XERF vs. RF Microneedling: Two Radiofrequency Treatments, Two Very Different Approaches
One question we get at Aurelian Med Spa Both is about how the results from XERF compare to RF Microneedling. After all, both use radiofrequency energy and both stimulate collagen and elastin production. They sound similar in theory, so what’s the difference? Fact is, they’re meaningfully different treatments that serve different purposes, work through different mechanisms, and are best suited to different patients and goals.
Understanding what separates them is genuinely useful. Not just as someone trying to make an informed decision, but because choosing the right treatment for your specific concerns is what produces the kind of results that actually make a difference. Here's an honest breakdown of both.
The One Thing They Have in Common
Before getting into the differences, it's worth establishing the shared foundation. Both XERF and RF Microneedling use radiofrequency energy to generate controlled heat within the skin's tissue. That heat triggers a healing and remodeling response that stimulates the production of new collagen and elastin, the two proteins most responsible for keeping skin firm, tight, and youthful. As we age, collagen and elastin production slows, which is why skin gradually loses its structure and elasticity. Both treatments address that underlying process rather than just masking its surface-level effects.
That's where the similarities largely end.
How RF Microneedling Works
RF Microneedling delivers radiofrequency energy through fine needles that penetrate the skin's surface and deposit that energy directly into the dermis (the layer of skin where collagen and elastin live). The needles create micro-injuries in the skin at the same time, which compounds the collagen-stimulating effect by triggering the body's wound-healing response on top of the RF-driven remodeling.
The result is a treatment that works primarily at the level of the dermis and addresses concerns that live there: fine lines, wrinkles, acne scarring, enlarged pores, surface texture irregularities, and mild to moderate skin laxity. Because the needles break the skin's surface, there is some recovery involved — typically 24 to 48 hours of redness and mild swelling, sometimes with minor pinpoint bleeding immediately after the session. Most patients complete a series of three sessions spaced four to six weeks apart for optimal results.
RF Microneedling is a surface-to-mid-depth treatment. It's powerful within that range, but it doesn't penetrate into the deeper structural layers of the face that are responsible for the kind of lifting and tightening that becomes noticeable as skin laxity progresses.
How XERF Works
XERF takes a fundamentally different approach. Rather than using needles to deliver energy beneath the skin, XERF uses dual-frequency monopolar radiofrequency technology to transmit energy through the skin's surface entirely non-invasively: no needles, no micro-injuries, no breaking of the skin at all.
What makes XERF genuinely distinct is the depth it can reach and the precision with which it reaches it. By simultaneously deploying two radiofrequency frequencies — 6.78 MHz targeting the upper dermis and 2 MHz penetrating into the deeper tissue layers — XERF treats the full thickness of the skin and the tissue beneath it in a single session. This includes the SMAS layer, the Superficial Musculoaponeurotic System, which is the same foundational tissue layer that surgeons address during a surgical facelift. It is the structural layer responsible for the lifting and contouring of the face, and it's a depth that RF Microneedling, for all its effectiveness, does not reach.
The practical implication is that XERF produces a more structural result (genuine lifting and tightening of facial contours) while RF Microneedling produces superior surface-level refinement. They are working at different depths and addressing different aspects of skin aging.
XERF also features Accurate Impedance Feedback technology that reads tissue resistance in real time and adjusts energy delivery accordingly, combined with integrated cryogen cooling that keeps the skin's surface comfortable throughout the session. The result is a treatment that most patients tolerate well without numbing, with no downtime and no recovery period required.
Comparing the Two Side by Side
To make this as clear as possible, here's how the two treatments stack up across the variables that matter most to patients making a decision:
Mechanism: RF Microneedling delivers energy through needles that penetrate the skin. XERF delivers energy non-invasively through the skin's surface.
Depth of treatment: RF Microneedling works primarily in the dermis. XERF reaches the dermis, deeper tissue layers, and the SMAS.
Primary concerns addressed: RF Microneedling excels at fine lines, acne scarring, enlarged pores, surface texture, and mild laxity. XERF excels at skin laxity, jowling, neck looseness, brow drooping, and loss of facial contour.
Downtime: RF Microneedling involves 24 to 48 hours of redness and mild swelling. XERF involves no downtime.
Comfort: RF Microneedling requires topical numbing cream applied 30 to 45 minutes before treatment. XERF requires no numbing and is well-tolerated without it.
Session length: RF Microneedling sessions typically run 30 to 60 minutes. XERF sessions typically run one to two hours.
Results timeline: Both treatments produce results that build gradually over weeks to months. RF Microneedling results peak around three to six months after a series. XERF results develop over four to twelve weeks and can last twelve to eighteen months with proper maintenance.
Ideal candidate: RF Microneedling is best for patients focused on surface texture, acne scarring, fine lines, and early laxity. XERF is best for patients with moderate laxity, loss of facial contour, jowling, or neck looseness who want structural improvement without surgery.
Which One Is Right for You?
The honest answer is that it depends on what you're trying to address, and in some cases, the answer is both.
If your primary concerns are acne scarring, enlarged pores, fine lines, or surface texture irregularities, RF Microneedling is likely the stronger choice. It works precisely where those concerns live, delivers results that are well-documented and consistent, and is a more targeted tool for surface-level skin refinement than XERF.
If your primary concerns are skin laxity, sagging, jowling, neck looseness, or loss of facial definition, XERF is the more appropriate treatment. The depth it reaches and the structural nature of its results put it in a category that RF Microneedling simply can't access.
If you have both sets of concerns (which is common, since surface texture issues and laxity often develop together as skin ages) combining the two treatments can be a highly effective approach. RF Microneedling addresses what's happening at the surface while XERF addresses what's happening in the deeper structural layers, giving you a comprehensive result that neither treatment could fully deliver alone. Your provider can help you determine the right sequencing and spacing between the two.
Why This Decision Deserves a Physician's Input
This is not a decision that should be made based on a quiz or a quick consultation with a front desk coordinator. The difference between a treatment plan that produces real, lasting improvement and one that produces a disappointing result often comes down to whether the provider correctly identified which layer of the skin needed to be addressed and chose the appropriate tool to address it.
At Aurelian Med Spa, every treatment recommendation starts with a physician consultation where we look at your skin, assess the depth and nature of your concerns, and give you an honest recommendation based on what we actually see. Dr. Aaron and Dr. Desarden bring board-certified internal medicine training to every assessment — which means they're evaluating your skin with the same clinical rigor they'd bring to any medical decision, not just running through a standard menu of options.
If XERF is the right fit, we'll tell you why. If RF Microneedling is the better choice, we'll tell you that. And if combining the two makes the most sense for your goals, we'll map out a plan that does both intelligently.
Ready to Figure Out Which Is Right for You?
Every new patient at Aurelian starts with a free consultation with one of our board-certified physicians. No pressure, no packages pushed before you're ready — just an honest conversation about your skin and what's actually going to make a difference.
Book your free consultation at 303-955-8460. We're located at 4545 E 9th Ave, Suite 370, Denver, CO 80220.