If you’ve been looking into skin tightening around New Canaan this fall, you’ve probably seen a new name: XERF. It’s showing up on med spa websites and social feeds across Fairfield County, usually with words like “structural,” “next generation,” and “no numbing.”
New technology isn’t a bad thing. But at Element Medical Aesthetics, we don’t add a device because it’s popular. We add it when the evidence is strong enough that we can confidently say it belongs in your treatment plan. That’s why our skin tightening treatment of choice is Sofwave, and why we’re watching XERF with interest rather than jumping on the bandwagon.
Here’s an honest, side-by-side look at both, so you can make a thoughtful decision either way.
Why Is Everyone Suddenly Talking About XERF?
XERF is a radiofrequency (RF) device made by Cynosure Lutronic. It launched in Asia in 2024 and was cleared by the FDA in August 2025, so in the U.S. it’s still very new. As with most new devices, the launch came with a strong marketing push, and many practices are now promoting it.
Sofwave, by comparison, has been in U.S. practices for several years, with a growing body of published research behind it. Newer isn’t automatically better, and older isn’t automatically outdated. The useful questions are the same for any device: How does it work? What is it actually cleared to do? And what does the research show?
How Do Sofwave and XERF Work?
Both treatments use controlled heat to trigger your body’s own collagen response. Neither one breaks the skin. The difference is the type of energy and where it goes.
- Sofwave uses ultrasound. Its SUPERB™ technology sends seven parallel ultrasound beams into the mid-dermis. Sofwave reports that the heating stays between 0.5 and 2 mm deep, centered at 1.5 mm, which is the layer where collagen and elastin are made. A built-in cooling system protects the skin’s surface and monitors temperature throughout the treatment.
- XERF uses monopolar radiofrequency. It combines two RF frequencies (6.78 MHz and 2 MHz) in one pulse, with a grounding pad placed on your back to complete the circuit. Cynosure Lutronic says this lets the energy reach shallow, middle and deeper layers of tissue. It uses cryogen spray cooling, and it’s typically performed without numbing.
In short, Sofwave is designed to be precise and consistent at one depth. XERF is designed to heat more broadly and more deeply. Deeper isn’t necessarily better. Collagen production happens in the dermis, and when it comes to your face, we value predictability.
What Does “FDA-Cleared” Mean for Each Device?
This is the part most marketing skips, and it’s worth understanding.
Sofwave is FDA-cleared as a non-invasive aesthetic treatment to improve facial lines and wrinkles, lift the eyebrow, and lift lax tissue under the chin and on the neck. It has since received additional clearances for acne scars, upper-arm skin laxity and the short-term appearance of cellulite. The pivotal clinical study behind its original clearance was submitted to the FDA.
XERF is FDA-cleared “for use in dermatologic and general surgical procedures for electrocoagulation and hemostasis.” In other words, the clearance itself doesn’t mention skin tightening, lifting or wrinkles. It was cleared on the basis of being substantially equivalent to an older RF device, Thermage FLX, and the FDA summary states that no clinical tests were included in the submission.
To be fair, this isn’t unusual for monopolar RF devices, and it doesn’t mean XERF doesn’t work. It does mean “FDA-cleared” tells you something different for each device. With Sofwave, the clearance is for the aesthetic results you’re actually looking for.
What Does the Research Show So Far?
Sofwave has a deeper published record, including:
- A multicenter study in Dermatologic Surgery in which blinded reviewers correctly identified before and after photos for 78% of patients after a single treatment, and 86% showed measurable improvement in wrinkles and skin quality at 12 weeks, with no device-related adverse events.
- Biopsy studies documenting new collagen and elastin in the dermis after treatment, which is actual tissue-level evidence, not just photos.
- A 2026 study in Lasers in Surgery and Medicine that followed patients for nine months after a single treatment. Many still showed improvement in neck and under-chin laxity at nine months, with no burns, scarring or pigment changes reported.
XERF’s published human data is still early. A 2026 multicenter U.S. study of 39 patients reported that most improved after two treatments, but the authors themselves noted there was no control group, the study wasn’t blinded, and the treating clinicians scored the results, so bias “cannot be excluded.” A second 2026 study of 16 patients was retrospective and also had no control group. No published study has compared XERF directly with Sofwave.
That doesn’t mean XERF is ineffective. It means the evidence is promising but early, and we’d rather wait for stronger research than ask you to be part of the experiment.
