XERF versus Thermage: the difference
XERF is often introduced as “the Korean Thermage”. Let us see how far that holds. And first, plainly: Miso Clinic does not have Thermage.
The short answer
XERF and Thermage are both 6.78 MHz monopolar RF, the same class of principle. What differs: XERF adds a 2 MHz frequency to heat fat layer and fibrous septa differently, uses four handpieces of different sizes, and received US FDA 510(k) clearance in August 2025. Thermage’s evidence base is far deeper. XERF has three human studies and 75 people, all single-arm. No head-to-head exists. Miso Clinic does not have Thermage.
In one table
| XERF | Thermage (FLX etc.) | |
|---|---|---|
| Maker | Lutronic (Korea) | Solta Medical (USA) |
| Mode | Monopolar | Monopolar |
| Frequency | 6.78 + 2 MHz | 6.78 MHz |
| Handpieces / tips | Four (i05 400, i10 300, E40 600, E60 600 shots) | EYE 450 REP, TOTAL 600 REP, etc. |
| Surface protection | Cryogen spray | Cryogen spray |
| Endpoint | Heat feedback | Heat feedback 2.0–2.5 (manual) |
| US FDA | 510(k) K251327 (2025-08) | Cleared (long-standing) |
| Human data | Three studies, 75 people, single-arm | Many, mostly uncontrolled |
| Head-to-head | None | None |
| Anaesthetic | Usually not needed | By condition |
| At Miso Clinic | Yes | No |
Why add 2 MHz
Frequency relates to where heat concentrates. Modelling and porcine histology showed 2 MHz heating the fat layer broadly and deep, 6.78 MHz heating locally along the fibrous septa. XERF chooses between them by zone. Whether that changes results in humans has not been confirmed.
How far “Korean Thermage” holds
Same 6.78 MHz monopolar class and the same heat-feedback endpoint. Different: one extra frequency, a different handpiece set, and a very different depth of evidence. So “a different device on the same principle” is the accurate phrase. Which gives the better result has never been compared.
If you want Thermage
A clinic that has it is the right place, and we do not hesitate to say so. Miso Clinic covers layers and zones with XERF, Density and Oligio Kiss, and XERF is the one we put first for no-downtime, zone-by-zone work.
Which treatment fits which concern
| Concern | Treatments to consider | Why |
|---|---|---|
| Want the deepest evidence base | Thermage (not at Miso Clinic) | We say so plainly |
| No downtime, by zone, US FDA cleared | XERF | Four handpieces |
| Thicker skin, deeper sagging | Density | Sequential polarity |
| Sagging into the deeper layer | Oligio Kiss | Focused ultrasound added |
| Thin, papery skin | Booster class first | Not the RF layer |
Which treatment is “best” is decided by the state of your skin right now, not by the product. In consultation we look first at what has been lost and what is still there, before we talk about any product name.
Frequently asked questions
Is XERF less painful than Thermage?
No comparison data. XERF usually runs without anaesthetic, but pain depends on zone and intensity.
Is 600 XERF shots the same as 600 Thermage shots?
Not if handpiece areas differ. Compare XERF E40 with the Thermage TOTAL tip area.
Is XERF FDA approved?
It has 510(k) clearance from August 2025. 510(k) means substantially equivalent to an existing device, not that a separate efficacy trial was passed.
Read next
If you want to go deeper
Product page
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, medical director of Miso Clinic in Daegu, South Korea. Studies are cited with their size and limitations, and where we could not find data we say so. Individual decisions need an in-person examination; this page does not replace one.
| 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 |
| KakaoTalk | Miso Clinic channel |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 / Closed Sundays and public holidays |
| Treatment guides | All guides |
| Comparisons | All comparisons |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Lutronic XERF product material — monopolar RF, 6.78 MHz + 2 MHz, four handpieces (XERF i05, i10; EFFECTOR E40, E60). MFDS-approved device. US FDA 510(k) K251327 (2025-08-11).
- XERF human studies, three — 20 people single-arm 12 weeks (Medical Lasers 2025), 39 people multicentre 90 days (Cureus 2026, manufacturer-supported), 16 people retrospective 3 months (Lasers Med Sci 2026). No control group in any.
- Thermage CPT Technical User’s Manual (Solta, 2021, NP009240-06) — endpoint heat feedback 2.0–2.5 on 0–4. No recommended total REP count for the face.
- Dover JS & Zelickson B, Dermatol Surg 2007;33(8):900–907 — the shift to low-energy multiple passes; survey of 14 physicians.
- Chapas A et al., JDD 2020;19(1):20–26 — international Delphi consensus, 19 recommendations. “Device specific guidelines are lacking.”
Everything on this page 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.
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