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Karisma Esthetics
XERF · Comparison

XERF vs Thermage: two frequencies or one?

Which is better? On evidence so far, Thermage FLX: cleared in 2017, with a wrinkle indication and maker data on how long results last. XERF, cleared in 2025 by comparison with it, adds a 2 MHz frequency but has only two small studies and no published head-to-head. Karisma offers XERF only, at $1,500 a session.

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Published · Written by Kay Woodson · Results vary.

How do XERF and Thermage FLX compare on paper?

When Lutronic applied for XERF's clearance, it put XERF next to Thermage FLX in a table. These rows come from that 510(k) summary, plus each maker's site, checked October 29, 2026.

XERFThermage FLX
MakerLutronic Corporation (Cynosure Lutronic)Solta Medical
FDA 510(k)K251327, August 11, 2025K170758, September 22, 2017
TypeMonopolar RFMonopolar RF
Frequency2 MHz and 6.78 MHz6.78 MHz
Maximum power400 W at 6.78 MHz, 300 W at 2 MHz400 W
Energy range listed1 to 250 J at 6.78 MHz, 1 to 120 J at 2 MHz15 to 600 J
Treatment tips12 tip types; listed sizes run from 9 x 4.5 mm to 27.6 x 17.6 mmFrom 0.25 cm² to 16 cm²
What touches the skinTip electrode, plus a return padTreatment tip, coupling fluid, plus a return pad
Comfort featuresCryogen spray with each pulse, per CynosureVibration plus cooling, per Solta
Cleared usesElectrocoagulation and hemostasis in dermatologic and general surgical proceduresThe same, plus non-invasive treatment of wrinkles, including around the eyes; with vibration, short-term improvement in the look of cellulite
Sessions and results, per the makerOne session, improvement as collagen buildsOne session; results build over 2 to 6 months and can last 1 to 2 years
At Karisma$1,500 a session, $3,000 for twoNot offered

Karisma offers only XERF of the two devices.

What is the difference between XERF and Thermage?

A 510(k) clearance works by showing a new device is substantially equivalent to one already on the market. For XERF, Lutronic chose Thermage FLX as that predicate. Both send radiofrequency through the skin from a handheld tip to a pad on the body, and the FDA file says the two heated and cooled tissue in an equivalent way in lab tests.

The difference is the second frequency. Thermage uses 6.78 MHz alone. XERF can also run at 2 MHz, which Cynosure presents as a way to reach deeper. A dermatologist quoted by Bustle in April 2026 put it simply: Thermage uses one frequency, XERF uses two. Whether that second frequency changes results in people has not been tested in a published comparison.

Does XERF hurt less than Thermage?

Pain is the reason many people ask. Solta lists mild to moderate pain in the treated area as the most commonly reported effect during a Thermage treatment, and adds vibration to help with comfort. Cynosure says XERF needs no numbing, and a plastic surgeon quoted by Bustle said older radiofrequency treatments "have been quite sensitive for patients" while his XERF patients rate it zero to three out of 10.

Treat that as one doctor's experience. The Bustle writer who tried XERF described "a deep, burning heat" that stopped short of unbearable. No study has measured pain on both devices in the same people.

Which has the longer record, and which costs more?

Thermage has decades behind it. Solta says the Thermage family has been used since 2002 and that more than 5 million treatments have been performed, counted by tips sold. XERF launched in Korea in 2024 and in the US in 2025, with two small published human studies as of October 2026, 55 people in all. The larger one enrolled only skin types I to IV.

Solta does not publish a Thermage price; its FAQ says cost depends on the area. RealSelf members report an average of $3,188 a treatment, from $1,500 to $7,900, across 187 reviews (page updated October 3, 2024). Bustle reported that XERF runs about $1,250 to $3,000 per session for the face and neck. At Karisma, it is $1,500. The XERF cost guide explains what that covers.

Thermage FLX may suit you if

You want the radiofrequency device with the longest history, a clearance that names wrinkles, and a maker that publishes how long results last. Look for a physician practice that offers it.

XERF may suit you if

You like the idea of two frequencies and no numbing, accept that the human data are early, and want a session at a Melbourne studio. Kay confirms the fit at a $150 consultation.

Questions about XERF vs Thermage

Is XERF just a newer Thermage?

Not quite. The FDA cleared XERF by comparing it with Thermage FLX, so the two are closely matched on paper. XERF adds a 2 MHz frequency and a cryogen cooling system. In practice they are separate devices from separate makers.

Which lasts longer, XERF or Thermage?

Solta says Thermage FLX results can last 1 to 2 years. Published XERF data stop at 3 months, so no fair comparison exists yet. Read how long XERF lasts.

Is Thermage FDA-cleared for wrinkles?

Yes. Its 2017 clearance includes non-invasive treatment of wrinkles, including around the eyes. XERF's clearance does not include that wording. It covers electrocoagulation and hemostasis.

Who should not have Thermage or XERF?

Solta says not to have Thermage with a pacemaker, defibrillator or other electrical implant. Cynosure's XERF trial excluded the same group, plus pregnancy and metal implants in the energy path. Tell any provider about every implant you have.

Sources

Talk it through with Kay first.

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