also a "medium-to-long-term effect from collagen regeneration over the following 1 to 3 months".

With regular maintenance treatments, you can offset age-related collagen loss and maintain youthful-looking skin over the long term.

Tighter pores and improved facial redness

RF treatmenttightens pores by boosting collagen production around them.

In addition, thermal stimulationcauses dilated capillaries to constrict, improving facial rednesscan also be expected.

XERF Downtime, Side Effects, and Risks

XERF is a treatment with minimal downtime, though depending on individual factors and the specifics of treatment, the following reactions may occur.

These are temporary reactions that resolve naturally, andmost patients can resume their normal routine on the day of treatment..

Post-XERF Care | Everyday Precautions

How you care for your skin after treatment affects how long the results last and the risk of side effects.

Please keep the following in mind.

How Much Does XERF Hurt? Is Anesthesia Required?

Some may assume that RF treatments are painful, given the discomfort associated with sagging.
It's true that Thermage, for example, could involve significant pain.

However,Patients often describe XERF's sensation assimilar to standing under a warm shower, and in most casesanesthesia is not required.

Wave Fit Pulse: Reducing Pain

XERF significantly reduces discomfort through its patented Wave Fit Pulse technologyso it does.

Wave Fit Pulse delivers energy intermittently as "waveform pulses."
Specifically, by finely alternating between high and low output during treatment, itsimultaneously achieves three effects: delivering heat effectively to the deep layers, minimizing damage to the epidermis, and reducing discomfortso it does.

A Powerful Cooling System

XERF's handpiece is also equipped witha powerful cooling systemis being provided.
During treatment,cooling the skin's surface while delivering energy helps "reduce the risk of burns," "minimize discomfort," and "ensure a comfortable treatment experience"so it does.

Thanks to Wave Fit Pulse and the cooling system, XERF avoids the "pain that resonates in the bone" or intense discomfort sometimes associated with HIFU or Thermage.

Who Should Not Receive XERF | Contraindications

• Those with a pacemaker or metal implants (as radiofrequency energy may affect these devices)
• Those who are pregnant or breastfeeding (as safety has not been established)
• Those with a tendency toward keloid scarring, diabetes, or other conditions affecting wound healing
• Those with metal plates, silicone, gold threads, or other implants in the treatment area
• Those with significant skin inflammation or infection

When Can You Expect Results From XERF? How Long Do They Last? Are Results Visible After One Session?

Immediate effect	Right after treatment to 2 weeks	Thanks to the immediate contraction of collagen fibers, you can feel a firming effect right after treatment.
Medium-to-long-term effect	1 to 3 months later	Through collagen regeneration, the effect peaks 1 to 3 months later.
Duration of effect	6 months to 1 year	–
Interval between sessions	Every 3 to 6 months	–

XERF's effects appear in two stages: an "immediate effect" and a "medium-to-long-term effect."

Results can be felt after just one session, but regular maintenance allows the effect to be sustained over the long term.

Results vary from person to person.

How XERF Differs From HIFU and Other RF Treatments

Many people wonder, "Should I choose XERF or HIFU?" or "How is it different from Volnewmer or Thermage?"

Here, we take a closer look at how XERF compares with other major sagging treatments.

Device	XERF	HIFU	Thermage	Volnewmer	Potenza
Energy / type	Monopolar RF (6.78MHz + 2MHz)	Ultrasound	Monopolar RF (6.78MHz)	Monopolar RF (6.78MHz)	Needle RF
Target	Dermis to subcutaneous fat (surface heating)	SMAS layer (point heating)	Dermis to subcutaneous tissue	Dermis to superficial fat layer	Dermis
Main effects	Tightening Fat reduction Improvement of skin quality	Lift-up Tightening	Tightening	Tightening Skin firmness	Acne scars, pores, and skin quality improvement Improvement of sagging and fine lines
Pain	Minimal	Pain that resonates in the bone	Strong	Minimal	Repeated needle-prick sensation A tingling, electric-current sensation
Downtime	Almost none	A few days · Redness · Swelling · Muscle-ache-like soreness	Almost none	Almost none	About a few days to a week · Redness · Swelling Bruising

①Differences From HIFU*Not offered at our clinic

XERF is recommended for those with more fat who also want to improve skin quality, while HIFU is recommended for those who want a strong lift from the fascia.

