Thermage, Ultherapy PRIME, Sofwave, XERF & More: Which Skin Tightening Treatment Is Right for Your Face?

With so many skin tightening and lifting treatments available today, choosing the right procedure can feel overwhelming. Thermage, Ultherapy PRIME, Sofwave, Shurink, XERF, DENSITY, ONDA, Profound, InMode, and Oligio all use different technologies to address specific aesthetic concerns.

But here is the most important question: What is actually making your face look older?

A less-defined jawline, deeper nasolabial folds, a double chin, and loose skin may appear similar at first glance. However, they can result from very different anatomical changes, including deeper tissue laxity, localized fat accumulation, reduced skin elasticity, or loss of facial volume.

A treatment that works well for one concern may be unnecessary—or even counterproductive—for another.

In this guide, we compare 11 aesthetic devices, explore illustrative patient scenarios, and explain how a dermatologist might approach treatment selection based on facial anatomy and individual goals.

We also review published clinical research to help distinguish established evidence from promising but less extensively studied technologies.

Important note: The patient scenarios below are illustrative examples, not actual patient case reports. Treatment outcomes vary, and the published studies discussed here do not establish that one device is universally superior to another.

1. Start With the Cause: Three Different Faces Can Have the Same Concern

Imagine three patients who all say the same thing: “My jawline is disappearing.”

Case A: The patient with loose skin

A patient in their early 50s notices that the lower face looks less defined than it did five years ago. There is little fat beneath the chin, but the skin and supporting tissues appear less firm.

The primary concern may be tissue laxity rather than excess fat. An ultrasound-based lifting treatment or a radiofrequency treatment may be considered, depending on the depth and severity of the changes.

Case B: The patient with a double chin

A patient in their 30s has relatively firm skin but persistent fullness beneath the chin, even at a stable body weight.

In this case, localized submental fat may contribute more to the facial contour than skin laxity. A contour-focused treatment such as ONDA may be considered after assessing fat distribution and skin quality.

Case C: The patient with a lean, hollowing face

A patient in their 40s has lost weight and now notices hollow cheeks, deeper folds around the mouth, and a less defined lower face.

Additional fat reduction may worsen the hollow appearance. The priority may instead be to preserve facial volume and address skin quality or selected areas of laxity.

These examples illustrate why a device should never be selected solely because a particular facial area looks older.

The first step is to identify the tissue responsible for the concern.

2. Comparing 11 Popular Aesthetic Devices

1. Thermage FLX: When Skin Firmness Is the Main Concern

Technology: Monopolar radiofrequency (RF)

Primary goals: Skin tightening, improved firmness, and reduction in the appearance of fine lines.

Illustrative case: A patient in their late 40s has relatively good facial volume and a reasonably defined jawline but notices that the skin looks less firm around the cheeks and lower face.

Thermage FLX delivers radiofrequency energy that heats tissue and promotes collagen remodeling. It is generally considered when the goal is to improve overall firmness rather than selectively reduce a pocket of fat.

The expected result is usually gradual improvement in skin tightness and texture, not a surgical-style repositioning of descended tissues.

When to be cautious: Patients expecting a dramatic lift may be disappointed if the primary problem is substantial tissue descent.

Research: Systematic review of radiofrequency for facial and neck rejuvenation (PubMed)

This review examined clinical literature on radiofrequency treatments and found generally positive results across several rejuvenation outcomes. However, it included different RF technologies, so its findings should not be interpreted as proof of Thermage FLX-specific effectiveness.

2. Ultherapy PRIME: When Deeper Tissue Laxity Is the Concern

Technology: Microfocused ultrasound with real-time imaging.

Primary goals: Nonsurgical lifting and improvement in selected areas of facial and neck laxity.

Illustrative case: A patient in their 50s notices a gradual loss of jawline definition and mild descent around the lower face. The skin is not particularly thin, and excess fat beneath the chin is not the dominant concern.

Ultherapy PRIME uses focused ultrasound to create thermal coagulation points at selected tissue depths. Real-time ultrasound imaging allows the practitioner to visualize underlying tissue layers and guide treatment.

