XERF vs. Thermage vs. Ultherapy: How They Compare

What if your skin could look firmer, your jawline more defined and your face beautifully refreshed, without surgery or an entirely different appearance?

For many people, the goal isn't to look younger at any cost. It's to look like themselves, with skin that feels more supported, smoother and less affected by the passage of time.

That's where non-surgical skin-tightening treatments become interesting.

XERF, Thermage and Ultherapy all aim to improve visible skin laxity, but they don't use the same technology. XERF and Thermage use radiofrequency energy. Ultherapy uses focused ultrasound. Each approaches tissue heating, collagen remodeling and treatment planning differently.

So which one is right for your skin?

The answer depends on what you'd like to change, how much laxity is present, your comfort preferences and the kind of result you're hoping to achieve.

XERF vs. Thermage vs. Ultherapy: What's the Difference?

All three are non-surgical energy-based treatments used in aesthetic medicine. Their central difference is how energy is delivered to tissue.

The important distinction: none of these treatments is automatically the strongest, deepest or most effective choice for every face.

They work differently, and your anatomy matters.

How Does XERF Work?

XERF is a newer approach to noninvasive skin tightening that uses multifrequency monopolar radiofrequency energy.

Unlike conventional single-frequency monopolar RF systems, XERF combines two frequencies, 6.78 MHz and 2 MHz, with adjustable depth settings and energy levels.

The system is designed to create controlled tissue heating at different levels while using integrated cooling to help protect the skin surface and improve comfort.

Its manufacturer, Cynosure Lutronic, describes three selectable depth settings and ten intensity levels that allow providers to customize energy delivery.

That flexibility is one of XERF's distinguishing features.

However, the two frequencies should not be interpreted as two fixed treatment depths. Actual heating patterns depend on the device settings, applicator, tissue characteristics and treatment technique.

For you, the attraction is straightforward: the possibility of firmer-looking skin without needles, surgical incisions or a lengthy recovery.

Explore what makes XERF different from other radiofrequency treatments for a closer look at the technology.

How Does Thermage Work?

Thermage is one of the better-established names in non-surgical radiofrequency skin tightening.

Like XERF, Thermage FLX uses monopolar radiofrequency energy to heat tissue and stimulate processes associated with collagen remodeling.

The system delivers RF energy through a treatment tip while incorporating cooling and feedback mechanisms designed to support controlled treatment.

Thermage uses a single RF frequency, but that doesn't mean it treats only one precise layer of skin.

Radiofrequency energy produces a distribution of heating within tissue. The treatment pattern depends on the device design, settings and tissue properties.

Thermage has been used for facial and body tightening for many years, giving it a longer history of clinical use than XERF.

If you're interested in an established RF treatment and prefer a noninvasive approach to mild or moderate laxity, Thermage may be worth discussing with your provider.

How Does Ultherapy Work?

Ultherapy takes a different approach.

Instead of radiofrequency, it uses microfocused ultrasound with visualization to deliver energy to selected depths beneath the skin.

Depending on the transducer and treatment plan, Ultherapy can target depths of 1.5 mm, 3.0 mm and 4.5 mm.

Its real-time ultrasound visualization allows trained providers to see relevant tissue layers and plan where energy will be delivered.

At certain treatment depths, ultrasound energy can reach fibromuscular tissue, including the superficial musculoaponeurotic system, commonly called the SMAS.

But this doesn't mean Ultherapy produces the same effect as a surgical facelift. A facelift physically repositions tissue; Ultherapy uses controlled thermal stimulation to encourage gradual remodeling.

Ultherapy has FDA clearances for noninvasive lifting of the brow, neck and under-chin areas, as well as improvement of lines and wrinkles on the décolletage.

Its official treatment information describes the role of focused ultrasound and visualization in selecting treatment depths.

For someone whose primary concern is visible laxity around the lower face or neck, Ultherapy may be an option worth evaluating.

Which Treatment Goes Deeper?

It's tempting to assume that deeper treatment means better results.

But skin tightening isn't quite that simple.

Ultherapy delivers focused ultrasound energy at defined depths, including 4.5 mm in appropriate treatment areas.

XERF and Thermage create broader patterns of radiofrequency heating rather than isolated ultrasound focal points.

Because these technologies distribute energy differently, comparing a single depth measurement does not tell you which treatment will produce more tightening.

The better question is: Which tissue needs to be treated to achieve the result you want?

If your concern is early skin laxity, the ideal treatment may be different from the one recommended for more pronounced changes around the jawline and neck.

For another comparison involving energy delivery and treatment depth, read XERF versus HIFU: different energy, different depths and different trade-offs.

Is XERF Less Painful Than Thermage or Ultherapy?

