XERF, Ultherapy & Thermage.
Three technologies. One question.
Radiofrequency or ultrasound? Two depths or one? Tightening or lifting? This guide compares XERF (dual-frequency RF), Ultherapy Prime (focused ultrasound) and Thermage FLX (monopolar RF) so you can weigh depth, comfort, downtime and results before a consultation.
The 30-Second Comparison.
These are objective technology differences, not a claim that one device is better. The right choice depends on your anatomy, goals and comfort preferences.
Quick Answer
XERF, Ultherapy Prime and Thermage FLX all tighten skin without surgery, but differ in energy and depth. XERF uses dual-frequency monopolar radiofrequency (6.78 + 2 MHz) on the dermis and fascia with no numbing; Ultherapy Prime delivers visualised focused ultrasound to the SMAS; Thermage FLX applies single-frequency RF to the dermis. Suitability is confirmed at consultation.
| Technology | Energy | Depth | Numbing | Downtime |
|---|---|---|---|---|
| XERF Dual-frequency monopolar RF | Radiofrequency · 6.78 + 2 MHz | Dermis + subcutaneous fascia | Not required | None |
| Ultherapy Prime Focused ultrasound · MFU-V | Focused ultrasound (visualised) | SMAS | Sometimes | Minimal |
| Thermage FLX Single-frequency monopolar RF | Radiofrequency · single frequency | Dermis | Sometimes | Minimal |
Comparison figures are drawn from published clinical literature and manufacturer information. Nothing on this page is a claim that one device is superior to another. Individual results vary and suitability is confirmed at consultation.
How Each Technology Works.
Two Frequencies, Two Depths
XERF combines 6.78 MHz to heat the dermis and 2 MHz to reach the deeper subcutaneous fascia in one session. Built-in cryogen cooling protects the surface, so the treatment is delivered without numbing and without downtime. It is positioned around structural tightening.
Focused Ultrasound to the SMAS
Ultherapy Prime delivers micro-focused ultrasound with visualisation (MFU-V) to the SMAS — a deeper structural layer — creating controlled thermal coagulation points that trigger a lifting response. It is positioned around lifting.
Single-Frequency Heat in the Dermis
Thermage FLX uses a single monopolar radiofrequency with cooling and vibration to evenly heat the dermis, driving collagen contraction and remodelling. It is positioned around tightening and contouring.
Which Layer Does Each Target?
From the surface inward, the skin layers are: epidermis, dermis, subcutaneous tissue and fascia, then the SMAS. Each device focuses its energy at a different depth.
Acts primarily in the dermis, the skin’s collagen-rich supporting layer.
Spans two depths at once — the dermis and the deeper subcutaneous fascia — for structural tightening across the layers.
Reaches the SMAS, the deeper structural layer associated with facial lifting.
Depth of action is one factor to weigh, not a measure of “better”. A consultation matches your anatomy and goals to the right depth.
Numbing, Sensation and Downtime.
No Numbing, No Downtime
Cryogen cooling and comfortable pulse delivery mean most people don’t need numbing. A tolerable warmth is the typical sensation, and most return to their day straight after.
Brief, Focused Sensation
Because ultrasound energy is delivered to a deeper layer, people may feel short, focused pulses. Some manage comfort with oral analgesia or numbing. Recovery is minimal.
Warmth with Cooling
Thermage uses cooling and vibration alongside heat. Sensation is managed per area, and downtime is minimal for most people.
Comfort is subjective and varies by individual and treatment area. Your practitioner will explain what to expect for your chosen treatment at consultation.
Timeline and Maintenance.
| Device | First Change | Peak | Maintenance |
|---|---|---|---|
| XERF | Days after treatment | ~2–3 months | ~6–12 months* |
| Ultherapy Prime | Gradual, weeks | ~3 months | ≥1 year |
| Thermage FLX | Gradual, weeks | ~3–6 months | 12–24 months |
*XERF maintenance reflects manufacturer-funded and early clinical sources. All timelines vary by individual — age, skin thickness, lifestyle and your own collagen response all affect how long results last. None of these are surgical lifts and none produce a surgical result.
Matching a Device to Your Goal.
If comfort and no downtime lead
A dual-frequency radiofrequency approach like XERF is designed around a tolerable warmth with no numbing and no downtime, while still reaching the fascia for structural tightening.
If lifting is the goal
Ultherapy Prime targets the SMAS with focused ultrasound for a lifting response — a different objective from surface-level tightening.
If surface tightening suits
Single-frequency RF such as Thermage FLX acts in the dermis. For a closer-to-surface tightening alternative offered in-clinic, see HIFU Skin Tightening.
If you’re comparing two specific devices
For a deeper look at ultrasound versus radiofrequency lifting, read Ultherapy Prime vs Thermage for Asian Faces, or Non-Surgical Facelift Options: Ultherapy vs HIFU.
Energy Devices and Asian Skin.
