Objective and subjective retrospective evaluation of XERF, a novel single-shot dual-frequency non-invasive monopolar radiofrequency

Abstract Facial support is maintained by the vertical anchoring system, a collagen-rich network comprising the dermis, retinacula cutis, superficial musculoaponeurotic system, and retaining ligaments, which progressively deteriorates with age. Noninvasive monopolar radiofrequency (NMRF) induce collagen contraction and remodeling within these structures; however, clinical outcomes with conventional NMRF remain variable. XERF (Cynosure-Lutronic, South Korea) is a dual-frequency NMRF that sequentially delivers 6.78 MHz and 2 MHz energy within a single pulse. This study objectively and subjectively evaluated its efficacy for improving facial skin laxity and skin quality. This retrospective study reviewed adult patients who underwent a single XERF treatment session. Outcomes were extracted from routinely collected clinical data obtained immediately post-treatment and at 1- and 3-month follow-up visits relative to baseline. Objective assessments included three-dimensional stereophotogrammetry for volumetric redistribution, standardized morphometric analysis of periorbital lifting, and computerized skin-quality evaluation. Subjective outcomes were derived from completed prefilled questionnaires, including validated FACE-Q instruments, visual analog scales for perceived age and pain, overall satisfaction, willingness to repeat or recommend treatment, and Patient Global Aesthetic Improvement Scale scores. Safety was assessed through retrospective review of documented adverse events in medical records. Sixteen adult female patients completed follow-up. Objective assessments demonstrated volumetric redistribution, characterized by lateral volume augmentation and medial volume reduction. Periorbital morphometric analysis ( n = 15) revealed progressive elevation of the eyebrows and upper eyelids. Skin-quality assessment showed improvements in wrinkle severity, skin evenness, pore size, and oiliness, with no significant changes in pigmentation. Subjective outcomes were consistent with objective findings, demonstrating improvements in FACE-Q scores accompanied by a reduction in perceived age. Treatment was well tolerated, with high patient satisfaction and only mild and transient adverse events. In this retrospective study, XERF demonstrates improvements in facial skin laxity and quality, supported by objective and subjective outcomes, with a favorable safety and tolerability profile. These findings should be considered preliminary and require confirmation in larger prospective controlled studies.