17 May XERF vs Ultherapy in Singapore: Which Skin Tightening Treatment Is Right for You?
By Dr Rachel Ho | Aesthetic Doctor, Founder, The Skin Longevity Clinic, Singapore
XERF uses dual frequency monopolar radiofrequency, while Ultherapy uses microfocused ultrasound with real time visualisation. Both deliver heat below the skin surface, but XERF distributes heating across a treatment area whereas Ultherapy creates small focal treatment zones at selected depths1,2.
For someone comparing skin tightening treatments in Singapore, that difference is more useful than a simple claim that one treatment is stronger. The decision should consider the concern being treated, facial anatomy, expected improvement and the practical treatment plan. For how XERF compares with another monopolar radiofrequency device, see XERF vs Volnewmer.
XERF vs Ultherapy at a glance
XERF uses radiofrequency, while Ultherapy uses microfocused ultrasound with visualisation.
| Feature | XERF | Ultherapy |
|---|---|---|
| Energy | Monopolar radiofrequency using 6.78 MHz and 2 MHz1. | Microfocused ultrasound2. |
| Energy delivery | Distributed tissue heating with adjustable depth settings1. | Focal heating at selected depths, commonly 1.5, 3.0 and 4.5 mm8. |
| Imaging | Impedance feedback rather than an ultrasound image of the tissue1. | Real time ultrasound imaging to help identify treatment layers8. |
| Published clinical findings | Recent human studies report improvements in facial laxity and appearance3,4. | Clinical research supports improvement in selected patients with mild to moderate laxity7. |
| Treatment sensation | Warmth or heat; discomfort varies4. | Brief heating sensations during energy delivery; tolerance varies2. |
| How to compare cost | Compare the treatment area, proposed sessions, assessment, aftercare and total fees. | Request the same information so that the quotations cover comparable treatment plans. |
The technical differences are described in the manufacturers’ documentation. Clinical findings come from separate studies and should not be interpreted as a direct comparison demonstrating that one device is superior1–4,7,8.
What is XERF, and what are its benefits?
XERF uses radiofrequency energy to deliver controlled heat that may support collagen remodelling and skin tightening in suitable patients.
XERF is a needle free radiofrequency treatment designed to improve skin firmness. Electrical resistance within tissue produces heat, and the device combines two frequencies with adjustable settings and surface cooling1.
The intended effect is collagen contraction followed by remodelling. Experimental XERF research has documented changes in collagen within treated tissue, while more recent human studies have assessed visible improvements in facial laxity3,5.
XERF may be worth discussing when reduced firmness or early changes in facial contour are the main concern. Our XERF guide explains the treatment in more detail, including the assessment used to decide whether it fits your goals.
What is Ultherapy, and what are its benefits?
The core difference is energy delivery. XERF converts electrical current into a broad, controlled thermal field, while Ultherapy focuses ultrasound energy into small thermal points at selected tissue depths.
Ultherapy delivers focused ultrasound energy to selected tissue layers. Its imaging feature helps the practitioner identify the tissue being treated before placing energy, including within the dermis and deeper fibromuscular layers where appropriate8.
Clinical applications include lifting the brow and treating laxity beneath the chin and on the neck. It is also used to improve lines on the upper chest, with suitability assessed for the specific area2.
Ultherapy can target both dermal and deeper fibromuscular tissue. Treatment depth is selected for the anatomy being treated. XERF and Ultherapy are better distinguished by their energy delivery and imaging capabilities than by labelling one superficial and the other deep1,8.
What are the procedures like?
At The Skin Longevity Clinic, the assessment considers skin laxity, facial volume, skin condition, previous procedures and treatment goals. Bring details of earlier fillers, threads, energy treatments and surgery so that the discussion is based on your actual treatment history.
XERF procedure
The handpiece is placed against the skin and delivers radiofrequency pulses across the planned area. Cooling is used during energy delivery, and treatment settings are adjusted rather than applied identically to every patient1.
Tell the treating doctor how the heat feels throughout the session. Discuss comfort measures in advance, as individual tolerance varies even with a needle free procedure.
Ultherapy procedure
Where does each treatment work? XERF distributes controlled heat broadly through the dermis and support layers. Ultherapy places focal heat at selected depths, so suitability depends on where the laxity is actually located.
Ultrasound gel and the imaging transducer are used to assess the treatment layers. Focused energy is then delivered in a planned pattern, with the chosen transducers determining the focal depths8.
The clinician should explain the areas being treated and how discomfort will be managed. The duration of the appointment depends on the area and the individual plan2.
