Changes in skin firmness tend to arrive quietly. A jawline looks a little less defined in photos, the skin along the cheeks feels softer, and fine texture becomes harder to ignore. Many women and men in Annapolis and Northern Virginia want to address these early changes, but not at the cost of surgery, needles, or days spent recovering at home. XERF offers a different path, using advanced radiofrequency energy to reach several layers of the skin at once and encourage firmer, smoother-looking skin over time.
With more than three decades in plastic surgery, Dr. Haven J. Barlow evaluates skin laxity with the same understanding of facial anatomy he has applied throughout his surgical career, including 17 years as Chief of Plastic Surgery at INOVA Fairfax Hospital. He is certified by the American Board of Plastic Surgery, is a Fellow of the American College of Surgeons, and has been named to Washingtonian magazine’s Top Doctors list since 1992. That depth of experience allows him to recommend XERF when it is the right fit and to guide patients toward options such as laser resurfacing or a facelift when those would better serve their goals.
“Patients who ask about skin tightening usually aren’t hoping to look different. They want to look like themselves, just firmer and more refreshed. XERF lets us move toward that gradually, without incisions and without taking time out of their lives.” — Dr. Haven J. Barlow
Excellent experience each and every time! Great staff, beautiful office and always leave feeling beautiful!
What Is XERF Radiofrequency Skin Tightening?
XERF is a monopolar radiofrequency (RF) system from Cynosure Lutronic that received FDA clearance in 2025. It is the first RF device to pair two frequencies, 6.78 MHz and 2 MHz, in one treatment. This dual-frequency design allows energy to travel to the shallow, middle, and deep layers of the skin instead of stopping at a single depth, which is where many conventional RF treatments fall short.
As radiofrequency energy warms the tissue beneath the surface, the skin responds in two ways. Patients often notice an immediate sense of tightness, and the heat also signals the body to begin producing new collagen, the protein that gives skin its structure and resilience. Since that collagen rebuilding continues for weeks, results develop gradually and look natural as they emerge.
Technology That Adapts to Your Skin
XERF is designed to respond to each patient’s skin during the treatment itself, allowing a more personalized session than one-setting devices.
- Accurate Impedance Feedback: Real-time analysis of your skin guides how energy is delivered throughout the session.
- Customizable depth and intensity: Three depth settings and ten intensity levels allow treatment to be tailored to each area and each patient.
- Integrated Cryogen Delivery: Built-in cooling monitors skin temperature to protect the surface while energy works below it.
- Wave Fit Pulse: Energy delivery is paired with cooling to keep the treatment warm and comfortable.
These features are what allow XERF to be performed without topical numbing or needles, which also keeps appointments efficient.
Common Concerns XERF Can Address
XERF is best suited for mild to moderate laxity in patients who want visible refinement without surgery. Patients often consider it for:
- Softening definition along the jawline and lower face
- Loss of firmness in the cheeks and midface
- Crepey or thinning skin texture
- Early sagging that does not yet call for surgical correction
- Maintaining results after a facial procedure
When skin laxity is more advanced, surgical treatment typically produces a more significant change. Dr. Barlow will assess your skin quality and facial structure during your consultation and give you a clear, honest picture of what XERF can realistically achieve.
Is XERF Right for You?
XERF is generally a good option for healthy adults who are noticing early to moderate changes in skin firmness and would prefer a gradual, low-maintenance approach. It is also well suited to patients who have put off skin tightening because of needles, numbing, or recovery time.
Before treatment, your medical history, medications, skin type, and any implanted electronic devices will be reviewed to confirm that radiofrequency is safe for you. XERF can also be paired with other treatments from our non-surgical services, including microneedling to refine texture or injectables to address volume and expression lines, for a more comprehensive plan.
What to Expect From Your XERF Treatment
Most XERF sessions last about 30 minutes, depending on the areas treated. Because no numbing cream is needed, treatment can begin soon after your skin is cleansed and your plan is reviewed.
During the session, the handpiece is moved across the treatment area as energy is delivered. Most patients describe the sensation as warm and comfortable, with integrated cooling working throughout to protect the skin’s surface.
XERF is designed to require no downtime. Most patients return to work and daily routines immediately, and any mild redness generally fades within a few hours. A tighter feeling is often noticeable right away, while collagen continues to rebuild over the following weeks. The number of treatments recommended depends on your skin and your goals, and Dr. Barlow will create a schedule based on your individual needs. Results vary from patient to patient.
Before and After 1 Treatment. Photos courtesy of Cynosure Lutronic. Individual results vary.
Before and After 1 Treatment. Photos courtesy of Cynosure Lutronic. Individual results vary.
Frequently Asked Questions About XERF Skin Tightening
A typical session takes about 30 minutes, although timing depends on the areas being treated. No numbing is required, so there is no added wait before treatment starts.
XERF was engineered with comfort as a priority. Most patients feel warmth rather than pain, and integrated cooling monitors skin temperature throughout the session. No needles or topical numbing are involved.
XERF is considered a no-downtime treatment. Most patients return to their normal activities right away, and any mild redness usually resolves within hours.
Many patients feel a tighter sensation immediately after treatment. Visible improvement continues to build over the following weeks as new collagen forms, and individual results vary.
That depends on your skin condition, the areas treated, and your goals. Some patients see improvement after a single session, while others benefit from a short series. Your plan will be outlined during your consultation.
Conventional RF devices typically target one depth, while XERF uses two frequencies to reach shallow, middle, and deep layers of the skin. For patients with more advanced laxity, a surgical approach such as a facelift may deliver more dramatic and longer-lasting improvement.
Why Choose Dr. Haven J. Barlow for XERF
- Decades of Surgical Insight: More than 30 years of plastic surgery experience shapes every non-surgical recommendation.
- Candid Guidance: Patients receive an honest assessment of whether XERF, another non-surgical option, or surgery best matches their goals.
- Natural-Looking Results: Treatment plans reflect the practice’s commitment to refined results that never look overdone.
- A Full Range of Options: XERF is part of a complete menu of surgical and non-surgical treatments, so your plan can evolve over time.
- Two Convenient Locations: Patients are welcomed at offices in Annapolis, Maryland, and Vienna, Virginia.
Schedule XERF Skin Tightening in Annapolis, MD & Vienna, VA
Firmer, more refreshed skin is possible without surgery or an extended recovery. To find out whether XERF is the right choice for you, schedule a consultation with Dr. Barlow at our Annapolis or Vienna office.
XERF is FDA-cleared for use in dermatologic and general surgical procedures for electrocoagulation and hemostasis. The term “skin tightening” describes tightening effects that occur through soft tissue coagulation. Individual results vary, and a consultation is required to determine candidacy.
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Medically reviewed by Haven Jesse Barlow, M.D. on
