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100+ XERF Patients Later: What Our Dermatologist Has Learned About Skin Tightening
Radiofrequency tightening is easy to sell and harder to do well. This is what more than a hundred XERF treatments at our clinic in Denpasar have taught us about selection, dosing and honest expectations.
Short answer. XERF is a dual-frequency monopolar radiofrequency device that heats skin and the tissue beneath it, tightening existing collagen and prompting new collagen over the following months. After more than 100 XERF treatments at Elea Clinic Bali since June 2026, the clearest lesson is that who is treated, and how the energy is distributed across the face, matters more than the machine. Good candidates usually have early-to-moderate laxity and reasonable skin quality. Heavy laxity, a significant fat pad under the jaw, or a jawline that has softened mainly through bone and volume loss often need something else, or something in addition.
Why write this now
Elea Clinic introduced XERF in Bali at the end of June 2026, and passed one hundred treatments within three months. That is enough experience to see patterns in who responds well, where a face needs more or less energy, and what patients misunderstand before a first session.
It is not yet enough time to say how long results last. Radiofrequency results develop over roughly three to six months (O’Connor 2021), and most of our patients were treated within the last twelve weeks. What follows separates what we have observed from what research has shown. Where the two are different kinds of knowledge, we say so.
What 100 treatments in twelve weeks does not tell you
A high number of treatments in a short period says something about demand, and about how quickly a team becomes fluent with a device. On its own it says nothing about how well the treatment works: there is no comparison group, no blinded assessment and, at this stage, no long follow-up. Read everything below as experience, not proof.
What the published evidence on XERF actually says
As of September 2026 four papers describe the device or its dual-frequency approach:
- two animal and modelling studies, both with manufacturer-affiliated authors (Hong 2024, Ko 2025);
- one prospective multicentre study of 39 people, with no control group and 90 days of follow-up (Cureus 2026);
- one retrospective study of 16 women, whose authors call the findings preliminary (Erlich 2026).
There is no randomised controlled trial of XERF and no published follow-up beyond three months. XERF holds US FDA 510(k) clearance (K251327, August 2025) for “dermatologic and general surgical procedures for electrocoagulation and hemostasis”, granted on the basis of equivalence to the Thermage FLX rather than clinical trials (FDA 510(k) summary K251327).
The evidence for monopolar radiofrequency as a category is older and larger. Heat makes collagen fibrils contract immediately and prompts new collagen over time (Zelickson 2004), and most patients see mild-to-moderate improvement rather than dramatic change (O’Connor 2021, Austin 2021).
Seven things 100+ treatments have taught us
1. Patient selection decides the result more than any setting
The patients who are happiest after XERF tend to share a profile: early-to-moderate laxity along the jawline or under the chin, skin that is still reasonably thick and elastic, and one clear concern. That matches the published literature, which reports better outcomes in younger patients with mild-to-moderate laxity (O’Connor 2021) and higher satisfaction among people seeking modest change (Austin 2021).
The patients we now advise against XERF, or advise to combine it with something else, usually have heavy skin excess, a large fat pad beneath the jaw, or a jawline that has softened mainly through bone and volume loss. Radiofrequency cannot replace lost bone or remove a significant fat pad.
2. “Jowls” are not one problem
The jowl forms from several processes at once. Fat compartments change and descend (Rohrich & Pessa 2007), the mandible loses height and length with age (Shaw 2010), and the connective tissue around the mandibular ligament lengthens (Minelli 2023). Two people with similar-looking jowls can need quite different plans — see who is a good candidate.
3. The neck behaves differently from the face
Neck skin is thinner and more easily irritated, and neck ageing often includes platysmal bands, which are muscle rather than skin. The neck is treated at lower energy and with different expectations, and some necks are better served by another approach: why the neck needs its own strategy.
4. Protocols should not be identical
The staged approach dr. Jesslyn trained in at the Cynosure Lutronic advanced programme in Korea (the Seoul article) treats regions differently: a deeper pass along the lower face and under the chin, a mid-depth pass across the midface, and a lighter pass on the neck or forehead where appropriate. Pulses are budgeted per region and per side of the face.
In practice two patients rarely receive the same plan. Asymmetry is common — one side of the jaw often needs more work than the other — and previous injectables, HIFU or liposuction change where energy is reduced.
5. Under-treating is a common reason radiofrequency “does nothing”
When patients tell us a radiofrequency treatment elsewhere did nothing, the history often suggests a short or low-energy session. Delivering enough energy safely, within a patient’s comfort, is a clinical skill, and the plan should be sized to the face rather than to a fixed package. Published safety data for monopolar RF are reassuring when devices are used correctly (Weiss 2006). The aim is adequate dosing, not maximum dosing.
