How Many XERF Sessions Do You Need for the Face and Neck?
Oct 02, 2026
How Many XERF Sessions Do You Need for the Face and Neck?
There is currently no single scientifically established number of XERF sessions appropriate for every patient.
This is particularly important because XERF is a relatively new technology and published clinical studies have used different treatment protocols.
A prospective multicenter study involving 39 participants used two sessions approximately four weeks apart.
A newer study involving 16 women reported measurable improvement following a single treatment with follow up through three months.
Current evidence therefore does not establish that every patient requires two treatments, nor does it show that one session is sufficient for everyone.
Can one XERF session be enough?
Improvement can occur after one treatment in selected patients.
The newer XERF study evaluated patients immediately after a single session and again at one and three months, reporting objective and subjective improvements in several measures of facial laxity and skin quality.
However, the study was small and retrospective.
It demonstrates that improvement after one treatment is possible, but it does not establish a universal one-session protocol.
Why did another study use two sessions?
The prospective multicenter study used two treatments approximately four weeks apart.
Clinical improvement in facial laxity was reported during follow up.
This demonstrates that a two-treatment protocol can produce improvement in the studied population, but it does not prove that the second session is necessary for every patient.
That question would require direct comparison between one-session and multiple-session groups.
Are three treatments better than two?
There is currently insufficient direct XERF evidence to conclude that three treatments are superior to two or one for every patient.
More treatment does not automatically mean more tightening.
Each session exposes tissues to thermal energy and should therefore have a clear clinical rationale.
What determines the number of treatments?
Factors include degree of tissue laxity, skin and fat thickness, treatment area, tissue quality, desired outcome and response to previous treatment.
The cause of the concern also matters.
If significant excess skin or advanced tissue descent is present, repeatedly applying RF may not provide the correction required regardless of the number of sessions.
Do the face and neck require the same number of treatments?
Not necessarily.
The face and neck differ in tissue thickness and anatomy.
The cause and degree of laxity can also differ between the jawline, submental area and neck.
Treatment planning and parameters should therefore reflect anatomy rather than assuming that every region responds identically.
When should the first treatment be assessed?
Assessment should not be rushed.
Early changes may occur, but collagen and tissue remodeling continue during the following weeks and months.
Current studies have assessed outcomes at one and three months.
Allowing sufficient time for remodeling before deciding whether additional treatment is required is therefore more rational than automatically retreating early.
Can XERF be repeated after one month?
One prospective study used an interval of approximately four weeks between treatments.
This demonstrates that four weeks was part of that particular study protocol.
It does not establish four weeks as the ideal universal interval for every patient, treatment setting or clinical objective.
Retreatment should reflect protocol, tissue response, device instructions and clinical assessment.
Will maintenance treatments be necessary?
Some patients may choose further treatment as aging continues, but current long term XERF evidence does not establish a fixed maintenance schedule.
It would not be evidence based to state that every patient needs treatment every six months or every year.
The face should instead be reassessed and the current problem identified.
Can XERF be repeated every year?
Repeat treatment may be reasonable in selected patients if there remains an appropriate indication.
There is no scientific rule requiring annual treatment.
A patient may eventually benefit from another XERF session, another technology, or no additional procedure at that particular time.
Do repeated treatments continually produce more collagen?
Current evidence does not support a simple linear assumption that more sessions always produce proportionally more collagen.
Tissues have biological responses and thermal limits.
Collagen stimulation should therefore not be used as a reason to repeat treatment without a defined clinical need.
What if I do not see enough improvement after one session?
Timing should first be considered.
If assessment occurs too early, tissue remodeling may still be developing.
If sufficient time has passed and improvement remains limited, the reason should be reassessed.
Another treatment may be appropriate, but the underlying concern may also be poorly suited to XERF, such as advanced excess skin or an anatomical issue requiring a different approach.
Does age determine how many sessions are needed?
No.
Chronological age alone does not determine treatment planning.
A younger patient can have meaningful laxity while an older patient may retain favorable tissue quality.
Anatomy, laxity, skin quality and treatment response are more useful than age alone.
How do I know when another session is unnecessary?
If the intended improvement has been achieved and there is no remaining concern that requires further treatment, additional sessions should not be added simply because a commercial package includes a predetermined number.
The objective should be an appropriate result using the least treatment necessary to achieve it safely.
What does the scientific evidence show?
Direct human evidence involving XERF remains limited.
A prospective multicenter study used two sessions, while a newer retrospective study demonstrated improvement following one treatment.
There is currently no large randomized trial directly comparing different numbers of XERF sessions to establish an optimal universal protocol.
Treatment planning should therefore remain individualized.
The bottom line
There is no fixed number of XERF sessions appropriate for everyone.
Current evidence demonstrates that improvement can occur after one treatment, while a two-session protocol has also produced encouraging results.
Evidence does not yet establish whether one, two or three treatments represent the ideal approach for every patient.
A rational strategy is to treat appropriately, allow sufficient time for tissue remodeling and reassess the result before deciding whether another session is necessary.
Frequently asked questions
Is one XERF session enough?
Improvement can occur after one treatment, but one session cannot be guaranteed to be sufficient for every patient.
How many sessions were used in clinical studies?
One prospective study used two treatments approximately four weeks apart, while another reported improvement following a single session.
Do I need XERF every year?
There is currently no scientific rule requiring annual treatment.
Do more sessions produce better results?
Not necessarily. Each additional treatment should be based on clinical need and individual response.
This content is intended for medical education and general patient information. Treatment number and timing should be determined according to individual assessment, treatment response and device instructions.