Sofwave vs. XERF at a Glance
| Sofwave | XERF | |
|---|---|---|
| Energy | Ultrasound (SUPERB™ parallel beams) | Dual-frequency monopolar radiofrequency |
| Depth | Mid-dermis, centered at 1.5 mm | Multiple depths, including deeper tissue |
| FDA clearance | Lines and wrinkles, brow lift, under-chin and neck lift, plus acne scars, upper arms, cellulite (short-term) | Electrocoagulation and hemostasis |
| U.S. availability | Several years | Cleared August 2025 |
| Published evidence | Multiple clinical and biopsy studies | Early, small studies without control groups |
| Comfort | Warm pulses; topical numbing often used | Warm sensation; usually no numbing |
| Downtime | Little to none | Little to none |
| Results | Develop over 3–6 months | Develop over weeks to months |
Does XERF Have Any Advantages?
Yes, and we think you deserve to hear them. Many patients find XERF comfortable without numbing, which can make the appointment shorter. Its interchangeable tips and adjustable depths give providers flexibility, and some patients notice a feeling of tightness right after treatment.
Sofwave can feel more intense in short pulses, which is why we often apply a topical numbing cream first. Results also take patience: some improvement may be visible within several weeks, but the full effect builds over three to six months as new collagen forms.
If comfort and speed were the only measures, the choice would be closer. For us, they aren’t.
Why Does Element Choose Sofwave?
We’re not anti-radiofrequency. We use RF every day in Genius RF Microneedling, where it’s the right tool for texture, scarring and skin quality. Our choice of Sofwave for non-surgical lifting comes down to three things:
- Its clearance matches the goal. Sofwave is FDA-cleared specifically to improve lines and wrinkles and to lift the brow, under-chin and neck.
- The evidence is stronger. Larger studies, blinded photo assessment, biopsy data and longer follow-up give us more confidence in what you can realistically expect.
- It’s precise. Keeping the heat in the mid-dermis gives us consistent, controlled results, which matters most when you’re working toward a natural look that still feels like you.
That last point reflects our whole approach. Our goal is to help you look refreshed and well cared for, not “done,” and that starts with treatments we can stand behind.
Is Sofwave Right for You?
Sofwave is typically a good fit if you’re noticing mild to moderate skin laxity, fine lines and wrinkles, early jowling, a heavier brow, or crepey skin on the neck. Many patients also choose it as a preventative treatment to maintain firmness over time.
It isn’t the answer to everything. If your main concern is lost volume, such as hollowing after weight loss, regenerative options like Sculptra, Radiesse or Renuva may do more, and we often combine Sofwave with them for more complete rejuvenation. And if you have significant loose skin, no energy device can match a surgical facelift. We’ll tell you honestly if a surgeon is the better path.
Sofwave vs. XERF: Frequently Asked Questions
Is XERF FDA-approved for skin tightening?
Energy devices like these are FDA-cleared, not approved. XERF was cleared in August 2025 for electrocoagulation and hemostasis in dermatologic and general surgical procedures. Skin tightening is how it’s marketed and used, but it isn’t named in the clearance. Sofwave is cleared specifically to improve facial lines and wrinkles and to lift the brow, under-chin and neck.
Which lasts longer, Sofwave or XERF?
No study has compared them directly. Published Sofwave research has followed patients for up to nine months after a single treatment, with many still showing improvement. Published XERF studies have followed patients for about three months so far. At your consultation, we’ll talk about how long results typically last for your skin and when maintenance makes sense.
How many treatments will I need?
Many patients see results from a single Sofwave treatment, and the pivotal clinical study behind its FDA clearance used just one session. Published XERF studies used one or two sessions. Your plan depends on your skin and goals.
Does Sofwave hurt?
You’ll feel brief pulses of heat. We often apply a topical numbing cream first, and most patients tolerate treatment well. Some mild redness or swelling is common and typically resolves within a few hours, and most patients return to normal activities right away.
Is Sofwave safe for all skin types?
Ultrasound energy isn’t absorbed by pigment, and Sofwave’s pivotal study included patients across all skin types (Fitzpatrick I–VI). As with any treatment, we’ll review your history before recommending it.
Can Sofwave be combined with other treatments?
Yes. Sofwave is often paired with Sculptra, Radiesse or Genius RF Microneedling for more complete rejuvenation, addressing firmness, volume and skin quality together.
Does Element offer XERF?
Not at this time. We continue to follow the research, and we’ll always recommend the treatments we believe give you the most predictable, natural-looking results.
Make the Choice With Clarity
New devices will keep arriving, and every one of them will come with a big launch. Our job is to cut through that noise and recommend what’s right for your skin, your goals and your timeline, based on evidence and experience rather than trends.
Schedule Your Personalized Consultation and we’ll assess your skin, talk through your options (including whether Sofwave is right for you), and build a plan that helps you age with intention.
Not ready to book yet? Start With Clarity and take our Intentional Aging quiz to discover your aesthetic element.
Individual results vary. Treatment recommendations are made after an in-person consultation.