XERF vs. Thermage vs. Ultherapy: How the Three Skin Tightening Treatments Compare
If you have started researching non-surgical skin tightening, three names come up again and again: XERF, Thermage and Ultherapy. All three use heat to prompt your skin to build new collagen, and none of them involves needles or surgery. Where they differ is the kind of energy they use, how they reach the deeper layers, how the treatment feels, and how many visits it takes.
At Point of View Medical Aesthetics we offer XERF skin tightening in Calgary. We do not offer Thermage or Ultherapy, so read this as a guide from a clinic that works with one of the three, written to help you ask better questions wherever you book.
The Short Version
- XERF is a monopolar radiofrequency (RF) treatment that combines two frequencies, 6.78 MHz and 2 MHz, so one session can heat shallow, middle and deeper layers of the skin. It is designed to be done without numbing.
- Thermage FLX is also monopolar RF, using a single frequency. It has more than 20 years of clinical use behind it and is usually done as one treatment.
- Ultherapy PRIME uses micro-focused ultrasound instead of RF. The provider sees your tissue layers on a screen and places energy at set depths of 1.5, 3.0 or 4.5 mm.
How Each Technology Works
XERF: Dual-Frequency Radiofrequency
Radiofrequency energy turns into heat as it meets resistance in your tissue. XERF, made by Cynosure Lutronic, delivers two frequencies within the same pulse. According to the manufacturer, the 6.78 MHz frequency works closer to the surface while the 2 MHz frequency travels deeper, along the fibrous bands that anchor skin to the structures beneath it. Your provider chooses from three depth settings and ten energy levels, so the jawline can be treated differently from the forehead.
Built-in cooling protects the surface of the skin throughout. Health Canada cleared XERF in April 2025, which made Canada the device’s first North American market.
Thermage FLX: Single-Frequency Radiofrequency
Thermage, made by Solta Medical, is the treatment that established monopolar RF for skin tightening. The current FLX model heats the deeper, collagen-rich layers of the skin with a single 6.78 MHz frequency, cools the surface, and vibrates the handpiece to make the heat easier to tolerate. It also adjusts its energy from pulse to pulse to suit your skin.
Ultherapy PRIME: Micro-Focused Ultrasound
Ultherapy, made by Merz Aesthetics, concentrates ultrasound energy into tiny points of heat at a chosen depth and leaves the surface of the skin untouched. Its distinguishing feature is live imaging: the provider can see the layers of your skin and aim at the deeper supportive layer, called the SMAS, that surgeons work with during a facelift.
XERF vs. Thermage vs. Ultherapy at a Glance
| XERF | Thermage FLX | Ultherapy PRIME | |
|---|---|---|---|
| Energy | Dual-frequency monopolar radiofrequency (6.78 MHz + 2 MHz) | Single-frequency monopolar radiofrequency (6.78 MHz) | Micro-focused ultrasound with live imaging |
| Made by | Cynosure Lutronic | Solta Medical | Merz Aesthetics |
| How depth is controlled | Three depth settings and ten energy levels | Heats the deeper, collagen-rich layers broadly, adjusting energy pulse by pulse | Set depths of 1.5, 3.0 or 4.5 mm, chosen while viewing the tissue on screen |
| Typical plan | One session or a short series | Usually a single session | Usually a single session |
| Comfort | Designed to be done without numbing; felt as deep warmth | Cooling and vibration built in; much more comfortable than early Thermage devices | Can be uncomfortable for some; numbing or pain relief is often offered |
| Downtime | Mild redness that usually settles within hours | Temporary redness or minor swelling, usually gone within 24 hours | Little to none |
| Track record | Newer: launched in 2024, cleared by Health Canada in 2025 | More than 20 years of clinical use | Well established, with years of published studies |
Comfort and Downtime
Comfort is where XERF has drawn the most attention. It was engineered to be performed without numbing cream, and most people describe it as a deep warmth. Our clients go straight back to work or errands afterwards, with mild redness that typically fades within a few hours.
Thermage FLX is far more comfortable than the early Thermage devices thanks to its cooling and vibration, and most people now manage it without anaesthetic. Ultherapy’s focused points of energy can feel sharper for some people, which is why clinics often offer numbing or pain relief beforehand.
None of the three calls for real recovery time. Pain tolerance is personal, so ask any clinic you are considering which comfort measures they use.
Sessions and Results
All three work by triggering collagen remodelling, so the full result arrives gradually and not on the day of treatment.
- XERF: many people notice some firmness right away, with improvement continuing for about two to three months. Some are happy after one session and others do a short series. In the manufacturer’s clinical trial, most participants had two sessions about four weeks apart.
- Thermage FLX: usually one session, with results appearing over two to six months. The manufacturer says they can last one to two years, depending on your skin and how it ages.
- Ultherapy PRIME: usually one session, with lifting that builds over the following months.
Whichever you choose, skin keeps ageing, so occasional maintenance treatments are normal. Individual results vary.
Which One Fits Which Goal?