It may be considered when the objective is to improve the appearance of mild to moderate laxity by targeting deeper supporting tissues.

However, the amount of improvement depends on anatomy, treatment technique, and the degree of laxity. It cannot reliably reproduce the results of surgical lifting in patients with significant tissue descent.

When to be cautious: Patients with a naturally lean face or limited facial fat require careful treatment planning. Energy-based treatments should be selected and administered with attention to anatomy and the risk of unwanted volume changes.

Research:

• Systematic review and meta-analysis of microfocused ultrasound with visualization (PubMed)
• Systematic review of microfocused ultrasound for facial skin tightening (free full text)

These reviews support the potential of microfocused ultrasound for selected lifting and tightening indications. They also highlight variability in outcomes and the need for better standardized studies.

3. Sofwave: When the Goal Is Dermal Tightening and Subtle Lifting

Technology: Synchronous parallel ultrasound beams, often referred to as SUPERB technology.

Primary goals: Improvement in skin laxity, fine lines, and selected lifting concerns.

Illustrative case: A patient in their early 40s has mild brow or lower-face laxity and wants to improve skin firmness without undergoing an invasive procedure.

Sofwave uses multiple parallel ultrasound beams to create controlled thermal effects in the mid-dermis, generally targeting a shallower tissue layer than the deeper focal treatment points associated with conventional microfocused ultrasound protocols.

Its approach is designed to stimulate collagen and elastin remodeling while preserving the overlying epidermis.

This makes Sofwave a distinct option for patients whose concerns center on dermal firmness and mild laxity. It should not be assumed to have the same mechanism or treatment depth as Ultherapy PRIME.

When to be cautious: Sofwave is not a fat-reduction procedure. Patients whose primary concern is a prominent double chin caused by substantial fat accumulation may need a different treatment strategy.

Research:

• Clinical study of high-intensity parallel ultrasound for lower-face skin tightening (PubMed)
• Clinical and histological study of parallel ultrasound for facial skin tightening (free full text)

The published research is promising, but some facial studies have relatively small sample sizes. Results from these studies should not be treated as definitive proof of superiority over other ultrasound technologies.

4. Shurink: A Focused Ultrasound Option for Selected Lifting Concerns

Technology: High-intensity focused ultrasound (HIFU); specifications vary by model.

Primary goals: Nonsurgical tightening and improvement in selected areas of mild laxity.

Illustrative case: A patient in their late 30s has early changes in jawline definition but does not yet have substantial skin excess.

Shurink delivers focused ultrasound energy at selected tissue depths. Depending on the specific model, cartridges, and treatment protocol, it may be used for facial tightening and lifting.

Although Shurink and Ultherapy belong to the broader category of focused ultrasound treatments, they are not interchangeable. Imaging capabilities, energy delivery, treatment parameters, and supporting clinical evidence can differ.

When to be cautious: The name of the device alone does not tell you whether the treatment is appropriate. Confirm the exact model and treatment protocol, and ask about the practitioner’s experience.

5. XERF: A Radiofrequency Option for Skin Firmness

Technology: Dual-frequency radiofrequency.

Primary goals: Skin tightening and improvement in the appearance of facial contours.

Illustrative case: A patient in their 40s notices reduced firmness around the cheeks and jawline but has no major double chin or severe skin excess.

XERF is a radiofrequency-based treatment designed to deliver controlled thermal energy to tissue. Its dual-frequency approach is intended to support tissue heating and collagen remodeling.

Unlike focused ultrasound treatments, XERF uses radiofrequency energy rather than ultrasound to generate thermal effects. The clinical relevance of this distinction depends on the patient’s anatomy, treatment settings, and desired outcome.

XERF may be considered when skin firmness is a major concern, but it should not automatically be described as more powerful or more effective than other RF devices without appropriate comparative evidence.

When to be cautious: Publicly available independent clinical evidence for XERF is more limited than the broader published literature on radiofrequency skin rejuvenation. Claims about long-term results, superiority, or optimal treatment combinations should therefore be interpreted cautiously.

Research context: Systematic review of radiofrequency for facial and neck rejuvenation (PubMed)

This review provides background on RF-based rejuvenation as a category. It does not establish the effectiveness of XERF specifically.

