XERF and Thermage: what is the difference? — The same family, a different device
“Is XERF a Korean Thermage?” We hear this question often in consultation. Let us be clear first: Miso Clinic does not offer Thermage. So this article does not recommend either one. It sets out how far the two devices are the same and where they part, and how far the data comparing them actually go.
The short answer
XERF and Thermage are both 6.78 MHz monopolar radiofrequency devices; XERF adds a 2 MHz frequency and uses four effectors of different sizes, which makes it a different device. Thermage has far more data, but the majority are uncontrolled observations; for XERF, the three human studies (75 people) are all single-arm with no control group. No study comparing the two devices directly was identified. Miso Clinic (4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea; +82-53-428-2700) uses XERF, Density and Oligio Kiss. Miso Clinic does not offer Thermage, so we describe it here as a point of comparison and nothing more.
How do XERF and Thermage differ, side by side?
We have set them side by side using published specifications and registration information alone. The Thermage column follows the manufacturer’s manual and public material; it is not based on experience of a device Miso Clinic has used.
| Item | XERF | Thermage |
|---|---|---|
| Manufacturer | Lutronic (now Cynosure Lutronic) | Solta Medical |
| Delivery | Monopolar radiofrequency | Monopolar radiofrequency |
| Frequency | 6.78 MHz + 2 MHz (manufacturer: “dual monopolar”) | 6.78 MHz |
| Tips · effectors | i05 400 · i10 300 · E40 600 · E60 600 shots | EYE 450 REP, TOTAL 600 REP and others |
| Korean · US registration | Korean class: general-purpose electrosurgical unit; US 510(k) K251327 (2025-08) | Device registered with the US FDA |
| Human data | 3 studies, 75 people, none with a control group | Many, but mostly uncontrolled observations · physician surveys |
| Head-to-head study | None | None |
| At Miso Clinic | Yes | No |
The XERF cooling method (ICD gas cooling) appears in the manufacturer’s public material and nowhere else, so it is not an independently verified value. A version set out as a treatment comparison is also at XERF vs Thermage: the difference (treatment comparison).
How far is ‘Korean Thermage’ accurate?
It is half right and half overstated. Both belong to the same 6.78 MHz monopolar family, and the broad principle of cooling the epidermis while heating towards the dermis is the same. So “the same family” is accurate.
But XERF uses one more frequency, 2 MHz, has a different effector line-up, and has a different Korean device class and US registration route. And which gives the better result has never been compared. The accurate description is “a different device in the same family of principle”. The data do not support the explanation “identical to Thermage, but Korean”.
What does adding 2 MHz change?
In radiofrequency, the frequency is related to where heat concentrates within the tissue. In a study using computer simulation and porcine tissue, 2 MHz heated the fat layer broadly and deeply, and 6.78 MHz heated locally along the fibrous septa (Ko 2025).
However, this is not a human study, and the majority of the authors work for the manufacturer. So we cannot yet say “two frequencies give a better result on the human face”. The design intention is confirmed; whether that intention makes a difference in people is not — that is the honest summary. The principle itself is set out separately in The radiofrequency principle of XERF.
Are 600 shots of XERF and 600 shots of Thermage the same amount?
The same number is not the same amount. A shot (REP) is the rated count sealed into a single-use tip, not a recommended dose, and when tip areas differ, the area covered at once differs. Even within XERF, 600 shots of E60 and 400 shots of i05 are completely different amounts.
The Thermage manual, too, sets the treatment endpoint not as a shot count but as the patient’s heat feedback of 2.0–2.5 (0–4 scale), and gives no recommended total REP count for the face. The XERF studies also vary in tip combination and number of sessions (E60 alone, a mean of 568.8 shots · two sessions / E60 300 + E10 200 + E5 100 shots · one session), so “how many shots” alone allows no comparison between clinics or between devices. Shots are discussed in How many XERF shots are right.
Which has more data, and how should it be read?
Thermage has been in use for a long time, so there are many publications. But the majority are uncontrolled observational studies or physician surveys, and a 2020 international Delphi consensus noted that “device-specific guidance is lacking” (Chapas 2020).
| Study | Subjects · sessions | Follow-up | Points to note |
|---|---|---|---|
| Hwang 2025 | 20 women (aged 28–63) · 1 session | 12 weeks | Mean GAIS 2.75/4, pain VAS 4–5 (no anaesthesia) |
| Weiss 2026 | 39 people · 2 sessions | 90 days | Improvement 84.6% at 30 days → 92.3% at 90 days, manufacturer support |
| Erlich 2026 | Retrospective, 16 people · 1 session | 3 months | Lower face 24–36 kJ, three tip combinations |
For XERF, the longest follow-up is about 3 months, and there are no data on maintenance beyond a year. A 2026 systematic analysis of the RF literature (15 studies · 1,230 people) stated that no direct comparisons between devices were identified. A comparison of “which lasts longer” cannot be made with the current data. Data on XERF duration are in How long do XERF results last? — the evidence.
How does Miso Clinic answer this question?
