XTherma vs. Thermage vs. Ultherapy: An Honest Comparison
Thermage, Ultherapy, and XTherma all do essentially the same job — controlled heat that triggers new collagen to firm the skin. The practical difference: XTherma is the most comfortable and the most affordable of the three, which is why we adopted it after it became hugely popular in Korean clinics. Here is the honest comparison, including where the incumbents still win.
Medically reviewed by Sal Nadkarni, DO · Last updated August 21, 2026
What do all three actually do?
Strip the brand names off and all three sell the same biology: heat the deeper layers of skin in a controlled way, and the body responds by remodeling and building collagen over the following months. That new collagen — not the appointment itself — is what firms a softening jawline or a crepey neck.
RF vs. ultrasound: the real difference
Thermage and XTherma are both monopolar radiofrequency devices — current passes from the handpiece through your tissue to a return pad, which is what lets the heat reach depth — and both bulk-heat the dermis, the collagen-rich layer just under the surface. Thermage FLX, the current model from Solta Medical, has run this play for two decades: bulk heating triggers an immediate contraction of existing collagen plus months of new collagen, on the face and on body areas like the abdomen, arms, and thighs, with a dedicated tip for the eyes.
Ultherapy, from Merz, is the odd one out — and its difference is real. It uses micro-focused ultrasound, not RF, which reaches deeper planes including the SMAS — the layer surgeons address in a facelift. That is why Ultherapy is the only one of the three with an FDA lift indication: it is cleared to lift the eyebrow and the skin under the chin and on the neck, and to improve lines on the décolletage. If you have read that Ultherapy “lifts” while RF “tightens,” this is the grain of truth behind the shorthand.
Deeper is only better when a deep lift is the job, though. For the dermis-level softening most non-surgical patients are treating, dermal RF is aimed at exactly the right layer.
The three-way comparison
Where a cell reads qualitatively, that is deliberate — Thermage and Ultherapy pricing varies widely by city and area, and an honest range beats a fake-precise number.
| XTherma | Thermage FLX | Ultherapy | |
|---|---|---|---|
| Energy | High-frequency monopolar RF, 6.78 MHz, up to 400 W | Monopolar RF (current model: Thermage FLX) | Micro-focused ultrasound — not RF |
| Depth & target | Dermis — collagen remodeling | Dermis — bulk heating for collagen contraction + remodeling | Deeper planes including the SMAS, the facelift layer |
| Comfort | Virtually painless — cryogen cooling on every pulse, no numbing | Vibration + cooling assist; deep heating can be intense in moments | Historically the least comfortable; newer protocols improved it |
| When you see it | Builds over 1–3 months | Develops over 2–6 months | Builds over 2–3 months |
| Downtime | None required | None required — non-invasive | None required — non-invasive |
| Body areas | Face, neck, eye area, arms, abdomen, thighs — 3 applicator sizes | Face and body — eyes (dedicated tip), abdomen, arms, thighs | Brow, under-chin, neck, décolletage (per its clearance) |
| FDA clearance | K232992 — electrocoagulation and hemostasis; tightening is off-label | Cleared in the wrinkle/rhytid category | Cleared to lift the brow, under-chin and neck; improve décolletage lines |
| Evidence base | Newest — the least long-term published evidence | Two decades on the market; large published-study base | Long, deep published evidence base |
| Typical published cost | $950–$1,200 per session (from $895 at Neoderma) | Commonly from the low thousands per session | Full face commonly in the low-to-mid thousands |
The comfort question
All three must get deep tissue hot enough to remodel collagen without damaging the surface — and without hurting you enough to need numbing.
Thermage FLX manages the heat with vibration and cooling assistance, though moments of the deep heating can still feel intense. Ultherapy has historically been the least comfortable of the three — focused energy at depth simply feels like something — though newer protocols have improved it. Neither should scare you off; comfort is simply where the three diverge most.
XTherma's answer is architectural: cryogen cooling is integrated into every single pulse. Seven cooling bursts fire around each shot — two before the RF energy, three alongside it, two after — holding the skin surface near 10–15°C while the dermis heats. Most patients find it virtually painless, with no numbing needed — deliberately, because your ability to feel the heat is part of the safety mechanism.
Why we chose XTherma
Choosing XTherma for our own treatment room came down to what the patients we actually see need most: the most comfortable session of the three, a single visit, coverage from the eye area to the arms and abdomen, and a founding price under $1,000. If your laxity question is the body more than the face — skin that stayed loose after weight loss — we walked through that in our post on body contouring after GLP-1 weight loss.
One more routing note: ONDA Coolwaves is our tool for fat and cellulite, and Secret RF microneedling is the one for texture and acne scarring. Not sure which problem your mirror is showing you? Start with our concerns guide or just ask at a consultation.
What does XTherma cost in Anaheim?
Nationally, XTherma is published at roughly $950–$1,200 per session. During our founding-patient launch — limited to our first 20 XTherma patients — a full-face session at Neoderma is $895 (regularly $1,200) and face + neck is $995 (regularly $1,500). An optional BENEV exosome add-on starts at $250; body areas are quoted at consultation by size. For comparison, Thermage is commonly published from the low thousands per session and full-face Ultherapy in the low-to-mid thousands — both legitimate, at meaningfully higher price points.
Financing available through Cherry and CareCredit — split your treatment into flexible monthly payments. Learn more →
XTherma vs. Thermage vs. Ultherapy FAQ
Which is better: XTherma, Thermage, or Ultherapy?
There is no single winner — they are different tools. Ultherapy reaches the deepest plane and is the only one FDA-cleared to lift the brow, under-chin, and neck. Thermage has two decades on the market and a large published-study base. XTherma is the most comfortable and least expensive, with cryogen cooling on every pulse. The right choice depends on your anatomy, priorities, and budget.
Does Neoderma offer Thermage or Ultherapy?
No. We chose XTherma for its per-pulse cryogen cooling, single-session protocol, face and body applicators, and a price meaningfully below the incumbents. Thermage and Ultherapy are legitimate, well-studied devices — and if a deep lift at the SMAS level is your priority, Ultherapy elsewhere or a surgical consultation is the honest answer. We will tell you that at your consultation.
How much do XTherma, Thermage, and Ultherapy cost?
Thermage is commonly published from the low thousands per session, varying by area and city; Ultherapy full-face treatments commonly run in the low-to-mid thousands. XTherma nationally runs around $950 to $1,200 per session. At Neoderma in Anaheim, founding-patient pricing is $895 for the full face (regularly $1,200) and $995 for face and neck (regularly $1,500), with financing through Cherry and CareCredit.
Thermage and Thermage FLX are trademarks of Solta Medical; Ultherapy is a trademark of Merz. Comparisons reflect each manufacturer's published specifications and clearances. XTherma is an FDA 510(k)-cleared device (K232992), manufactured by Tentech and distributed in the U.S. by BENEV; cosmetic skin tightening is an off-label use. Pricing reflects published pricing as of August 2026 and varies by provider, city, and area. Individual results vary; suitability is determined at consultation.
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Related Treatments
XTherma Skin Tightening →
High-frequency RF with cryogen cooling on every pulse — founding pricing from $895 in Anaheim.
ONDA Body Contouring →
Coolwaves microwave energy for fat and cellulite — the body-contouring counterpart to XTherma's skin firming.
Microneedling (Secret RF & Exceed) →
Fractional RF microneedling for texture, acne scars, and pore refinement.