6. DENSITY: Combining Monopolar and Bipolar Radiofrequency

Technology: Monopolar and bipolar radiofrequency.

Primary goals: Skin firmness, elasticity, and improvement in the appearance of fine lines.

Illustrative case: A patient in their late 40s has mild lower-face laxity and notices that the skin looks less firm, even though the overall facial contour remains relatively stable.

DENSITY combines monopolar and bipolar RF technologies to deliver thermal energy to tissue and support collagen remodeling.

Its intended role differs from that of focused ultrasound devices. Radiofrequency treatments generate tissue heating through electrical energy, while focused ultrasound creates localized thermal effects at selected focal depths.

Depending on the patient’s condition, an RF treatment may be considered on its own or as part of a broader treatment plan.

When to be cautious: More energy is not necessarily better. Treatment parameters should be chosen with consideration for facial fat distribution, skin thickness, and the risk of excessive heating.

7. ONDA: When Localized Fat Contributes to a Double Chin

Technology: Microwave energy.

Primary goals: Selected areas of localized fat reduction and contour improvement.

Illustrative case: A patient in their late 30s has fullness beneath the chin despite relatively firm skin. Their primary concern is the appearance of a heavier lower face rather than generalized skin laxity.

ONDA uses microwave energy to produce controlled thermal effects in targeted tissues. Depending on the applicator and protocol, it may be used for selected contouring indications, including submental fullness.

A published clinical study evaluated a microwave-based system for submental fat and skin laxity in 48 participants. After six treatment sessions, the investigators reported improvements in clinician-rated submental fat and laxity scores at follow-up.

Research: Clinical evidence for microwave treatment of unwanted fat and submental skin laxity (PubMed)

The study supports the potential of microwave-based treatment for selected submental concerns. It does not establish that every ONDA protocol will produce the same results, and its six-session protocol should not be generalized to every treatment setting.

When to be cautious: Patients with naturally lean cheeks, facial hollowing, or limited subcutaneous fat may be poor candidates for additional fat reduction. Unwanted volume loss can make the face appear older.

8. Profound: A More Invasive Approach to Tissue Remodeling

Technology: Radiofrequency-based tissue remodeling, including microneedling-based approaches.

Primary goals: Selected concerns involving skin laxity, wrinkles, and tissue remodeling.

Illustrative case: A patient has more pronounced skin texture changes and laxity and is willing to consider a procedure with greater recovery requirements than a fully noninvasive treatment.

Profound is associated with radiofrequency-based treatment approaches that deliver controlled thermal energy to targeted tissue. The specific technique and depth depend on the system and protocol being used.

Unlike fully noninvasive devices, procedures involving needles or more invasive tissue delivery may involve greater swelling, bruising, discomfort, and recovery time.

When to be cautious: Confirm the exact Profound system and procedure being offered. Its risk profile and downtime should not be equated with those of noninvasive RF or ultrasound treatments.

9. InMode: The Treatment Depends on the Handpiece

Technology: Varies by device and handpiece.

Primary goals: Selected combinations of skin tightening, facial contouring, and localized fat treatment.

Illustrative case: A patient has mild fullness beneath the chin along with some loss of skin firmness.

InMode is a platform that includes different treatment technologies. For example, Forma is used for skin tightening, while MiniFX uses radiofrequency and suction-assisted treatment for selected contouring concerns.

These procedures do not have identical indications or expected outcomes. The appropriate choice depends on whether excess fat, skin laxity, or both are contributing to the patient’s appearance.

When to be cautious: Ask which handpiece will be used and what the treatment is intended to accomplish. The brand name alone is insufficient to predict results or recovery.

10. Oligio: Monopolar RF for Skin Tightening

Technology: Monopolar radiofrequency.

Primary goals: Improved skin firmness, elasticity, and the appearance of fine lines.

Illustrative case: A patient in their early 40s has early signs of aging and wants to improve skin firmness without specifically targeting a pocket of fat.

Oligio uses monopolar radiofrequency to heat tissue and stimulate collagen remodeling. It belongs to the same broad technology category as Thermage, but the two devices differ in design and treatment delivery.

