Density and XERF for men — can women’s data guide the decision?
More men are coming in for lifting consultations. Yet the people studied for Density and XERF were almost all women. This column separates what has been confirmed for men from what is borrowed from data on women.
The short answer
There are almost no male-specific data on Density or XERF. The 39-person XERF study included 2 men, and the paper itself states that generalising to men is limited; the 16-person Density data included 1 man. That male facial skin is thicker was confirmed in all 16 site-and-age combinations in ultrasound measurement of 200 Chinese adults, but no comparative study shows that RF settings for Density or XERF should be changed to match that difference. So Miso Clinic assesses men by the same criteria as women — depth of sagging, skin thickness, lost volume — and discusses beard areas, pain and scheduling separately.
How many men were in Density and XERF studies?
| Data | Size | Men |
|---|---|---|
| XERF multicentre study (Weiss 2026) | 39 people | 2 — the paper states generalisation is limited |
| Density case series (Oku 2025) | 16 people | 1 |
| XERF Korean study (Hwang 2025) | 20 people | 0 (women) |
| Ultrasound lifting systematic review (2023) | 16 studies | Every study enrolled women |
Lifting recommendations for men, including for Density and XERF, are mostly carried over from data on women, and the literature in this field acknowledges it.
How is men’s skin different for Density and XERF treatment?
Men’s facial skin really is thicker. In ultrasound measurement of 200 Chinese adults, men’s skin was thicker in all 16 site-and-age combinations. But the often-quoted “male skin is 20–25% thicker” originally came from the forearm, not the face — and none of these measurements involved Density or XERF.
Thicker skin does not translate directly into “more shots for men” or “higher power for men”. No Density or XERF study has compared such differences in settings.
What men should raise separately in a Density or XERF consultation
- Beard area — shaving and the Density or XERF treatment area are agreed in advance
- Pain — pain with XERF without anaesthesia averaged in the 4s out of 10 in studies, and some people scored 7 or more. We agree whether to use topical anaesthesia
- Schedule — non-invasive RF such as Density and XERF does not break the epidermis, and clinical trials advised immediate return to normal activity. Redness can last from a few hours to a day
- Expectations — is jawline sagging the main concern, or fat under the jaw? — there is no Density or XERF evidence for fat reduction
Jawline concerns in men: when do Density or XERF come first?
| Concern | Consider first | Why |
|---|---|---|
| Men: jawline blurred, cheeks dropped | Density or XERF | Sagging is what RF treats |
| Men: thicker skin, deep sagging | Density | Sequential polarity design |
| Men: short treatment without anaesthesia, same-day return | XERF | Usually no anaesthesia |
| Men: a lot of fat under the jaw | Not Density or XERF first | No evidence of fat reduction |
| Men: frown lines and forehead expression lines | Botulinum toxin | An area where a dose difference in men has been confirmed |
About the only sex difference confirmed in a randomised trial for men is botulinum toxin dose (a starting dose of at least 40 units for frown lines, in an 80-person trial). There are no such data for RF lifting such as Density or XERF.
Density and XERF for men summary
What is established
- Male facial skin is thicker (ultrasound, 200 Chinese adults)
- 2 men of 39 in the XERF study, 1 man of 16 in the Density study
- Lifting recommendations for men, including Density and XERF, are mostly carried over from data on women
What we could not find
- Density or XERF results assessed in men alone
- Comparative studies showing men need different Density or XERF shot counts or power
- Density or XERF data on reducing fat under the jaw in men
Density and XERF for men: frequently asked questions
Do Density and XERF work for men too?
Almost no data assess Density or XERF in men alone, so we cannot answer with numbers. The 39-person XERF study included 2 men and the 16-person Density data 1 man. Miso Clinic assesses men, too, by depth of sagging and skin thickness.
Men have thicker skin, so do they need more shots?
Male facial skin has been confirmed to be thicker, but no comparative study shows that Density or XERF shot count or power should therefore be increased. The shot count is set by area and region.
Does XERF work on a double chin in men?
We consider XERF when sagging makes it look like a double chin, but there are no human XERF data showing that it reduces fat under the jaw itself.
Can I go to work the day after treatment?
Non-invasive RF such as Density and XERF does not break the epidermis, and clinical trials advised immediate return to normal activity. Redness and mild swelling can last from a few hours to a day.
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Who wrote this
Written and reviewed by Lee Chi-Hak, MD, medical director of Miso Clinic in Daegu, South Korea. Every study cited above is given together with its design, its size and the limitations the authors themselves recorded, and where we could not find data, we have said that we could not find any.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Male skin and lifting data — in ultrasound measurement of 200 Chinese adults, men’s skin was thicker in all 16 site-and-age combinations. The original source of “male skin is 20–25% thicker” is the forearm. A systematic review of ultrasound lifting (2023, 16 studies) found every study enrolled women. The 39-person XERF study included 2 men; the 16-person Density study included 1.
- Density human data — Oku K, J Cosmet Dermatol 2025;24(10):e70504, PMID 41090512. The paper names DENSITY (Jeisys Medical) in the main text. 16 Japanese adults (1 man · 15 women, mean age 49.4 ± 6.1) · one session of about 500–600 shots · 24 weeks · no control group · single author. Tightening 0.82 mm, lower-face thickness −0.89 mm, GAIS improved in 15 of 16, pain 1.4/5, no burns, persistent erythema or scarring reported. The abstract (0.82 ± 0.36) and the main text (± 0.34) give different values.
- Three XERF human studies — Hwang JK, Medical Lasers 2025;14(1):23–30 (20 subjects · one session · 12 weeks) · Weiss RA et al., Cureus 2026;18(3):e104546, PMID 41930066 (39 subjects · two sessions · 90 days, manufacturer support) · Erlich G et al., Lasers Med Sci 2026;41(1), PMID 42611100 (retrospective, 16 subjects · one session · 3 months). None of the three has a control group.
- Non-invasive RF and the skin barrier — Skalska-Stochaj A et al., J Clin Aesthet Dermatol 2022;15(12):22–27 (150 women): no meaningful change in transepidermal water loss. For microneedle RF, Wu X et al., Dermatol Ther 2022 (20 subjects): raised on day 3, recovered by days 5–7.
- Miso Clinic clinical protocols — criteria for indications, design by area, and the explanation and consent process before treatment. The source of the sentences marked “clinical judgement” in this column.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.