If you are comparing non-surgical skin tightening treatments and wondering which skin tightening treatment fits you best, the first difference to understand is the type of energy each device uses. XERF and Thermage use radiofrequency energy. Sofwave and Ultherapy use ultrasound energy.
This difference affects how each treatment delivers heat and which skin tissue layers it targets. It can also change how your session feels and how your doctor plans it. A device that reaches deeper tissue is not automatically better for your skin or your goals. The right choice depends on where your skin is loose and how much it sags.
Your tissue, comfort needs, schedule, health history, and budget also matter. This guide compares XERF vs. Thermage, XERF vs. Sofwave, and XERF vs. Ultherapy.
What Is The Difference Between Radiofrequency vs. Ultrasound
Radiofrequency, or RF, is a type of electrical energy. Both XERF and Thermage FLX use it to warm tissue under the skin without needles. The main difference is how each device spreads that heat through the skin and the tissue below it.
Thermage FLX uses one RF frequency, 6.78 MHz. Its small Eye Tip warms a small, shallow area around the eyelids. Its larger tips treat wider areas of the face or body. They spread heat through collagen-rich skin and the support bands beneath it. The heat can tighten some existing collagen and prompt the body to build and reorganize collagen over time. This may smooth wrinkles and gradually firm mildly loose skin.
XERF gives the doctor three depth settings. Its shallow and middle settings use 6.78 MHz. Its deep setting adds 2 MHz. In computer models and studies using pig tissue, the 2 MHz setting spreads heat through a wider area and farther into the fat layer under the skin. The 6.78 MHz setting kept more heat around the collagen bands that connect the skin to the tissue below it. These settings do not create one exact treatment depth for every person because skin and fat thickness vary.
Both XERF and Thermage heat up the layers of collagen in your skin for the same reason. The heat can tighten some existing collagen fibers and prompt the body to make new collagen and gradually reorganize it. The difference is how the doctor controls where the heat goes.
- XERF changes the frequency to shift the heating pattern between shallower and deeper tissue.
- Thermage uses one frequency and adjusts the treatment tip, energy level, pulse length, and number of passes.
Ultrasound devices focus sound-wave energy below the skin.
- Sofwave targets the middle layer of skin, called the mid-dermis, at about 1.5 mm.
- Ultherapy PRIME uses focused ultrasound with real-time imaging. It can deliver energy at depths of 1.5, 3.0, and 4.5 mm. Its deepest setting can reach the superficial musculoaponeurotic system, or SMAS, a fibrous support layer below the skin.
The thickness of your tissues varies across your face, neck, and body, so the most useful treatment depth for you is the one that reaches your tissues that need treatment, while protecting other nearby areas.
XERF, Thermage, Sofwave, and Ultherapy Comparison
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| Comparison Basis | XERF | Thermage FLX | Sofwave | Ultherapy PRIME |
|---|---|---|---|---|
| Energy type | Radiofrequency (RF) energy at two frequencies: 6.78 MHz and 2 MHz. | Radiofrequency (RF) energy at one frequency: 6.78 MHz. | Ultrasound energy delivered through several beams at the same time. | Focused ultrasound with live images that show the doctor where to treat. |
| Treatment depth | The 6.78 MHz setting keeps more heat near the skin’s collagen support bands. Deep mode adds 2 MHz so heat can spread farther into the fat layer under the skin. | The tip and settings control how large an area is heated. | Mid-dermis, centered at about 1.5 mm. | Selected depths of 1.5, 3.0, and 4.5 mm. |
| Typical treatment areas | Face, jawline, under the chin, neck, chest, abdomen, arms, and thighs, depending on the treatment plan. | Face, eye area, and body areas covered by various treatment tips and indications. | Facial lines and wrinkles, eyebrows, under the chin, neck, acne scars, upper arms, and cellulite-related concerns within cleared indications. | Eyebrows, neck, under the chin, décolleté, abdomen, arms, and knees within current cleared indications. |
| Session experience | A handpiece passes over the skin while RF heats targeted tissue and built-in cryogen cooling helps manage surface heat. | RF pulses create a brief heating sensation while cooling and vibration features help with comfort. | Ultrasound pulses may feel warm as they treat the mid-dermis. | Ultrasound gel and imaging are used before focused energy is delivered. Heat or tingling may be felt. |
| Numbing | Cynosure describes XERF as a treatment that does not require numbing. IBI may adjust the comfort plan for sensitive areas. | Comfort practices vary. Your doctor may discuss options based on the treatment area and your sensitivity. | A topical numbing cream may be applied before treatment. | Comfort planning varies by doctor and treatment area. |
| Discomfort | Often described as warmth, with cooling between energy pulses. Sensitivity varies. | Heating sensations can range from mild to more noticeable. Sensitivity varies. | Usually described as warmth, but some areas can feel more sensitive. | Heat, tingling, or tenderness may be more noticeable in some areas. Sensitivity varies. |