Comfort is one of the most important considerations for many clients.

You may want tighter-looking skin, but that doesn't necessarily mean you're willing to tolerate significant discomfort to achieve it.

XERF was designed with comfort in mind. Its integrated cooling and adjustable energy delivery are intended to make treatment more tolerable, often without topical numbing.

Thermage can produce sensations of deep warmth or brief discomfort as RF energy is delivered. Cooling and treatment adjustments help providers manage those sensations.

Ultherapy can cause more intense sensations in some patients because focused ultrasound creates discrete points of heating beneath the skin. Comfort varies by treatment area, energy settings, individual sensitivity and the pain-management approach used.

It would be inaccurate to guarantee that XERF is painless or that Ultherapy is always more painful than either RF treatment.

Direct comparative evidence is limited, and individual experiences vary.

If comfort is a priority, tell your provider before choosing a device. A treatment you can tolerate comfortably may be more appealing than one selected purely for its technical specifications.

Which Treatment Produces Better Skin Tightening?

Imagine noticing that your jawline looks a little more defined. That the skin around your lower face appears firmer. That your reflection looks refreshed, but still unmistakably you.

Those are the kinds of changes many clients hope to achieve with non-surgical tightening.

All three technologies may improve selected concerns involving skin laxity, but they have not been established as interchangeable treatments with identical outcomes.

XERF uses multifrequency RF with adjustable settings to produce controlled heating.

Thermage uses an established monopolar RF platform to support tissue remodeling.

Ultherapy uses focused ultrasound at selected depths, with visualization to guide energy placement.

What none can promise is the degree of lifting associated with surgery.

Results depend on your baseline laxity, anatomy, treatment settings and biological response.

Someone with early loss of firmness may be satisfied with subtle improvement. Someone with significant tissue descent may need a different approach to achieve the change they envision.

The best result is one that matches your goals, not simply the most aggressive treatment available.

How Many Treatments Will You Need?

Another practical question: Do you want one appointment, or are you comfortable with a treatment plan that develops over time?

Ultherapy is commonly performed as a single treatment, although some patients may benefit from additional sessions or maintenance.

Thermage is also frequently performed as a single treatment, with future maintenance depending on individual needs.

XERF treatment schedules are individualized. Some patients receive one session, while others may undergo additional treatments based on their concerns, provider assessment and treatment goals.

There is no universal requirement that everyone receive three to five XERF sessions.

Our guide to how many XERF sessions you may need explores why treatment planning varies.

When Will You See Results?

With all three treatments, patience is part of the process.

Some people notice an early change in the appearance of firmness, but collagen remodeling develops over time.

Improvements may become more noticeable over the following weeks and months, depending on the procedure and individual response.

Ultherapy results are often assessed around two to three months after treatment, although remodeling can continue beyond that point.

Thermage and XERF also rely on biological responses that develop gradually.

That means your final result shouldn't necessarily be judged by how your skin looks immediately after leaving the treatment room.

Think of these treatments as part of a longer-term approach to skin quality and firmness, rather than an overnight transformation.

Which Treatment Has the Longest Clinical Track Record?

When considering an aesthetic treatment, it is reasonable to ask how long the technology has been used and how much clinical evidence supports it.

Thermage has a long history in radiofrequency-based aesthetic treatments.

Ultherapy also has an extensive clinical history, including FDA clearances dating back to 2009 and subsequent developments in ultrasound visualization and treatment technology.

Clinical literature on microfocused ultrasound with visualization includes studies and expert guidance on tissue targeting, patient selection and treatment outcomes.

A published expert consensus review of microfocused ultrasound with visualization discusses its mechanism, clinical applications and treatment considerations.

XERF is newer, with a smaller and still-developing body of published clinical evidence.

Early studies are encouraging, but the longer-term evidence base is not yet as extensive as that of the older platforms.

For a closer look, explore what the first human clinical study of XERF actually found.

A newer technology isn't necessarily inferior, just as an older technology isn't automatically better.

What matters is the quality of the evidence, the treatment indication and the provider's experience.

What Is Recovery Like After XERF, Thermage or Ultherapy?

One of the appeals of noninvasive tightening is that these treatments generally don't require the recovery associated with surgery.

But minimal downtime doesn't mean zero possibility of side effects.

After XERF, temporary redness, warmth, tenderness or swelling may occur. Many patients can resume their usual activities quickly, although individual responses vary.

Thermage can also cause temporary redness, swelling or discomfort. Less common adverse effects are possible.

Ultherapy may cause temporary redness, swelling, tenderness, tingling or altered sensation. Less common complications, including nerve-related symptoms, have been reported.