② Differences From Thermage and Volnewmerdifference between "A" and "B

Volnewmer is also an excellent device, butbecause XERF also uses a 2MHz wavelength, it can reach a deeper layer (the subcutaneous fat layer).

XERF retains the benefit of being a "pain-free RF treatment" while also meeting the need to tighten fat a little deeper.

3. Differences From Potenza (Needle RF) *Not offered at our clinic

Potenza is well known as a "microneedle RF" device that inserts ultra-fine needles into the skin, like a shiatsu press, and delivers RF energy from the needle tips.

It uses frequencies of around 1 to 2MHz, but its approach differs fundamentally from XERF.

The Synergy Between XERF and Skin Boosters (Same-Day Treatment Available)

XERF's "sagging and tightening treatment" and the "skin quality improvement" offered by various skin boosterscan be received on the same day.

Because they act on different layers of the skin and use different approaches, they don't cancel each other's effects out. In fact, combining them in a single visit reduces the burden of multiple clinic visits while delivering a greater synergistic effect than either treatment alone — a combination that also makes medical sense.

Treatment Order Must Always Be "XERF First, Then Skin Booster"

The most important rule for same-day treatment is thatXERF must always be performed first, with the skin booster injected afterwardThis order has a medical rationale.

1. To Avoid the Risk of Heat-Denaturing the Formulation

Ingredients in skin boosters (such as non-cross-linked hyaluronic acid or polynucleotides) can potentially break down or lose structure when exposed to high heat. If the injection were performed first, XERF's powerful RF heat could damage these valuable active ingredients.

2. To Take Advantage of the "More Receptive" Skin Environment After RF Treatment

XERF's thermal action boosts blood flow in the dermis, temporarily increasing cellular metabolic activity. Injecting a skin booster into skin in this "activated, more receptive" state can help active ingredients reach the tissue more efficiently.

Three Expected Synergistic Effects

Combining XERF with a skin booster is not simply additive — it multiplies "heat-based tightening" with "formulation-based skin regeneration support."

1. A Three-Dimensional Approach: "Foundational Tightening" Plus "Surface Skin Quality Improvement"

XERF's multi-frequency monopolar RF delivers heat broadly from the dermis through the fat layer, powerfully tightening the "deep laxity" that causes sagging. Skin boosters, meanwhile, act directly on the area just beneath the epidermis through the dermis, improving hydration, firmness, and fine lines. To use a building analogy,XERF reinforces the "structural framework" (the foundation) while the skin booster handles the "interior finishing" (surface texture) — both done at the same timeis the image to have in mind.

2. A "Double Approach" to Collagen Production

XERF's thermal stimulation triggers the skin's wound-healing response, switching on collagen and elastin production. Injecting a skin booster on top of this delivers the "materials" (such as amino acids and hyaluronic acid) and "stimulation" needed for cellular remodeling directly to the tissue, accelerating the strengthening of the skin's foundation more efficiently.

3. Optimal Remodeling of the Extracellular Matrix (ECM)

To make the tightening effect last and maintain beautiful skin, it's important for the dermis's extracellular matrix — the environment that supports collagen and other structural components — to be in good condition. Applying a hyaluronic acid- or PN-based skin booster to skin that has just received XERF's heat reinforces proper hydration retention and a regenerative environment, guiding the skin toward a more three-dimensional, healthy state.

"Custom-Tailored Combination Treatment" — Only Possible at Smart Skin Clinic

Even among skin boosters, each formulation has its own strengths and the specific changes it brings. Likewise, the results of XERF's RF treatment vary significantly depending on how much heat is delivered and at what depth.

Since opening, Smart Skin Clinic has offered a wide range of skin boosters — including Juvelook, Profhilo, Sunekos, and Rejuran — and has built deep expertise in improving skin quality through injection treatments.

With the addition of XERF, our next-generation RF device, we can now combine our greatest strengths at an even higher level: injection techniques that make the most of each formulation's properties, together with precise treatment planning for sagging devices.