| Downtime | Minimal expected downtime. Temporary pinkness or warmth may occur. | Minimal expected downtime. Temporary redness or swelling may occur. | Most people can return to their routine right away. Mild redness or swelling may last a few hours. | Most people can return to their routine right away. Temporary redness, swelling, tingling, or tenderness may occur. |
| Expected result timeline | Some people notice an early change, with gradual improvement over about two to three months as collagen remodeling continues. | Changes develop gradually, often over two to six months. | An early change may appear sooner, with fuller improvement developing over about 12 weeks. | Lifting develops gradually, often becoming more visible over two to three months. |
| Number of sessions | Individualized. One session may produce a visible change, while some treatment plans use more than one. | The manufacturer describes a single treatment for many patients, with maintenance based on individual goals. | The manufacturer says most facial patients need one treatment. Some body protocols may use more than one. | The manufacturer says many patients receive one session, with future treatment based on skin response and aging. |
| Potential side effects | Temporary redness, warmth, swelling, or tenderness may occur. Your doctor should review the full device risks with you. | Temporary redness, swelling, bumps, or tenderness may occur. Other less common effects are possible. | Pain, tenderness, redness, swelling, bruising, pigment changes, and other less common effects are possible. | Redness, swelling, pain, tenderness, and temporary nerve-related effects are among the reported possibilities. |
| Cost factors | Treatment area, number of areas, session plan, and package structure. | Treatment area, treatment tip, number of pulses, doctor experience, and local market. | Treatment area, number of pulses, comfort plan, session count, doctor experience, and local market. | Treatment area, number of treatment lines and depths, comfort plan, doctor experience, and local market. |
XERF vs. Thermage
Both XERF and Thermage warm the collagen-rich tissue under your skin without using needles. The heat can make some of your existing collagen fibers contract right away. It also signals the body to build and reorganize collagen over the next several months, which may make the skin look smoother and feel firmer. The difference is how each device places that heat. Thermage uses one RF frequency and changes the treatment pattern by using different tips and settings. XERF can use 6.78 MHz alone or add 2 MHz when the doctor wants the heat to spread farther into the tissue beneath the skin.
Thermage FLX uses one RF frequency, 6.78 MHz. Its attachments change how much skin is covered. There is a small eye tip that warms a small, shallow area around the eyes. Larger tips can cover wider areas and spread heat through collagen-rich skin and the support bands beneath it. The goal is to smooth wrinkles and help firm the skin as collagen tightens and rebuilds.
XERF adds a second, lower RF frequency. Its shallow and middle settings use 6.78 MHz. Its deep setting adds 2 MHz. In computer models and studies using pig tissue, 2 MHz spread heat farther into the fat layer under the skin. The 6.78 MHz setting kept more heat around the collagen support bands closer to the skin. This gives the doctor more control over how far the heat spreads below the surface.
No direct clinical trial has shown that one treatment is better than the other.
Comfort may help you compare the two. XERF uses Wave Fit pulse delivery and built-in cryogen cooling. Cynosure says it does not require numbing. Thermage also uses cooling and vibration, but the heat may feel strong in sensitive areas. With either treatment, your experience will depend on the area, settings, and your sensitivity.
Results become noticeable over time with both treatments. Thermage says changes can appear over two to six months after one session. IBI explains that XERF results often become clearer over two to three months. Neither treatment can remove a large amount of extra skin or create surgical facelift-level changes.
XERF vs. Sofwave
XERF vs. Sofwave compares RF with ultrasound. XERF can deliver RF across different tissue layers. Sofwave focuses ultrasound energy in the mid-dermis at about 1.5 mm. Its cooling system helps protect the skin’s surface.
That difference may matter when your concern sits closer to the skin’s middle layer. Sofwave’s current approved uses include improving facial lines and wrinkles and lifting the eyebrows and loose tissue under the chin and on the neck. Other uses include acne scars, upper-arm laxity, and short-term improvement in the look of cellulite. Your doctor should confirm that your concern matches a cleared use and that the depth suits your body.
The two devices handle comfort in different ways. Sofwave uses a numbing cream that is applied before the 30- to 45-minute treatment. You may still feel warmth. XERF uses pulse control and cryogen cooling, so numbing is usually not needed. Your session may not feel the same as someone else’s.