Every energy-based procedure also carries risks associated with improper energy delivery or unsuitable patient selection.

Before treatment, your provider should explain the expected recovery, relevant contraindications and potential complications.

Our article on XERF side effects and what to watch for offers additional guidance.

Who Is a Good Candidate for XERF?

XERF may appeal to people interested in improving the appearance of early to moderate skin laxity without needles or surgical intervention.

It may be especially attractive if you're looking for a treatment that can fit into your routine with limited expected downtime.

However, suitability depends on your anatomy, medical history, skin condition and treatment goals.

People with more pronounced laxity may need a different approach, and certain medical conditions or implanted devices may affect eligibility for energy-based treatments.

Our guide to who is a good candidate for XERF explains the considerations in more detail.

How Do You Choose Between XERF, Thermage and Ultherapy?

Start with what you want to see when you look in the mirror.

Is it a firmer jawline? Skin that appears less lax around the lower face? A more defined neck? Or simply the feeling that your skin looks as vibrant as you feel?

Then consider what matters most to you.

• If comfort and a needle-free experience are priorities: XERF may be particularly appealing because of its integrated cooling and adjustable RF delivery.
• If you prefer a long-established radiofrequency platform: Thermage may be worth discussing.
• If targeted ultrasound lifting is appropriate for your anatomy: Ultherapy may be an option, particularly for concerns involving the brow, neck or under-chin area.
• If your laxity is more advanced: a medical evaluation may reveal that noninvasive energy treatments alone are unlikely to deliver your desired result.

No single device can be chosen responsibly on the basis of age, advertised depth or comfort claims alone.

The right treatment begins with your skin, not the machine.

The Joanna Vargas Approach: Your Skin, Your Treatment Plan

At Joanna Vargas, our philosophy begins with healthy skin and a personalized approach to visible change.

For twenty years, we've focused on helping clients care for their skin through a combination of professional treatments, advanced technology and consistent home care.

XERF adds another option within our medically guided aesthetic services, allowing eligible clients to explore noninvasive radiofrequency tightening as part of an individualized treatment plan.

That doesn't mean everyone needs XERF. Or that one technology can address every concern.

It means understanding what your skin needs today, what you would like to improve and which approach offers a reasonable path toward that goal.

The Bottom Line

XERF, Thermage and Ultherapy all offer non-surgical approaches to improving the appearance of skin laxity.

XERF stands out for its multifrequency radiofrequency technology and comfort-focused design. Thermage offers an established monopolar RF approach. Ultherapy uses focused ultrasound with visualization to target selected tissue depths.

Each has strengths, limitations and a different clinical history.

And while technology matters, the most important question isn't which device sounds the most advanced.

It's which treatment is most likely to help you see the change you want, while respecting your skin, your comfort and your expectations.

To explore whether XERF is appropriate for your goals, schedule a medically guided consultation at Joanna Vargas.

Frequently asked questions

Is XERF less painful than Ultherapy?

XERF is designed for comfort using multifrequency radiofrequency energy and integrated skin cooling, often without numbing. Ultherapy uses focused ultrasound, which can produce deeper sensations of discomfort in some patients. However, pain tolerance varies, and there is insufficient direct comparative evidence to guarantee that XERF is less painful for everyone.

Does Ultherapy give better results than XERF?

Not necessarily. Ultherapy uses focused ultrasound at selected depths and has established clinical applications for noninvasive lifting. XERF uses multifrequency monopolar radiofrequency to create controlled heating at adjustable treatment settings. The better option depends on your anatomy, degree of laxity, desired result and medical evaluation. There is insufficient direct comparative evidence to establish one as universally superior.

How is XERF different from Thermage?

Both XERF and Thermage use monopolar radiofrequency energy. XERF combines two frequencies, 6.78 MHz and 2 MHz, with adjustable treatment settings and integrated cooling. Thermage FLX uses single-frequency RF with its own cooling and feedback technologies. Both produce tissue heating, but their energy-delivery systems differ. A single RF frequency does not mean Thermage treats only one precise skin depth.

How many XERF sessions do you need compared with Ultherapy?

Ultherapy is commonly performed as a single treatment, with results developing over several months. Thermage is also frequently performed as a single session. XERF treatment plans vary, and one or more sessions may be recommended depending on the patient's skin, treatment goals and provider assessment. There is no universal three-to-five-session requirement for XERF.

Which treatment has the longest clinical track record?

Thermage and Ultherapy both have substantially longer clinical histories than XERF. Thermage has been used in aesthetic medicine for more than two decades, while Ultherapy received its first U.S. FDA clearance in 2009. XERF is a newer multifrequency RF platform with a growing evidence base, but it does not yet have the same length of published clinical follow-up.