Neither should be assumed to produce identical outcomes simply because both use monopolar RF.

When to be cautious: Expectations should remain realistic. Skin tightening is not equivalent to removing significant excess skin or repositioning markedly descended tissues.

11. Soprano Titanium: Not a Lifting Device

Technology: Diode laser hair removal.

Primary goal: Reduction of unwanted facial and body hair.

Soprano Titanium is included here to clarify an important distinction: it is primarily a hair-removal platform, not a facial lifting or skin-tightening device.

Although laser hair removal is part of aesthetic medicine, it should not be compared directly with technologies designed to improve skin laxity.

3. Quick Comparison: Which Technology Addresses Which Concern?

Device	Technology	Main treatment focus
Thermage FLX	Monopolar RF	Skin firmness and fine lines
Ultherapy PRIME	Microfocused ultrasound with imaging	Selected deeper tissue lifting
Sofwave	Parallel-beam ultrasound	Dermal tightening and mild lifting
Shurink	Focused ultrasound	Selected lifting and tightening
XERF	Dual-frequency RF	Skin firmness and tightening
DENSITY	Monopolar and bipolar RF	Skin firmness and elasticity
ONDA	Microwave energy	Selected localized fat and contouring concerns
Profound	RF-based tissue remodeling	Selected skin and soft-tissue concerns
InMode	Varies by handpiece	Fat treatment and/or skin tightening
Oligio	Monopolar RF	Skin tightening and fine lines
Soprano Titanium	Diode laser	Hair removal

These are general categories, not a ranking. Indications and outcomes vary by model, applicator, settings, treatment technique, and patient characteristics.

4. Three More Illustrative Cases: How a Dermatologist Might Choose

Case 1: “My jawline is disappearing, but my face is already slim.”

Assessment: The patient has limited facial fat, mild-to-moderate tissue laxity, and little submental fullness.

Possible approach: Ultherapy PRIME or Sofwave may be considered depending on the depth and pattern of laxity. A radiofrequency treatment such as Thermage, XERF, DENSITY, or Oligio may also be considered for skin firmness.

The decision should be based on examination rather than an assumption that ultrasound is always better for lifting or RF is always better for tightening.

What may not be appropriate: Routine fat-reduction treatment simply because the jawline is less defined. Further volume loss could worsen the patient’s appearance.

Case 2: “I lost weight, and now my face looks tired.”

Assessment: The patient has reduced cheek volume, more visible folds, and mild skin laxity after weight loss.

Possible approach: The first priority is to distinguish volume loss from tissue descent. Skin-tightening treatment may help selected areas, but it cannot replace lost facial volume.

A physician may consider whether conservative skin tightening, volume restoration, or a combination of approaches is appropriate.

What may not be appropriate: Automatically combining a lifting treatment with ONDA or another fat-reduction procedure. The patient’s existing volume loss makes careful selection particularly important.

Case 3: “My skin is still fairly firm, but I have a double chin.”

Assessment: The patient has localized submental fullness, with relatively good skin elasticity.

Possible approach: A contour-focused treatment such as ONDA may be considered if the fullness is attributable to treatable subcutaneous fat and the patient is an appropriate candidate.

If the problem is instead related to loose skin, deeper anatomy, or another cause, fat reduction alone may not address it.

What may not be appropriate: Assuming that every double chin is caused by fat. A clinical examination is necessary to identify the underlying anatomy.

5. Should You Combine Ultherapy PRIME, ONDA, and DENSITY?

The rationale behind this combination is that each technology has a different intended treatment target:

• Ultherapy PRIME — selected deeper tissue laxity: Focused ultrasound may help improve the appearance of mild-to-moderate laxity.
• ONDA — selected localized fullness: Microwave treatment may be considered when submental fat is an important contributor to the contour.
• DENSITY — skin firmness: Radiofrequency may be considered to improve the appearance of reduced skin elasticity.

An illustrative combination scenario

Consider a patient in their late 40s with three distinct findings:

1. Mild descent of the lower face.
2. Persistent fullness beneath the chin.
3. Reduced skin firmness.

A dermatologist might evaluate each concern separately and determine whether more than one treatment is justified.