Both treatments rely on a gradual tissue response. Sofwave results usually develop over about 12 weeks. XERF results often develop over two to three months. Sofwave says one session may be enough for many facial patients, although some body plans use more. The number of XERF sessions you will need also depends on the results you are trying to get.
XERF vs. Ultherapy
XERF vs. Ultherapy compares multi-depth RF with image-guided ultrasound. XERF delivers heat through dual-frequency radiofrequency. Ultherapy PRIME uses real-time ultrasound images so the doctor can see the tissue layers and place the energy at different depths.
Ultherapy’s real-time images help when you need precise ultrasound placement. Its deeper settings can reach a fibrous support layer called the superficial musculoaponeurotic system, or SMAS. XERF’s manufacturer also describes energy reaching shallow, middle, and deep layers. It uses RF rather than focused ultrasound.
The sessions may also feel different. XERF uses cryogen cooling and is designed to work without numbing. With Ultherapy, you may feel heat or tingling as the device delivers focused ultrasound. Comfort varies by area and person. Both treatments usually allow a quick return to daily activities, but short-term redness, swelling, or soreness may occur.
If Morpheus8 is also on your list, it belongs in a separate comparison because it combines RF with microneedling. Our XERF vs. Morpheus8 guide explains how needles, texture goals, and recovery change that decision.
How to Choose the Right Skin Tightening Treatment
Start with the change you want, not the device name. During a consultation, your doctor can match your concern to the tissue that needs treatment. You can also discuss how much change a non-surgical option may provide.
Useful decision factors include:
- Your main concern, such as early jowls, a softer jawline, neck laxity, fine lines, or loose skin on a body area.
- The amount of laxity. Mild or moderate laxity may respond differently from heavy or hanging excess skin.
- Your skin and tissue thickness in the treatment area.
- Whether a surface, mid-dermal, or deeper tissue target makes sense for your anatomy.
- Your comfort preferences and whether you want to avoid topical numbing.
- How much redness, swelling, tenderness, or social downtime you can manage.
- How soon you hope to see a change and whether you are comfortable waiting several months for collagen remodeling.
- Whether your plan is likely to involve one session, a series, or future maintenance.
- Your medical history, medications, implanted devices, recent fillers or procedures, and any active skin condition.
- Your full treatment cost, including the area, session count, comfort plan, and maintenance rather than only the advertised starting price.
If loose skin developed after body contouring, the cause and treatment options may be different. Our guide to skin tightening after liposuction explains the next steps. Skin quality, age, the amount of fat removed, and the treatment area all play a role.
XERF Right for You?
XERF may be worth considering if you want needle-free RF for early skin laxity. It offers gradual firming with minimal expected downtime. It is not a substitute for surgery when you have a large amount of extra skin or want a more dramatic change.
A consultation with a specialist at IBI Plastic Surgery & Med Spa, starts with the area that bothers you and the amount of loose skin. You can discuss the change you hope to see and the type of treatment experience you want. Your IBI specialist can explain your options and discuss the suggested depth, session plan, and cost that may fit your needs.
Learn more about XERF and if you should include it in your treatment plan. Schedule a consultation with IBI Plastic Surgery & Med Spa and let us answer your questions about XERF and what you can expect during your treatment.
FAQs
Is XERF Better than Thermage?
Neither treatment is better for everyone. Thermage uses a single 6.78 MHz RF frequency and shapes the treatment with specialized tip sizes, energy settings, calibration, and passes. XERF can use 6.78 MHz alone or add 2 MHz to create a broader and deeper heat pattern. Both contract and remodel collagen, but they distribute heat differently. No direct head-to-head clinical trial has established that one produces better results.
Which Feels More Comfortable, XERF or Sofwave?
Comfort varies by person and treatment area. XERF uses cryogen cooling and is designed to work without numbing. Sofwave says numbing cream may be used before ultrasound treatment. Ask what the office uses for comfort and how the target area may feel.
Is XERF Better than Ultherapy Because It Can Treat Deep Tissue?
No. Depth alone does not determine which treatment is right for you. XERF uses multi-depth RF, while Ultherapy PRIME uses real-time imaging to place focused ultrasound at selected depths. Your doctor should choose the technology and depth that match your anatomy and concern.
How Much do XERF, Thermage, Sofwave, and Ultherapy Cost?
There is no useful universal price. Cost depends on the area, number of pulses or lines, session count, comfort plan, doctor’s experience, and local market. Compare written quotes for the same area. Ask if follow-up or maintenance is included. IBI’s current XERF pricing information is on the practice’s pricing page.
