If you’ve started noticing loose skin along your jawline, cheeks, or neck, you’re not alone. Skin laxity is one of the most common concerns patients bring to Dr. Marie Hayag as collagen naturally declines with age. Having XERF, Sofwave, Morpheus8, and Ultherapy all available in-house means your provider can build a plan around your skin rather than being limited to a single device, but it also means patients want to know which one to start with.
After walking patients through all four options, XERF is where we usually land first, and here’s why.
What Is XERF?
XERF is an advanced dual-frequency monopolar radiofrequency treatment that combines 6.78 MHz and 2 MHz energy to firm, lift, and remodel collagen without surgery, needles, or downtime. Unlike devices that only reach a single depth of tissue, XERF heats multiple layers in a single session while using built-in safety technology to protect the skin’s surface and underlying fat. That lets your provider deliver effective collagen stimulation while minimizing unwanted volume loss, with minimal discomfort, no numbing, and no downtime.
How Does XERF Work?
As we age, collagen and elastin, the proteins responsible for keeping skin firm and youthful, gradually decrease. XERF delivers controlled radiofrequency energy that gently heats tissue to stimulate the body’s natural collagen remodeling process, offering two benefits working together:
- Immediate tissue contraction: which can provide an early, visible tightening effect
- Long-term collagen production: with continued improvement over the following several months as new collagen develops
That combination of an early result and a longer-term one is part of why XERF is our default recommendation.
XERF vs. Sofwave, Morpheus8, and Ultherapy at a Glance
Line all four in-house options up side by side, and the pattern is clear: XERF is the only one that skips both needles and numbing while still reaching multiple tissue depths per session.
| Treatment | Needles? | Numbing Needed? | Depths Reached in One Session |
| XERF | No | No | Multiple (dual-frequency) |
| Sofwave | No | Usually yes | Single (mid-dermis) |
| Morpheus8 | Yes | Usually yes | Single, delivered via microneedles |
| Ultherapy | No | Usually yes | Single (SMAS layer) |
Why XERF Usually Comes Out Ahead of Sofwave
Sofwave uses ultrasound energy rather than radiofrequency, targeting the mid-dermis to stimulate collagen production. It’s FDA-cleared to lift the eyebrows, neck, and tissue beneath the chin while improving fine lines and wrinkles, but topical numbing cream is typically recommended, and patients may feel temporary warmth or discomfort during treatment. XERF covers greater tissue depth in a single session without that numbing step, which is why it’s usually the better starting point outside Sofwave’s FDA-cleared areas.
Why XERF Usually Comes Out Ahead of Morpheus8
Morpheus8 combines microneedling with radiofrequency energy, using tiny needles to deliver heat into the deeper layers of the skin. It’s genuinely the stronger choice for acne scars and textural concerns, but for patients whose main issue is general firmness rather than scarring, the needles, numbing, and several days of downtime are a trade-off XERF simply doesn’t require.
Why XERF Usually Comes Out Ahead of Ultherapy
Ultherapy uses focused ultrasound energy to reach the SMAS layer, the same connective tissue layer addressed during a surgical facelift, and can lift and tighten the face, neck, and under the chin. But it typically requires numbing cream or other comfort measures and can be uncomfortable during treatment. XERF reaches meaningful depth with a noticeably easier in-office experience, which is why many patients prefer it as a starting point.
What About Thermage and Surgical Facelifts?
Thermage uses monopolar radiofrequency energy to heat the deeper layers of the skin and is one of the longest-established non-surgical skin-tightening treatments, but it only targets a single tissue depth per session. It isn’t part of the current treatment menu at Marie Hayag MD, but XERF’s dual-frequency design is the clearest reason patients weighing the two tend to choose XERF when it’s available.
A surgical facelift remains the gold standard for significant skin laxity and sagging. A plastic surgeon can reposition tissue and remove excess skin directly, delivering a more dramatic and longer-lasting result than any non-surgical option, XERF included. For patients whose laxity has progressed beyond what non-surgical treatments can meaningfully address, Dr. Hayag and her team can help guide next steps, including a surgical referral when appropriate.
Find Your Right Fit
XERF, Sofwave, Morpheus8, Ultherapy, and the other options covered here each solve a different piece of the skin laxity puzzle, but for most patients, XERF delivers the most benefit for the least trade-off.
Schedule a consultation with Dr. Marie Hayag and the team at Fifth Avenue Aesthetics on the Upper East Side to find out whether XERF is the right starting point for your skin.
Frequently Asked Questions
If Fifth Avenue Aesthetics offers Sofwave, Morpheus8, and Ultherapy too, why recommend XERF first?
XERF is the only one of the four that requires no needles and no numbing cream while still reaching multiple tissue depths in a single session. For most patients whose main concern is general firmness rather than scarring or advanced sagging, that combination makes XERF the more comfortable and efficient starting point.
Is XERF as effective as Ultherapy?
XERF and Ultherapy can both reach deep tissue layers, but XERF typically does it without the numbing cream Ultherapy requires, and most patients find it more comfortable. For most patients, XERF offers a similar depth of treatment with an easier overall experience.
Why choose XERF over Sofwave or Thermage?
Sofwave and Thermage each rely on a single energy type reaching one primary depth, and Sofwave in particular is FDA-cleared for a narrower set of areas. XERF’s dual-frequency design reaches multiple depths in the same session, which is why patients weighing the options often choose XERF.
Can XERF replace a surgical facelift?
No. A surgical facelift remains the most effective option for significant skin laxity and sagging because it repositions tissue and removes excess skin. XERF is best suited to mild to moderate laxity and is usually the right non-surgical starting point before considering surgery.
How do I know if XERF is right for me?
A consultation with the team at Fifth Avenue Aesthetics can confirm whether XERF fits your skin and goals. For most patients dealing with general firmness concerns, it is the treatment we suggest trying first, even though Sofwave, Morpheus8, and Ultherapy are all available in-house as well.