Ulthera, Thermage, or Xerf: which lifting suits my face?

How is ultrasound lifting different from RF lifting?

Ultrasound lifting concentrates energy at a single point at a set depth under the skin. RF lifting heats the skin layer over a broad surface. Ulthera is an ultrasound device; Thermage and Xerf are RF devices.

Ulthera focuses ultrasound on a narrow spot, much like a magnifying glass gathers sunlight, and creates small thermal coagulation points. Heat forms only at the target depth and passes the surface, so it can reach the SMAS deep below the epidermis.

RF uses the resistive heat produced as current passes through tissue. Instead of one point, the whole area under the tip warms evenly. Dermal collagen contracts, then regenerates over several months, and the skin itself becomes firmer.

Thermage and Xerf are both RF. How do they differ?

Thermage and Xerf are both monopolar RF devices, but Xerf adds 2MHz to 6.78MHz and uses two frequencies. Thermage heats the dermis and the fibrous layer below with a single 6.78MHz frequency.

Xerf's 2MHz sends heat to deeper layers, and depth can be set in three steps for each area. Rather than one strong burst of heat, it raises temperature gradually with split pulses and cools the surface between pulses.

So Xerf tends to feel less hot and stinging than Thermage during treatment, and it is usually done with numbing cream alone. Still, pain varies widely by area and personal sensitivity, and it is hard to rank RF devices by a single standard.

Which device suits my face?

Even at the same age, sagging starts in different layers for different faces. In consultation, we first look at skin thickness, fat volume, and the direction of sagging, then choose the device.

Using a lot of deep-layer energy on already hollow cheeks can make them look more sunken, so in these cases we keep Ulthera's depth and shot placement conservative.

• Ulthera is considered first when the jawline is blurred, the cheeks and the area below the mouth have dropped, or a double chin is the concern.
• RF (Thermage, Xerf) is considered first when thin, loose skin makes fine lines and texture noticeable, or when the skin layer itself needs work, as around the eyes or forehead.
• Both are considered when SMAS sagging and loss of skin firmness occur together. Ultrasound handles the deep layer and RF the skin layer.
• Other options come first when sagging is advanced or hollow cheeks make the face look droopy. Thread lifting or volume treatment may suit better.

Is "Ul-Xerf" Ulthera and Xerf done together?

Ul-Xerf is the name for receiving Ulthera and Xerf on the same day. Ulthera addresses support at the SMAS, and Xerf addresses firmness in the skin layer.

The two devices use different energy and act on different layers, so they can be done on the same day. Because total energy increases, we decide which device to weight in each area and reduce overlap where the skin is thin.

Combining Thermage with Ulthera follows the same principle. Which RF to choose depends on how you feel about pain and the depth you want.

How do pain and recovery differ?

Of the three, Ulthera is usually the one people feel most clearly. When ultrasound converges deep down, there is an aching or zapping sensation, stronger along the jawline and near bone.

Thermage can feel momentarily hot, which some people find hard. Xerf raises heat gradually, so it often feels mostly warm.

Recovery is similar for all three. Most people can wear makeup and go about daily life the same day, and redness or swelling settles within days. Rarely, bruising, numbness, burns, or blisters can occur, so seek care right away if anything seems wrong.

Common misconceptions about lifting

If you are pregnant or have inflammation in the treatment area, it is better to wait. If you have an implanted electronic device such as a pacemaker, be sure to tell us before any RF treatment.

• More pain means better results: pain reflects how energy is delivered, not the size of the result.
• More shots are better: placing shots at the right depth in the right areas affects results more than the shot count.
• What you see right after is the result: the immediate tightness is an early reaction; real change appears over the 2–3 months of collagen regeneration.
• Frequent treatments keep you younger: repeating at short intervals does not help. Results usually last about 6 months to 1 year and vary widely.

Prices (as of the October 2026 menu)

When Ulthera and Xerf are combined, shot counts and weighting are decided in consultation after assessing your face.

Frequently asked questions