How soon will you see results, and how long do they last?
Both XERF and Ultherapy results usually develop gradually because collagen response takes time.
Assess improvement over the following months rather than from the appearance immediately after treatment. For XERF, published clinical assessments include follow-up at one and three months; these observations support a gradual response but do not define the same result timeline for every patient3,4.
Ultherapy results commonly develop over approximately two to three months. Further treatment decisions depend on the degree of improvement and the continuing ageing process2.
Duration should be discussed separately from the time needed to see an initial change. Some microfocused ultrasound studies have followed improvement for up to a year, while the XERF clinical studies discussed here provide shorter follow-up. Their results cannot establish that one treatment lasts longer than the other3,4,7.
Recovery and possible side effects
Which treatment is more comfortable? XERF is commonly experienced as building warmth, while Ultherapy is often felt as brief, deeper pulses. Both are non-invasive and generally involve little social downtime, although individual sensation and recovery vary.
Published XERF clinical studies have reported temporary redness and swelling, with recovery varying between patients. The absence of persistent complications in a small study cannot establish that a treatment is risk free3,4.
After Ultherapy, temporary redness, swelling, tenderness or altered sensation can occur. Clinical literature also describes less common events such as burns or prolonged sensory symptoms, which should be covered during the consent discussion7,8.
Keep your treating clinic informed about unexpected symptoms, particularly blistering, worsening pain or persistent changes in sensation. Plan treatment with some flexibility before an important event, even when little visible recovery is expected.
What does the evidence show about XERF and Ultherapy?
What does the evidence show? Radiofrequency and microfocused ultrasound can produce real but moderate improvement in appropriately selected mild to moderate laxity. Neither should be presented as equivalent to a surgical facelift.
Device specifications, animal experiments and human clinical outcomes answer different questions. For a useful comparison, the evidence should identify the actual treatment studied and distinguish a promising finding from a confirmed comparative advantage.
XERF specific research
Hong and colleagues studied tissue changes in a porcine model in 2024. This was preclinical research, rather than a trial measuring cosmetic outcomes in people; a 2026 correction disclosed that the authors were employees of the manufacturer5,6.
A 2026 prospective study by Weiss and colleagues followed 39 participants at four centres after two treatments. It reported improvements in clinician ratings and patient satisfaction, but had no comparison group, short follow-up and manufacturer support3.
Erlich and colleagues subsequently reported a retrospective study of 16 women after one XERF session. Imaging and patient questionnaires suggested improvement over three months, although the small uncontrolled design makes the findings preliminary4.
Microfocused ultrasound research
A 2023 systematic review by Contini and colleagues included 16 studies of microfocused ultrasound. It supported improvement in mild to moderate facial laxity, while noting variation in treatment protocols and the need for better objective outcome research7.
These findings support ultrasound treatment as an option for appropriate patients, while the device and protocol remain important. Separate XERF and ultrasound studies cannot establish a universal winner: a reliable comparison requires comparable patients, treatment areas and outcome measurements.
XERF vs Ultherapy cost in Singapore: how to compare quotations
Compare the total cost for the same treatment area and proposed course, rather than a headline session price alone. A useful quotation identifies the device, treatment area, proposed sessions and any additional fees. This makes it easier to compare the initial treatment cost and any later maintenance separately.
For Ultherapy, the manufacturer’s Singapore information states that pricing depends on the area treated and the individual provider. Ask for a quotation for the actual treatment being considered rather than using a generic HIFU price as a substitute2.
What should a quotation include?
| Item | What to confirm |
|---|---|
| Device and treatment | Is the quotation for XERF, Ultherapy or another named treatment? |
| Area covered | Does it cover a targeted area, the full face, the neck, or a combination? |
| Sessions and review | How many sessions are proposed, and when will the response be reviewed? |
| Consultation and comfort measures | Are assessment and any planned pain relief included or charged separately? |
| Aftercare and total fees | Are review visits included? Does the quoted total include GST where applicable? |
Where a quotation specifies lines, shots or pulses, ask what those numbers represent within the proposed treatment. An RF pulse and an ultrasound treatment line are different delivery units, so matching their numerical counts would not produce a like-for-like comparison1,8.
A higher number or a higher price, on its own, is not evidence of a better result. The more useful discussion is why the proposed treatment area and plan are appropriate for your concern.
How many sessions should you budget for?
Ask for the cost of the recommended initial plan and the point at which it will be reassessed. Keep any proposed maintenance separate from the initial quotation, so that you can distinguish treatment recommended now from treatment that may be considered later.