6. Immediate tightening and lasting change are different things
Monopolar RF produces an early tightening effect followed by further tightening over time (Fitzpatrick 2003).
Many of our patients notice a firmer, more defined jawline on the day of treatment. Part of that early change is collagen contraction and part is temporary swelling. Patients who understand this in advance judge their result at three months rather than three days, and are rarely disappointed by the in-between. Our results timeline walks through each stage.
7. Comfort is better than most patients expect, but not the same for everyone
The manufacturer states that XERF’s integrated cooling is designed to avoid numbing (Cynosure Lutronic, August 2025). That is a device claim, not an independent finding.
In our experience most patients tolerate treatment without numbing cream. Areas over bone and along nerve pathways feel more intense, and energy is adjusted to feedback throughout the session.
Who should not have XERF
Not treated: anyone with a pacemaker, an implantable defibrillator or another implanted electrical device — monopolar radiofrequency passes current through tissue and can interfere with them. Pregnancy.
Assessed carefully first: metal implants or permanent filler in the treatment area; active skin infection or inflammatory skin disease at the site; a history of keloid scarring; isotretinoin within the past six months; current or recent malignancy; poorly controlled diabetes.
Probably better served by something else: heavy skin excess, where a surgical result is more meaningful than a tightening treatment. The full list sits on the XERF safety section.
What side effects should you expect?
Redness and warmth usually settle within hours. Mild swelling can last a day or two, and tenderness a few days. Uncommon effects include small raised marks from the treatment tip and temporary tingling. Burns, blisters and small areas of fat loss have been reported with monopolar radiofrequency but are rare: one early study recorded a second-degree burn rate of 0.36% with a first-generation device (Fitzpatrick 2003), and a review of more than 600 treatments found only temporary side effects (Weiss 2006).
What we will be able to tell you next
We will update this article as our patients reach six and twelve months. The question that matters most — how long results last — cannot be answered honestly yet. The manufacturer’s Australian page mentions effects lasting “several weeks to up to three years” (Cynosure Lutronic ANZ); that is a marketing statement rather than published follow-up.
dr. Jesslyn presented Elea’s early experience with immediate outcomes at the ARUNA International Summit 2026 in Jakarta. What that presentation was, and what a case report can and cannot show.
Considering XERF?
Send a photo of the area that concerns you and a note on anything you have had done before. dr. Jesslyn will tell you whether XERF is likely to help, or whether something else would serve you better.
Ask dr. Jesslyn on WhatsAppPrefer to read the treatment page first? XERF at Elea Clinic
Sources
- FDA 510(k) summary K251327 — indication, predicate device, no clinical testing.
- Hong 2024; Ko 2025 — animal and modelling studies of dual-frequency RF.
- Cureus 2026 — 39 subjects, no control group, 90 days.
- Erlich 2026 — retrospective, 16 women.
- Zelickson 2004; Fitzpatrick 2003; Weiss 2006; Austin 2021; O’Connor 2021; Wanitphakdeedecha 2022 — monopolar RF mechanism, outcomes and safety.
- Rohrich & Pessa 2007; Shaw 2010; Minelli 2023 — anatomy of the ageing lower face.
Questions we are asked
How many XERF sessions will I need?
Most patients have one session, reviewed at around three months. The 39-person multicentre study used two sessions (Cureus 2026), and some faces benefit from a second treatment. That decision belongs at review, not in advance.
Is XERF a non-surgical facelift?
No treatment without surgery reproduces a facelift. XERF can tighten and define early-to-moderate laxity. We set out the ceiling honestly on our non-surgical facelift page.
Does XERF work on all skin types?
The manufacturer states that XERF is suitable for all skin types. Radiofrequency does not target pigment the way many lasers do, which is why it is generally considered lower-risk in darker skin. Independent data in Southeast Asian skin are limited to older-generation monopolar RF devices (Wanitphakdeedecha 2022).
Is XERF FDA approved?
It is FDA 510(k) cleared, which is a different process from approval. The clearance covers electrocoagulation and hemostasis and rested on equivalence to the Thermage FLX (FDA 510(k) database).
Can I see real results?
Our XERF page shows unretouched before-and-after photographs taken immediately after one session. Individual results vary.
Medically reviewed by dr. Jesslyn Amelia, Sp.D.V.E — Dokter Spesialis Dermatologi, Venereologi dan Estetika. Registered with the Indonesian Ministry of Health, STR JT00000382760637. Verify registration. Last reviewed 23 September 2026. Individual results vary; this page is general information and not a substitute for consultation.