However, the combination is not automatically better than a single device. If the patient has no meaningful excess fat, ONDA may be unnecessary. If the patient has significant tissue descent, nonsurgical treatment may produce limited improvement. If skin firmness is already satisfactory, adding another RF treatment may offer little additional benefit.

The treatment order, intervals, and settings must be individualized. Performing multiple energy-based procedures does not guarantee better results and may increase discomfort or the risk of unwanted tissue effects.

The goal is not to use three devices. The goal is to treat three distinct problems only when all three are actually present.

6. What Does the Clinical Research Tell Us?

Published evidence can help explain how these technologies work, but it is important to distinguish between research on an entire technology category and research on a specific commercial device.

Microfocused ultrasound

A 2023 systematic review examined 16 studies involving microfocused ultrasound for facial skin tightening. The findings supported potential improvement in mild-to-moderate laxity, but the authors also noted limitations in the available evidence.

Read the systematic review — PubMed

A later systematic review and meta-analysis examined microfocused ultrasound with visualization, including 42 studies. It reported that many patients and investigators observed improvement, while also noting variability across the included studies.

Read the meta-analysis — PubMed

These findings support the potential role of microfocused ultrasound, particularly when tissue laxity is the concern. They do not establish that every focused-ultrasound device has equivalent effectiveness.

Radiofrequency

A systematic review of radiofrequency for facial and neck rejuvenation examined a broad body of clinical literature and reported positive findings across several skin-rejuvenation outcomes.

Read the systematic review — PubMed

However, radiofrequency devices differ in energy delivery, tissue heating, applicators, and treatment protocols. Evidence supporting RF as a category should not be presented as direct proof that Thermage, XERF, DENSITY, and Oligio produce identical outcomes.

Microwave-based contouring

A clinical study of microwave treatment for submental fat and skin laxity reported improvements after a six-session treatment course.

Read the clinical study — PubMed

This supports further consideration of microwave-based approaches for selected patients. It does not establish the ideal treatment schedule for every device or prove that fat reduction is appropriate for all facial shapes.

Sofwave and parallel ultrasound

Published clinical studies have reported improvements in selected facial laxity outcomes following high-intensity parallel-beam ultrasound treatment.

Read the clinical study — PubMed

A small clinical and histological study also reported changes in collagen and elastic fibers after treatment.

Read the clinical and histological study — full text

These findings are encouraging, but sample sizes and follow-up periods should be considered when interpreting the results. They do not establish that Sofwave is superior to Ultherapy PRIME or other skin-tightening treatments.

What about XERF, DENSITY, and the other specific devices?

For these technologies, the most relevant evidence would be device-specific prospective studies, controlled comparisons, and longer-term follow-up data. Broad research on radiofrequency is useful background, but it should not be substituted for clinical evidence on a particular device.

For an evidence-based article, claims should be matched to the exact technology, indication, and treatment protocol studied.

7. The Bottom Line: Choose the Treatment That Matches Your Facial Anatomy

There is no single lifting or skin-tightening device that is best for everyone.

• If deeper tissue laxity is the main concern, a focused-ultrasound treatment such as Ultherapy PRIME may be considered.
• If the main concern is dermal firmness and mild laxity, Sofwave or an appropriate radiofrequency treatment may be considered.
• If localized submental fat is contributing to a double chin, ONDA may be an option for selected patients.
• If the face has already lost substantial volume, further fat reduction may be inappropriate.
• If the concern is significant excess skin or tissue descent, nonsurgical devices may not provide the desired degree of correction.

A combination of treatments can be useful when several distinct concerns coexist, but it should be based on an individualized assessment rather than a standard package.

Before treatment, consult a qualified medical professional about expected benefits, limitations, risks, alternatives, and the evidence supporting the specific device and protocol.

The best treatment is not necessarily the newest, strongest, or most expensive device. It is the one that addresses the actual cause of your concern while preserving your natural facial structure.

Thank you.

Written by: Dr. Seung Hoon Kang Cheongdam Cellon Dermatology Clinic

For pricing and any other questions, please reach out to our staff member, Emily