XERF vs. XTherma: Which Skin Tightening Should You Choose?

First, the part nobody tells you: they're nearly the same machine

When two devices launch into the same market within eighteen months of each other, the temptation is to believe one is a breakthrough and the other is a knock-off. That is not what is going on here.

Both XTherma and XERF are monopolar radiofrequency devices. Both operate at 6.78 MHz with up to 400 watts of power. Both pass current from a handpiece, through your tissue, to a return pad on your back — which is what lets the heat reach the depth where collagen actually lives. Both cool the surface of your skin with cryogen spray so the energy can go deep without burning what you can see. Both are used without numbing, because your ability to feel the heat is the safety mechanism.

XTherma vs. XERF at a glance

The four differences that actually matter to you

1. How many appointments you have to take off for

XTherma is built around a single session. That is what the manufacturer recommends, what its published pilot study used, and how national chains schedule it. XERF's published trial allowed up to three treatments; every participant finished after two, about four weeks apart.

One appointment versus two sounds like a small thing until you are the one arranging childcare, taking a long lunch, or driving in from Irvine a second time. For most of our patients, one visit that does the job is the practical advantage.

2. What it costs

This is the clearest gap between them. XTherma is roughly half the price. LaserAway — the only large chain publishing prices for both categories — lists XTherma at $950 to $1,200 per session. Clinics offering XERF generally publish from about $1,500 per session, with full face and neck commonly quoted between $1,500 and $3,000.

At Neoderma, founding-patient pricing is $895 for the full face and $995 for face and neck. For a treatment that is nearly identical in mechanism, that difference buys you a lot — a second area, an exosome add-on, or simply the ability to say yes at all.

Financing available through Cherry and CareCredit — split your treatment into flexible monthly payments. Learn more →

3. How the cooling is delivered

Both devices cool with cryogen, but they structure it differently. XTherma fires seven cooling pulses around every single shot — two before the energy, three alongside it, two after — with a thermal sensor that shuts the tip down automatically if it gets too hot. XERF uses cryogen cooling adjustable across three levels.

Both approaches work, and both let the treatment be done without numbing. What matters more than the specification is that whoever is holding the handpiece is asking you how it feels and adjusting. Which brings us to the honest part.

4. What's been published

We are going to tell you something most clinics would leave out. XERF currently has more published human data than XTherma — a prospective study of 39 patients and a retrospective review of 16, versus XTherma's 13-patient pilot and 26-patient retrospective, with a larger randomized trial registered but not yet reported.

If published trial size is the only thing you weigh, XERF is ahead today. What we would add is that both evidence bases are small, both devices are new, and neither has anything like the decades of literature behind older platforms. In a category this young, a few dozen patients either way is not the difference between working and not working.

The FDA claim you should be skeptical of

If a clinic tells you their radiofrequency device is “FDA-cleared for skin tightening” and the competing one isn't, check it. For these two devices, that statement is not accurate about either.

XTherma's clearance (K232992) and XERF's clearance (K251327) contain the identical wording: indicated for use in dermatologic and general surgical procedures for electrocoagulation and hemostasis. Neither one carries an FDA clearance for wrinkles, laxity, or skin tightening. Using either device cosmetically is an off-label use.

Off-label use is legal and routine — once a device is cleared, a physician may use it for another purpose when their judgment supports it. It does not mean experimental or unregulated. But it does mean the responsibility sits with the medical team rather than with a certificate, and you deserve to know that before you book. You can read our full explanation on the XTherma treatment page, and it is disclosed in the consent form you sign with us.

Why we chose XTherma

Given how similar the two machines are, our reasoning was less about specifications and more about what a patient actually gets.

One session, at roughly half the price. For a treatment delivering comparable results by a comparable mechanism, we would rather more people be able to afford it and be done in a single visit. Skin tightening that stays out of reach doesn't help anyone.

We tried it on ourselves first. Before XTherma touched a single patient, our own Melissa Moore, RN went under the handpiece. Her one-session results — focused on the nasolabial area — are on our treatment page, unretouched.

The operator matters more than the logo. This is the same conclusion we reached comparing Morpheus8 and Secret RF. Two devices in the same category, used well, land in the same place. What separates a good result from a disappointing one is whether your provider maps the treatment properly, builds heat in even passes instead of stacking energy in one spot, and stops when you say stop. We have been doing energy-based treatments in Anaheim since 2001.

And the honest caveat, one more time: if you want the device with the larger published trial behind it today, that is XERF, and we would rather you hear it from us than discover it later.

Is this the right treatment for you at all?

Either device suits the same person: mild to moderate laxity, good overall skin quality, stable weight, realistic expectations. In practice that is an early softening of the jawline, some crepiness in the neck, a lower face that has lost a little definition — the stage where you don't want surgery and injectables alone aren't the answer.

If you have significant sagging or a lot of loose skin, neither device is going to produce a facelift, and any clinic implying otherwise is setting you up for disappointment. We'll tell you that at your consultation. Sometimes the right answer is a combination — ONDA for the body, filler for lost volume, or a surgical referral.

XERF vs. XTherma FAQ