There is no single winner, and direct head-to-head studies are limited. As a general guide:
- Mild to moderate looseness along the jawline, jowls, cheeks or neck, and you want a comfortable treatment with no numbing: XERF is built for this.
- You want a long-established RF treatment done in a single visit: Thermage FLX is worth asking about.
- Your main goal is lift, and you like the idea of imaging-guided treatment: Ultherapy PRIME lets the provider see and target specific depths.
- Significant sagging or excess skin: no energy device replaces surgery, and a good provider will tell you so.
Tightening Is Only Half the Picture: LaseMD Ultra and Mosaic 3D
XERF, Thermage and Ultherapy all work on firmness. None of them is designed for what sits on the surface: sun spots, uneven tone, rough texture or acne scars. Radiofrequency does not target pigment, which is part of why XERF may suit a wide range of skin tones, but it also means XERF will not fade a sun spot.
That is the job of laser resurfacing, and we offer two options:
- LaseMD Ultra is a gentle 1927 nm thulium laser for pigmentation, sun damage, dullness and overall tone. Expect mild redness and a fine, sandpaper-like texture for a few days.
- Mosaic 3D is a 1550 nm fractional laser that works deeper in the dermis to improve texture, fine lines and acne scars.
Many people who ask about skin tightening have two concerns at once: skin that has loosened and skin that has lost its even tone. In that case a plan might pair XERF for firmness with LaseMD Ultra or Mosaic 3D for the surface, spaced in the way your provider recommends. We map that out at your consultation.
XERF at Point of View Medical Aesthetics
XERF is the skin tightening treatment we offer at our clinic at 1000 Centre St N in north Calgary. We use it most often on the jawline and jowls, cheeks, brow, lower face and neck. Every plan starts with a free consultation, where we look at whether tightening, resurfacing or a combination is the right fit and review your medical history. XERF is not suitable during pregnancy or breastfeeding, or for anyone with a pacemaker or other implanted electronic device.
For treatment areas, before and after photos and more detail on what to expect, visit our XERF Calgary treatment page.
Frequently Asked Questions
Q: Is XERF better than Thermage?
A: They are close relatives: both are monopolar radiofrequency treatments. XERF adds a second frequency and adjustable depth settings, and is designed to be comfortable without numbing. Thermage FLX has a much longer track record and is usually done in a single session. Which is better depends on your skin, your goals and the experience of your provider.
Q: Is XERF the same as Ultherapy?
A: No. XERF uses radiofrequency, which heats tissue across several layers. Ultherapy uses focused ultrasound, which places small points of heat at specific depths while the provider views the tissue on a screen. Both aim to stimulate new collagen.
Q: Which is the most comfortable: XERF, Thermage or Ultherapy?
A: XERF is designed to be performed without numbing and is usually described as a deep warmth. Thermage FLX uses cooling and vibration for comfort. Ultherapy can be more uncomfortable for some people, so clinics often offer numbing or pain relief. Experiences vary from person to person.
Q: Can I have XERF if I have already had Thermage or Ultherapy?
A: In many cases yes, but timing matters because collagen keeps remodelling for months after any of these treatments. Tell your provider what you had and when, so they can plan around it.
Q: Does XERF replace laser treatments like LaseMD Ultra or Mosaic 3D?
A: No. XERF tightens, while lasers resurface. LaseMD Ultra and Mosaic 3D treat pigmentation, tone, texture and scars, which radiofrequency does not address. Many treatment plans use both.
Q: Can XERF, Thermage or Ultherapy replace a facelift?
A: No. Non-surgical skin tightening suits mild to moderate looseness and gives a subtler result than surgery. If you have significant sagging or excess skin, a surgical consultation is the more appropriate step.
References
- Hong J, Ryu HG, Park C, et al. Efficacy of dual-frequency noninvasive monopolar radiofrequency in skin tightening: Histological evidence. Skin Research and Technology. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11180671/
- Weiss RA, Wang J, DiBernardo B, Bhatia AC. Clinical Outcomes Following Dual-Frequency Noninvasive Monopolar Radiofrequency Treatment for Facial Laxity and Lower Face Lifting: A Prospective Multicenter Study. Cureus. 2026. https://doi.org/10.7759/cureus.104546
- ClinicalTrials.gov. Safety and Efficacy Evaluation of the XERF Device for Aesthetic Treatments (NCT07585591). https://clinicaltrials.gov/study/NCT07585591
- Cynosure Lutronic. Cynosure Lutronic Announces Health Canada Clearance for XERF. April 2025. https://www.businesswire.com/news/home/20250409238558/en
- Cynosure Lutronic. XERF Structural Skin Tightening. https://www.cynosure.com/xerf/
- Solta Medical. Thermage FLX. https://ca.thermage.com/
- Merz Aesthetics. Ultherapy PRIME. https://ultherapy.com/physicians/a-deeper-nonsurgical-lift
- Kerscher M, Nurrisyanti AT, Eiben-Nielson C, et al. Skin physiology and safety of microfocused ultrasound with visualization for improving skin laxity. Clinical, Cosmetic and Investigational Dermatology. 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6336023/