Melanin-rich and Asian skin (Fitzpatrick III–V) can react differently to heat-based energy. Careful settings reduce the risk of post-inflammatory pigmentation after any energy treatment.
At MARA.H in Chatswood, the clinical team works predominantly with Asian and multicultural skin. Device selection and settings are calibrated to skin type, and suitability is confirmed at consultation before any treatment. This is one reason the clinic’s approach is consultation-first rather than one-size-fits-all.
Risks, Recovery and Suitability
What most people experience
A warm, sometimes intense heat is felt as energy is delivered, most noticeably over bony areas. The skin is usually flushed for a short time afterwards and may feel warm and mildly tender for several hours to a couple of days.
Less common risks to know about
Bruising, short-lived swelling, and temporary numbness or altered sensation in small patches of skin can occur and settle over days to weeks. As with any radiofrequency or ultrasound treatment, burns, blistering or pigment changes are uncommon but possible. Careful assessment and technique reduce — rather than remove — these risks.
When these aren’t suitable, or need assessment first
These energy devices are not appropriate during pregnancy or breastfeeding, for anyone under 18, or over an implanted electronic device such as a pacemaker, or over metal implants, active infection, open wounds, or inflamed or broken skin. A history of keloid scarring, an autoimmune condition, a bleeding disorder, diabetes, epilepsy, or recent surgery or injectable placement in the area all mean we assess before proceeding and may recommend a different approach.
If something doesn’t seem right
Call the clinic on 0468 358 861. A burn, blistering, spreading redness, increasing pain, or anything that is getting worse rather than better should be looked at rather than waited out. If severe or concerning, contact your GP or call 000.
XERF, Ultherapy & Thermage FAQ
No. XERF uses dual-frequency radiofrequency (6.78 MHz and 2 MHz) to target the dermis and the deeper underlying fascia, aimed at comfortable, no-downtime structural tightening. Ultherapy Prime uses focused ultrasound to reach the SMAS layer, aimed at lifting. They can complement each other.
Thermage FLX is a single-frequency monopolar radiofrequency that acts mainly in the dermis. XERF adds a second, lower frequency (2 MHz) to reach the deeper fascia as well, in the same session. Both are radiofrequency; XERF is positioned around acting at two depths at once.
Ultherapy uses micro-focused ultrasound to reach the SMAS — a deeper structural layer — and is positioned around lifting. Thermage uses monopolar radiofrequency in the dermis and is positioned around tightening. Results from both build over weeks to months.
XERF is designed around comfort with built-in cryogen cooling and is performed without numbing. Ultherapy and Thermage are generally well tolerated but may involve more noticeable heat that some people manage with oral analgesia or numbing. Comfort preferences are discussed at consultation.
XERF has no downtime and most people resume normal activities straight after. Ultherapy and Thermage have minimal downtime, with possible short-lived redness or mild swelling. A consultation confirms what to expect for you.
Results vary by individual. As a guide, XERF maintenance is often around every 6 to 12 months, Thermage around 12 to 24 months, and Ultherapy a year or more. Age, skin thickness, lifestyle and your own collagen response all affect longevity.
They can complement each other — XERF for structural tightening across the dermis and fascia, and Ultherapy Prime for deeper SMAS lifting. Whether a combined plan is right for you is assessed at consultation.
Pricing is confirmed at consultation, after the MARA.H clinical team assesses your skin laxity, the area to be treated and the plan that suits you. Cost is not one-size-fits-all and there is no obligation to proceed.
MARA.H is at Level 2, 12 Thomas Street, Chatswood NSW 2067, a 2-minute walk from Chatswood train station on Sydney’s North Shore. Hours: Tuesday to Saturday, 10:00 AM – 6:00 PM, by appointment only.
Let the Consultation Confirm It.
The right device depends on your anatomy, goals and comfort preferences. The MARA.H clinical team in Chatswood assesses your skin and recommends a plan — no obligation, no pressure. Suitability and cost are confirmed at consultation.
Related Treatments at MARA.H
XERF Skin Tightening
TGA-registered dual-frequency radiofrequency for structural tightening — no numbing, no downtime.
Learn More → LiftingUltherapy Prime
Merz micro-focused ultrasound with DeepSEE visualisation, working at the deeper SMAS layer.
Learn More → AlternativeHIFU Skin Tightening
A focused-ultrasound tightening option, for goals that sit closer to the surface.
Learn More →This page provides general information only and does not constitute medical advice. All treatments require an individual consultation to assess suitability, and individual results vary. XERF (eXperience Exponential RF) is a TGA-registered Class IIb medical device (ARTG 516008). Ultherapy Prime and Thermage FLX are third-party devices referenced for comparison; comparisons draw on published clinical literature and manufacturer information and are not a claim that one device is superior to another. XERF, Ultherapy, Thermage and their manufacturers’ names are trademarks of their respective owners.