Lifting and Tightening in One Treatment: A Closer Look at XERF

■ Introduction A sagging jawline, cheeks that have lost their firmness, fine lines around the eyes. If you've started looking into treatments for any of these, you've probably come across the term "radiofrequency (RF) lifting." Today, I'd like to talk about one RF device in particular: XERF, a monopolar RF system that combines two frequencies (6.78 MHz + 2 MHz). We'll walk through how it works, what the research shows, and what's worth knowing before you get treated. ■ 1. How RF Lifting Works The tissues in our body contain ions such as sodium and potassium. When a radiofrequency current passes through, these ions move rapidly, and that movement generates heat. RF lifting is a treatment that delivers this heat to a targeted depth beneath the skin. Heated skin goes through two kinds of changes: • Immediate collagen contraction: Collagen fibers exposed to heat instantly shorten and tighten. This is the change you may notice right after treatment and over the following two weeks or so. • Long-term collagen regeneration: As the treated area heals, fibroblasts are activated and new collagen is gradually produced over 3 to 6 months. The healing process can be broken down into the following stages: ▸ Right after treatment to day 3 (Inflammatory phase): Damaged tissue is cleared and repair signals are released ▸ Day 3 to week 3 (Proliferative phase): Fibroblasts are activated ▸ Week 3 to month 3 and beyond (Maturation & remodeling phase): New collagen settles in That's why many people notice a change from RF lifting twice: once right after treatment, and again a few months later. ■ 2. What Makes "Monopolar" RF Different? RF devices fall into two broad categories depending on their electrode design: • Bipolar RF: The two electrodes sit close together, so the current stays concentrated around them. It works on relatively shallow areas. • Monopolar RF: The current flows between a single treatment tip and a pad attached to the body, allowing heat to be delivered more broadly and more deeply. One distinctive feature of monopolar RF is that it acts on the fibrous septa. These are collagen structures that run like a web between the fat layers beneath the skin. Fat doesn't conduct electricity well, but the septa act as pathways for the current. As a result, heat travels along this web, and as the septa contract, they can help tighten the skin from within. ■ 3. The Core of XERF: Two Frequencies The lower the frequency, the deeper RF energy penetrates. XERF takes advantage of this by combining two frequencies: • 6.78 MHz: Delivers heat mainly to the dermis and fibrous septa. • 2 MHz: Delivers heat to deeper areas, centered on the fat layer. This combination allows heat to be distributed by depth, from the dermis down to the SMAS (the facial fascia layer). That is XERF's defining feature. It aims to achieve both "tightening" (firmer skin) and "lifting" (raising sagging contours) with a single device. [ Three Modes, Chosen by Depth ] ▸ Shallow (6.78 MHz): Dermis ▸ Middle (6.78 MHz): Dermis to superficial fat layer ▸ Deep (6.78 MHz + 2 MHz): Dermis to deep fat layer A study conducted in the U.S. reported that Deep mode reaches a depth of about 9 mm and Middle mode about 5.5 mm, while Shallow mode primarily targets the upper dermis. In practice, the three modes are combined depending on skin thickness and treatment area, and a full-face treatment takes about 30 minutes. 💡 Will it cause fat loss? When people hear that heat reaches deeper layers, many worry about losing facial fat. Both preclinical research and a U.S. clinical study reported that no fat cell death was observed, even with the use of 2 MHz. ■ 4. Designed for Comfort and Safety Many people picture RF treatments as "hot and painful." XERF was designed with both pain and safety in mind: • Cooling with every pulse: The sequence "cooling → RF delivery → temperature measurement" repeats with every pulse, keeping the skin surface temperature stable. • Real-time temperature sensing: Five temperature sensors in the tip check skin temperature with every pulse, and RF output automatically shuts off at 43°C. • Heat & Hold pulse structure: Energy is first delivered at high power to reach the target temperature (Heat), then at lower power to maintain it (Hold). Rather than a short, intense jolt, it sustains deep heat over time. • Spider-pattern electrode (patented): RF energy tends to concentrate at the edges of an electrode. This design prevents that, so energy is distributed evenly across the entire tip. • Impedance matching: Before treatment, the device measures the skin's electrical resistance, which differs from person to person, and adjusts itself so the set energy is delivered accurately. • Standard ultrasound gel: Instead of a dedicated coupling oil, standard ultrasound gel is used, allowing the tip to glide smoothly over the skin. ■ 5. What the Research Shows Research data on XERF has been steadily building both in Korea and abroad since its launch. Here, I'll focus on studies that have been published. [ Clinical Studies (Human Subjects) ] ▸ Retrospective study in Korea (20 patients) • Improvement in facial wrinkles and sagging after a single treatment with 6.78 MHz + 2 MHz • Mean Global Aesthetic Improvement Scale (GAIS) score improved from 1.65 to 2.75, roughly a 40% improvement (p < 0.0001) • Mean patient satisfaction of 7.84/10, with every participant scoring 7 or higher • Pain rated 4–5 on the VAS (mild to moderate), with no adverse events reported ▸ Technical report from Israel (small periorbital tips, E10/E5) • Enables precise treatment even in delicate areas such as around the eyes • Improvements in brow position, upper eyelid laxity, and fine lines at 3 months • No unexpected or persistent adverse events [ Preclinical Studies (Animal and Tissue Models) ] ▸ Live porcine model studies (4 published papers) • Deep mode delivered heat beyond the dermis to the SMAS layer, and collagen denaturation was confirmed immediately after treatment. • Heat was effectively delivered to the dermis while the skin surface temperature remained safe, and collagen thickness and density increased after 30 days. • The 6.78 MHz + 2 MHz combination induced stronger immediate contraction and collagen regeneration than 6.78 MHz alone. • Even with both frequencies combined, no fat cell death was observed. ■ 6. Who Might Consider XERF ✔ Those whose jawline and cheek contours are starting to sag and who want lifting ✔ Those whose skin has become thinner and less firm and who want tightening ✔ Those concerned about drooping and fine lines around the eyes (using the periorbital tip) ✔ Those looking for a non-invasive treatment with a quick return to daily life ✔ Those who want to improve both skin texture and firmness XERF is designed so that a single standalone treatment can address lifting, firmness, and skin texture together. Whether to combine it with other treatments is best decided in consultation with your provider based on your skin condition. ■ 7. Frequently Asked Questions Q. How long does the treatment take? A. For a full face, using a mix of all three modes, it takes about 30 minutes. Q. Does it hurt? A. Pain varies from person to person, but XERF cools the skin with every pulse and uses a pulse structure refined to reduce discomfort. Pain reported in studies was generally mild to moderate. Q. When will I see results? A. You may notice firmer skin right after treatment thanks to collagen contraction, and changes will appear gradually over 3 to 6 months as new collagen is formed. Q. Will I lose facial fat? A. In the studies published to date, no fat cell death has been observed. ■ Closing Thoughts XERF is a monopolar RF device that uses two frequencies to target different depths of the skin. It addresses everything from dermal firmness to lifting at the SMAS level with a single device, while per-pulse cooling and real-time temperature sensing keep safety in check. That said, even with the same device, the mode and energy settings will vary depending on your skin thickness, degree of sagging, and the results you want. Be sure to have a thorough consultation beforehand to build a plan that's right for you. ※ This article is for informational purposes only. Treatment results and side effects may vary from person to person. Always consult a physician before undergoing any treatment.