XERF vs Ultherapy: heat from radiofrequency or ultrasound
XERF heats skin with radiofrequency. Ultherapy uses focused ultrasound and shows the layers under the skin on a screen. The FDA first authorized Ultherapy in 2009, and its current clearance names a brow, chin and neck lift. XERF was cleared in 2025 for electrocoagulation and hemostasis. Karisma offers only XERF, at $1,500 a session.
Published · Written by Kay Woodson · Results vary.XERF and Ultherapy side by side
Facts from the FDA 510(k) database and the two makers' own pages, checked October 29, 2026.
| XERF | Ultherapy | |
|---|---|---|
| Maker | Lutronic Corporation, sold as Cynosure Lutronic | Ulthera, Inc., marketed by Merz North America |
| Energy | Monopolar radiofrequency, 2 MHz and 6.78 MHz | Micro-focused ultrasound |
| Seeing under the skin | No imaging. The device reads skin impedance as it works | DeepSEE transducer shows tissue down to 8 mm |
| Latest FDA file | 510(k) K251327, August 11, 2025 | 510(k) K260618, May 21, 2026 |
| What the FDA cleared it for | Electrocoagulation and hemostasis in dermatologic and general surgical procedures | Lift the eyebrow; lift lax tissue under the chin and on the neck; improve lines and wrinkles of the décolleté; improve the look of skin laxity on the abdomen, arms and knees |
| Human data in the latest file | None. Electrical, bench and lab tissue tests | 3 published studies, 44 people in total, for the knee indication |
| First FDA authorization | 2025 | 2009, De Novo DEN080006 |
| Needles | No | No |
| Sessions, per the maker | One session, with improvement as collagen builds | One session |
| How long results last, per the maker | Not stated in months | A year or more on the face, up to 6 months on the abdomen and arms |
| At Karisma | $1,500 a session, $3,000 for two | Not offered |
Maker statements are claims, not independent findings. Karisma offers only XERF of these two devices.
How the two deliver heat
Ultherapy focuses sound waves into small points at set depths, a little like a magnifying glass focusing sunlight. Its imaging lets the practitioner see the skin layers on screen, to check the transducer is coupled to the skin and to stay clear of bone. Merz calls this real-time imaging and builds much of its marketing on it.
XERF works differently. Current flows from the handpiece tip through the tissue to a return pad placed on your back, and the tissue warms as it resists that current. A spray of cryogen cools the surface with each pulse. Cynosure says the device has three depth settings and ten intensity levels, and that its two frequencies let the provider aim heat shallower or deeper.
Where Ultherapy has the stronger record
On the paperwork, Ultherapy is ahead. Its FDA file names cosmetic results: lifting the brow, lifting lax tissue under the chin and neck, smoothing chest lines, and since 2025 and 2026, laxity on the abdomen, arms and knees. The knee clearance cited three clinical studies with 44 people. Merz reports more than 4 million treatments worldwide.
XERF's file names none of those effects. It was cleared as an electrosurgical device, and the 510(k) included no clinical testing. As of October 2026 there are two small published human studies of XERF, 39 people and 16 women, neither with an untreated comparison group. The larger one enrolled only skin types I to IV. If you want a device with years of human data behind a named lift, Ultherapy is the one with that history.
What draws people to XERF instead
Comfort comes up most. Cynosure says XERF needs no numbing. A plastic surgeon quoted by Bustle in April 2026 said his patients rate it zero to three out of 10 for pain. Merz lists pain among the most common side effects in Ultherapy's trials, along with redness, swelling and short-lived nerve effects. No study has put the two devices head to head, so treat comfort claims on both sides as reports, not proof.
Price and access matter too. At Karisma in Melbourne, XERF is $1,500 a session, with a $150 consultation credited to the first one. Kay completed Cynosure Lutronic's didactic training on the XERF System and on Radiofrequency Science and Safety.
Ultherapy may suit you if
You want a device with a cleared lifting indication and more than 15 years on the US market, you value seeing the tissue on screen, and you are fine with the discomfort its maker lists. Ask a physician-led practice that offers it.
XERF may suit you if
You want a needle-free option with no numbing, you can accept that the published evidence is still small, and you would like to start at a local studio. Cynosure's protocol for XERF covers the face and neck, jawline included.
Questions about XERF vs Ultherapy
Is XERF better than Ultherapy?
Nobody can say yet. No study compares them. Ultherapy has the longer record and cleared lifting indications. XERF is newer, uses radiofrequency instead of ultrasound, and its maker stresses comfort. The right choice depends on your area, your budget and how much evidence you want first.
Which one hurts less?
There is no head-to-head data. Merz lists pain among Ultherapy's most common trial side effects. For XERF, Cynosure says no numbing is needed, and one surgeon quoted in the press puts it at zero to three out of 10. Your own tolerance will vary.
Can you have XERF and Ultherapy on the same area?
No published study has tested that pairing. If you have had Ultherapy, tell the provider the date and the area. Cynosure's XERF trial excluded anyone with recent radiofrequency or other procedures on the treatment area in the prior 3 months.
Does Karisma offer Ultherapy?
No. Of the two, Karisma offers only XERF. See XERF treatment in Melbourne, FL for what a session there includes.
- FDA 510(k) K260618, Ulthera System, indications and summary, decision May 21, 2026
- FDA De Novo DEN080006, Ulthera System, September 11, 2009
- Ultherapy PRIME, Merz North America, checked October 29, 2026
- FDA 510(k) K251327, XERF, Lutronic Corporation, summary, decision August 11, 2025
- XERF, Structural Skin Tightening, Cynosure Lutronic, checked October 29, 2026
- Weiss RA et al. Dual-frequency noninvasive monopolar radiofrequency for facial laxity, a prospective multicenter study. Cureus, March 2, 2026
- Erlich, Dahan, Wolf. Retrospective evaluation of XERF. Lasers in Medical Science, August 18, 2026
- Safety and Efficacy Evaluation of the XERF Device, ClinicalTrials.gov NCT07585591, checked October 29, 2026
- I Tried XERF, Bustle, April 8, 2026