Our physicians carefully assess each patient's bone structure, skin thickness, degree of sagging, and ideal skin quality, then propose a personalized treatment plan combining the optimal XERF treatment depth with the most suitable skin booster.

Smart Skin Clinic Pricing

* The 400-shot and 600-shot options take longer, so there is a last-appointment cutoff time.
　Jimbocho Clinic: until 19:00 on weekdays / until 18:00 on weekends and holidays | Yokohama Clinic: until 18:00 every day
　If you book after the above times, the treatment cannot be completed within business hours, so we may ask you to reschedule.
　The 200-shot and 300-shot options are not subject to the above restrictions.

FAQ

Worried that XERF might cause cheek hollowing?

There is little risk of cheek hollowing — in fact, the heat can help reposition sagging fat back to its original position, so improvement in existing cheek hollowing can also be expected.
In the past, the common approach was to avoid treating hollowed areas directly, but recent evidence has shown that treating these areas directly can actually be effective. Smart Skin Clinic incorporates this latest insight, performing treatment designed to improve hollowing as well.

Does XERF show results after just one session? What is the ideal treatment frequency?

Some patients notice a change after just one session, but since XERF cannot stop new age-related changes from occurring, we recommend maintenance treatments roughly every 3 to 6 months to sustain the results. Individual results vary.

Is XERF treatment painful? Is anesthesia required?

This treatment is performed without anesthesia.
Thanks to Wave Fit Pulse technology, discomfort is greatly reduced. The sensation is similar to a warm shower.

Can I apply makeup right after XERF treatment?

Yes, you can apply makeup immediately after the treatment.

Treatment Flow

Details

Treatment Time	Treatment time varies depending on the number of shots. 200 shots: approx. 45 minutes 300 shots: approx. 60 minutes 400 shots: approx. 75 minutes 600 shots: approx. 105 minutes *The above are estimates only. Actual time may vary depending on the situation.
Recommended Number & Frequency of Treatments	We recommend treatment at intervals of roughly 3 to 6 months.
Downtime	Little to none · mild redness or swelling
Treatment on the day of counseling	Available
Makeup	Possible immediately after treatment
Skincare	Possible right after the treatment
Shower	Normal activities possible the same day; bathing possible from the next day (avoid long baths on the day of treatment)
Pain	A sensation similar to standing under a warm shower

*Results vary from person to person.

XERF Treatment at Smart Skin Clinic

XERF is a sagging treatment perfectly suited to modern lifestyles, offering an excellent balance of minimal pain, minimal downtime, and strong results.

If you'd like a treatment you can relax through without enduring pain, want to address fat around the mouth and chin at the same time, and also want firmer, more radiant skin —

we warmly invite you to book a free consultation.

We will recommend the treatment best suited to your individual facial structure.

Reference

· XERF

・LUTRONIC

Ko, K., Ryu, H. G., Park, J., Kim, W., Kim, S., Ko, J., & Cho, S. B. (2025). Computational modeling and histologic analysis of 6.78- and 2-MHz monopolar radiofrequency-induced thermal reactions. Lasers in Medical Science, 40 (1), 501. doi:10.1007/s10103-025-04746-8

CLINIC LIST

Clinic List

Jimbocho Clinic

〒101-0054
3-16-1 Kanda Nishiki-cho, Chiyoda-ku, Tokyo, EX Kanda Nishiki-cho Building 8F (general reception) / 7F

Hours: Mon–Fri 11:00–20:00 / Sat & Sun 10:00–19:00

Yokohama Clinic

〒221-0835
TS Plaza Building 2F, 2-23-2 Tsuruya-cho, Kanagawa-ku, Yokohama-shi, Kanagawa

Hours: 10:00–19:00

About the physician supervision of this site

This site is operated under the supervision of a Smart Skin Clinic supervising physician.

This page was produced in accordance with the Medical Advertising Guidelines Medical Advertising Guidelines revised and enforced in June 2018, under which we produce and provide this information.

• Scope of supervision: treatment descriptions, risks and side effects, price display
• Last supervision date: June 26, 2025

*Treatment effects vary from person to person. Please be sure to consult a physician regarding side effects and risks.

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