If you want Thermage, we tell you that the right course is to find a clinic that has Thermage. We do not offer XERF as a substitute for a device Miso Clinic does not have (clinical judgement).
If you are considering XERF, we look at the condition of the face before the device name. For faces where the tip has to change area by area, such as around the eyes and mouth, or where you want to reduce the burden of anaesthesia, we consider XERF first; if the skin is thick and the sagging deep, Density; and if hollowing is the main concern, the filler family first (clinical judgement). The skin XERF suits is set out in Which skin types XERF suits, and the difference from Density in XERF and Density: what is the difference?. Miso Clinic is a XERF ambassador selected by the manufacturer, but this is a manufacturer selection; it is not a national qualification, society certification or any assurance of results, and it does not mean better than other clinics (What being a XERF ambassador means).
XERF and Thermage: frequently asked questions
Do XERF and Thermage work on the same principle?
They belong to the same 6.78 MHz monopolar radiofrequency family. XERF differs in adding 2 MHz and using four effectors. It is accurate to see it as a different device in the same family of principle.
Is XERF more effective than Thermage, or less?
We cannot say. No study has compared the two devices directly, and a systematic analysis of the RF literature also stated that no direct comparisons between devices were identified.
Is XERF an FDA-approved device?
It has a US 510(k) clearance, K251327, from August 2025. The indication is electrocoagulation and haemostasis, and no clinical tests were submitted. A 510(k) does not mean the device passed a separate efficacy trial.
Is XERF less painful than Thermage?
There are no comparative data. In a 20-person XERF study, pain without anaesthesia was VAS 4–5, and pain varies with the area and intensity.
Can I have Thermage at Miso Clinic?
No. Miso Clinic does not offer Thermage or Ulthera; we use XERF, Density and Oligio Kiss. If you want Thermage, the right course is to find a clinic that has it.
Where can I have a XERF consultation in Daegu?
Miso Clinic is at 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, in front of Exit 1 of Kyungpook National University Hospital Station. +82-53-428-2700. Weekdays 11:00–19:00, Saturdays 10:00–16:00 (no lunch break); closed Sundays and public holidays.
Read next
- XERF lifting in Daegu: which skin it suits
- XERF vs Thermage: the difference (treatment comparison)
- XERF vs Density: what is the difference?
- How XERF RF works: the two frequencies
- How many XERF shots are right
- How long do XERF results last? — the evidence
- Density vs Thermage: the difference
- Lifting for facial sagging: which layer
Product pages
Related: XERF product information
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, director of Miso Clinic, Daegu. The treatment standards and injection design set out here are the ones we use in practice.
| 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
- XERF specifications — Lutronic published data: monopolar, 6.78 MHz + 2 MHz, handpieces i05 (5 × 10 mm · 400 shots) · i10 (10 × 10 mm · 300 shots) · E40 (20 × 20 mm · 600 shots) · E60 (20 × 30 mm · 600 shots). In Korea the device is approved in the general-purpose electrosurgical unit class; the mark “2024-16-054” seen on promotional material is a medical advertising pre-screening number, not an approval number.
- XERF US 510(k) — FDA K251327 (2025-08-11). The indication is electrocoagulation and haemostasis, and no clinical tests were submitted. In Korea the device is approved in the general-purpose electrosurgical unit class.
- 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.
- XERF heating by frequency — Ko K et al., Lasers Med Sci 2025, PMID 41315066. Computer simulation · porcine tissue. 2 MHz heated the fat layer broadly and deeply; 6.78 MHz heated locally along the fibrous septa. The majority of the authors work for the manufacturer, and it is not a human study.
- Thermage — Solta Medical, 6.78 MHz monopolar, device registered with the US FDA. There are many publications, but the majority are uncontrolled observational studies or physician surveys, and a 2020 international Delphi consensus noted that device-specific guidance is lacking. No study has compared it directly with Density or XERF. Miso Clinic does not have Thermage or Ulthera.
- Thermage user manual — Thermage CPT Technical User’s Manual (Solta, 2021, NP009240-06). The endpoint is the patient’s heat feedback of 2.0–2.5 (0–4 scale), and no recommended total REP count for the face is given. Tips include EYE 450 REP and TOTAL 600 REP. Chapas A et al., JDD 2020;19(1):20–26, international Delphi consensus with 19 recommendations — “device specific guidelines are lacking”.
- No device-to-device evidence — systematic analysis of the literature, Aesthetic Surgery Journal Open Forum 2026 (15 studies, 1,230 subjects; one randomised controlled trial). It states that no direct comparisons between devices were identified.
- Medical advertising law — Medical Service Act of Korea, Article 56(2), which prohibits testimonial advertising, comparison with other clinics, superlative claims and advertising that guarantees or implies a guaranteed treatment effect.
- Miso Clinic practice guidance — indication criteria, site-by-site design, and the explanation and consent procedure. This is the source for every sentence marked as clinical judgement.
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.
← Clinical columns · Reference library · Miso Clinic home
한국어 · English