XERF: How much can radiofrequency treatment improve sagging skin? Which patients are suitable candidates and which are not

XERF is a non-invasive treatment device that uses two frequencies of radiofrequency (RF) to warm the skin and achieve skin tightening for sagging (skin laxity)[1]. Radiofrequency treatment for sagging skin leaves minimal scarring and does not leave foreign material in the body; however, its results are reported to be less effective than surgery or injectable treatments[2]. Devices of the same type are classified as treatments suited to patients with mild sagging skin[3].

How does XERF work?

XERF is a monopolar radiofrequency device. The shallow mode uses 6.78 MHz radiofrequency to warm the deep layer of skin (dermis) and the fibrous tissue beneath that supports the skin.[1].

The deep mode combines 6.78 MHz and 2 MHz in a single application.[1]The goal is to deliver heat to the facial fascia (SMAS) and the ligaments that support the skin.[1].

The basic principle is that collagen shrinks from the radiofrequency heat, and then new collagen is generated, resulting in skin tightening.[4]In pig skin experiments, applying two frequencies in succession showed collagen regeneration while preserving fat cells.[5]However, results in animals do not necessarily translate to the same changes in human facial skin.

What changes can be expected with XERF, and what are its limitations?

Reports show that radiofrequency devices measurably improve sagging skin on the face and body.[4]On the other hand, the guidelines of the Japanese Society for Aesthetic Surgery rank the efficacy as lower than that of surgery or injectable treatments, giving it a weak recommendation.[2].

Regarding XERF specifically, there are reports at the stage of reviewing past treatment records and compiling images and patient assessments.[1]Among the papers reviewed, there were no high-quality comparative studies directly comparing XERF with other devices.

How does it differ from HIFU and surgery?

A distinction is made: HIFU (high-intensity focused ultrasound) aims to lift deep layers, while radiofrequency warms various depths of skin for tightening and wrinkle treatment.[6]Which option you choose depends on the degree of sagging (skin laxity) and how fat is distributed.[6].

The difference from surgery is also clear. Comparing the effect of lifting the eyebrows, the lift from radiofrequency and ultrasound tightening is smaller than surgery, and the duration is shorter according to reports.[7]A survey of dermatologists in Korea found that HIFU and radiofrequency are most commonly used, and they often report combining them with injections.[6].

Who is it suited for, and who is it not?

For monopolar radiofrequency devices of the same type, results are not as extensive as Facelift surgery, and it is considered suitable for people with mild sagging (skin laxity).[3]If the skin has significant sagging and excess, you would compare surgery and other methods as well.[3].

For people with little facial fat, there is a philosophy of using conservative treatment to prevent fat from decreasing further.[6]If you are concerned about looking thinner, mention this during your consultation.

What are the risks of pain, redness, and burns?

Commonly seen reactions are redness that subsides within a few hours and mild swelling lasting about 1–2 days.[8]Monopolar type reaches deeper, but tends to produce stronger pain than bipolar type.[9].

Most complications are mild and temporary, but serious complications are reported more often in monopolar type than bipolar type.[4]In surveys, responses included occasional burns and swelling from radiofrequency treatment, and rarely infection.[6].

XERF has cooling and temperature-monitoring functions aimed at preventing burns and unintended fat reduction.[1]If you feel strong heat or pain during treatment, do not endure it—tell the staff immediately.

What should you confirm during consultation before treatment?

Whether XERF is suitable depends on the degree of sagging (skin laxity), the amount of facial fat, your pain tolerance, and combination with other treatments.[6]From the article alone, you cannot decide whether radiofrequency is right for your sagging (skin laxity), or whether surgery or injections are more appropriate.

During your consultation, confirm which mode will be applied to which areas, measures for pain management, how many times and at what intervals you will repeat treatment, and what to do if redness or burns appear.