Abstract

Objectives: To evaluate depth-specific tissue remodeling induced by XERF®, a dual-frequency (2 MHz and 6 MHz) RF device capable of selective energy delivery to superficial and deep facial planes. Participants will learn how ultrasound imaging can quantify changes in dermal thickness, fibroseptal network density, and superficial fat architecture following treatment. Introduction: XERF® delivers RF energy at two frequencies—6 MHz for superficial dermis and 2 MHz for deeper fibroseptal and fat compartments—allowing precise depth-controlled thermal stimulation. Despite its clinical popularity, objective imaging-based evidence of structural changes remains limited. High-resolution ultrasound offers a noninvasive method to visualize real-time tissue remodeling. Materials / method: In this prospective study, ultrasound imaging was performed before and after XERF® treatment in predefined facial zones. Using a 15–18 MHz probe, dermal thickness, fibroseptal network (FSN) echogenicity, and superficial fat layer morphology were quantified. Changes in FSN thickness, dermal–fat interface clarity, and echogenic remodeling patterns were evaluated longitudinally. Results: Ultrasound demonstrated consistent post-treatment increases in dermal thickness and FSN echogenicity, indicating collagen remodeling and fibroseptal tightening. Deep regions treated with 2 MHz energy showed visible compaction of the superficial fat layer, while 6 MHz stimulation improved dermal uniformity. Depth-specific remodeling corresponded to the targeted frequency. Conclusion: XERF® induces measurable, depth-dependent structural changes across dermal and subdermal layers. Ultrasound imaging confirms FSN tightening, dermal thickening, and improved architectural definition, supporting its role as an evidence-based skin-tightening modality. These findings highlight ultrasound as an essential tool for validating energy-based rejuvenation mechanisms.