XERF studies have used different regimens, including one session and two sessions. Ultherapy is often offered as an initial single treatment, with additional sessions considered according to response; neither pattern should be presented as a compulsory schedule for every patient2,3,4.
Requesting a XERF quotation
For current XERF fees at The Skin Longevity Clinic, contact the clinic and specify the area you would like assessed. Confirm the treatment scope and inclusions alongside the fee; a consultation can establish suitability and whether further sessions are appropriate.
Our XERF price guide provides additional cost information. When comparing with Ultherapy elsewhere, request the corresponding details from that provider so that the two quotations answer the same questions.
XERF vs Ultherapy: which is right for you?
Should you choose XERF or Ultherapy? XERF can be considered when broader heating across the dermis and support layers suits the concern. Ultherapy can be considered when focal energy delivery at selected depths is the priority. Facial anatomy and the location of laxity should guide the decision.
A useful consultation begins with the change you want to address. You may be concerned about skin firmness, a softer jawline, neck laxity or changes in facial contour; these concerns deserve individual assessment rather than a treatment chosen from a brand comparison alone.
Ask the doctor to explain the expected change in your own face, the alternatives and how the result will be reviewed. Existing hollowness, previous procedures and the extent of sagging should be part of that discussion.
For a broader overview, read our guide to skin tightening in Singapore. It sets out other approaches that may be relevant when laxity is only one part of the concern.
Frequently asked questions
Four common skin-tightening misconceptions: deeper is not automatically better, a more comfortable treatment is not necessarily weaker, patients do not always have to choose one technology forever, and a newer device is not automatically more suitable.
Is Ultherapy the same as HIFU?
Ultherapy is a particular microfocused ultrasound system with visualisation. HIFU is a broader term used for focused ultrasound treatments, so a quotation or discussion using that term should identify the actual device rather than implying equivalence2,8.
Can XERF and Ultherapy be combined?
A combination needs its own clinical justification, including the intended benefit of each treatment and the timing. The studies discussed above do not establish a standard combined XERF and Ultherapy protocol, so their individual results should not be added together as a promise of greater improvement3,4,7.
Is a more painful treatment more effective?
Pain should be discussed as part of tolerability, rather than used to choose the more effective device. Ask what improvement is realistic for your concern and how the treatment will be delivered comfortably; a comparison based only on sensation leaves those questions unanswered.
Doctor Rachel’s takeaway on XERF vs Ultherapy
The practical question is what each treatment is expected to change in your face. Ask for an explanation that connects the proposed technology with your concern, realistic outcomes, recovery and total treatment cost.
At The Skin Longevity Clinic, Dr Rachel Ho assesses skin firmness and facial ageing as part of the wider clinical picture. To discuss XERF suitability, arrange a consultation at the clinic in Scotts Medical Center at Pacific Plaza, in the Orchard area of Singapore.
References
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Cynosure Lutronic. XERF: manufacturer information on frequencies, cooling and depth settings.
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Merz Aesthetics Singapore. Ultherapy: treatment information and patient questions.
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Weiss RA, Wang J, DiBernardo B, Bhatia AC. Clinical Outcomes Following Dual-Frequency Noninvasive Monopolar Radiofrequency Treatment for Facial Laxity and Lower Face Lifting: A Prospective Multicenter Study. Cureus. 2026;18(3):e104546. doi:10.7759/cureus.104546
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Erlich G, Dahan E, Wolf Y. Objective and subjective retrospective evaluation of XERF, a novel single-shot dual-frequency non-invasive monopolar radiofrequency. Lasers in Medical Science. 2026;41:194. doi:10.1007/s10103-026-04996-0
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Hong J, Ryu HG, Park C, et al. Efficacy of dual-frequency noninvasive monopolar radiofrequency in skin tightening: Histological evidence. Skin Research and Technology. 2024;30(6):e13821. doi:10.1111/srt.13821
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Correction to the Hong et al. study, including manufacturer employment and conflict-of-interest disclosure. Skin Research and Technology. 2026;32(3):e70335. doi:10.1111/srt.70335
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Contini M, Hollander MHJ, Vissink A, et al. A Systematic Review of the Efficacy of Microfocused Ultrasound for Facial Skin Tightening. International Journal of Environmental Research and Public Health. 2023;20(2):1522. doi:10.3390/ijerph20021522
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Merz Aesthetics. Ultherapy: treatment depths, real time visualisation and safety information.