Hello, this is Pria Clinic. Today, we'd like to talk about XERF, which could be called a new paradigm in RF lifting.
What sets XERF apart is that it uses two frequencies and three modes to control how thermal energy is delivered to tissue.
Rather than simply applying more energy, it focuses on where and how heat is delivered, tailored to the condition of the skin and subcutaneous tissue.
In this column, we'll look at the role each of XERF's two frequencies plays, how the three modes differ, and what to consider when comparing it with other RF treatments.
How Does XERF Work?
XERF is a non-invasive monopolar RF device that delivers radiofrequency energy through a handpiece placed in contact with the skin surface.
As RF energy passes through tissue, it generates heat. The basic principle of RF tightening is to use this thermal stimulus to induce collagen contraction, followed by collagen remodeling.
When thinking about skin firmness, it's easy to focus only on the dermis, but beneath the skin lie connective tissues that also support the shape of the face. The fibrous septa, which divide and connect the subcutaneous fat, are one of them.
To deliver heat to the skin and these subcutaneous tissues, XERF uses 6.78MHz and 2MHz. These are sometimes described as "two wavelengths," but since MHz is a unit of frequency, "two frequencies" is the accurate term.
What's the Difference Between 6.78MHz and 2MHz?
The difference between the two frequencies can't be explained simply as "one goes shallow, the other goes deep," because how heat is distributed within the tissue also differs.
6.78MHz: Energy That Reaches Not Only the Dermis but Also the Fibrous Septa
6.78MHz mainly delivers concentrated energy to the dermis. However, XERF-related clinical findings have confirmed that a thermal response also occurs along the fibrous septa between subcutaneous fat lobules, not just in the dermis.
Rather than viewing 6.78MHz as a frequency that acts only on the dermis, then, it's more accurate to see it as one that can also affect the fibrous supporting structures beneath the skin.
2MHz: Broader Heating Throughout the Subcutaneous Tissue
Under the same study conditions, 2MHz showed a broader and deeper heating pattern within the subcutaneous fat tissue.
Using both frequencies together is a way of combining these distinct heat distributions. However, the actual distribution also depends on tissue properties, electrode design, power output, and delivery time—not frequency alone.
It's important to note that heating of the subcutaneous fat layer does not mean fat cells are destroyed. In the relevant animal study of XERF, no adipocyte death was observed. Likewise, when the jawline appears more defined, it's important to distinguish between fat reduction and the tightening of skin and connective tissue.
Shallow, Middle, Deep: How Do the Three Modes Differ?
XERF offers three modes: Shallow, Middle, and Deep.
The names might suggest the same energy simply being sent to shallow, middle, or deep levels. In reality, each mode adjusts the heating pattern by varying the frequency used and the timing structure of the pulses.
Shallow: A Mode Focused on Dermal Firmness
The manufacturer describes Shallow as a setting that targets the dermis. It can be considered when addressing fine lines or loss of skin elasticity.
Middle: A Mode That Extends to the Superficial Subcutaneous Tissue
Middle is a setting that also addresses the superficial subcutaneous tissue below the dermis. It is selected after assessing both the thickness of the skin and underlying tissue and the degree of laxity.
Deep: A Mode for Sagging in Deeper Tissue
Deep is designed to deliver heat to the deeper tissues associated with sagging. It may be considered when evaluating laxity in the lower face or jawline, but being "deeper" does not automatically make it more suitable for every area.
| Mode | Frequency Used in the Study | Pulse Structure |
|---|---|---|
| Shallow | 6.78MHz | Delivered in short, divided pulses |
| Middle | 6.78MHz | Individual pulses delivered longer than in Shallow |
| Deep | 6.78MHz + 2MHz | Pulses of both frequencies delivered sequentially |
This table summarizes the configurations used in the study. Shallow and Middle use the same frequency but differ in delivery timing, while Deep combines both frequencies. Thinking of the three modes simply as "low, medium, and high" means missing the real differences.
How Does XERF Compare With Thermage and Oligio?
When comparing RF devices, you need to look not only at frequency but also at the energy delivery method, pulse structure, and cooling features.
vs. Oligio: The Option of Two Frequencies
Oligio is an RF device that uses 6.78MHz. XERF differs in that it also incorporates 2MHz.
That said, the number of frequencies does not indicate the size of the effect. The two frequencies are a technical feature for controlling heat distribution, and which device is suitable depends on your skin condition and treatment goals.
vs. Thermage FLX: Energy Delivery and Pain Management
Thermage FLX uses cooling and vibration while delivering RF energy.
In addition to its two frequencies and three modes, XERF uses WaveFit technology, which splits energy into multiple pulses, along with a cooling system. According to the manufacturer, this is designed to reduce sudden heat sensations and discomfort during treatment.
So XERF's difference isn't simply that it "treats with more heat." It also lies in the timing structure with which heat is delivered and how the skin surface is protected. Pain levels can vary depending on the treatment area, settings, and individual sensitivity.
vs. Potenza Needle RF: Whether Needles Are Used
Potenza delivers energy into the skin using microneedles. XERF, by contrast, delivers energy from the skin surface without inserting needles.
Potenza also uses multiple frequencies and RF modes, but because the use of needles and the energy delivery structure differ, the two can't be compared on frequency numbers alone.
Can XERF Treatment Plans Differ From Person to Person?
Even within the same face, the thickness of the skin and subcutaneous tissue varies by area. Sagging that looks similar on the surface may call for a different approach depending on whether fine lines are the main concern or lower-face laxity is the bigger issue.
XERF's three modes and stepwise intensity settings are options for accounting for these differences. No single mode is the best setting for every area or every person.
During your consultation, it helps to review the following together:
- Whether your main concern is fine lines, firmness, or facial contour
- The thickness of the skin and subcutaneous tissue in each area
- Which areas need their facial volume preserved
- Whether your expectations align with what the treatment can realistically achieve
In RF Lifting, Your Skin Condition Matters as Much as the Device Name
XERF's key feature is that it can control energy delivery by combining two frequencies, three modes, and pulse and cooling technologies.
Understanding these technical differences lets you go a step beyond asking "Is this a new device?" or "How many shots will I get?" and consider what kind of treatment approach your own skin concerns actually require.
At Pria Clinic, we assess skin firmness and the degree of sagging along with facial volume and structure, and recommend a treatment approach tailored to your individual concerns.
If you're considering RF lifting, try pinpointing exactly what you'd like to improve. The right approach can differ depending on whether your main concern is fine lines, loose skin, or a less defined jawline.
Medical Information Notice — This column provides general medical information and does not recommend specific treatments. The appropriate treatment may vary depending on individual skin conditions and health status.
