Two people can book XERF on the same afternoon, get the same number of pulses from the same machine, and walk out having received genuinely different treatments.
That is not a flaw in the technology. It is the entire point of it, and it is the thing we most want patients to understand before they start comparing clinics on price.
We recently sat down with Dr. May Lee, Executive Managing Director at Cynosure Lutronic Korea, to talk about the part of XERF that never makes it into the marketing: customization. Korea is where XERF was researched, built and refined, and where it launched more than a year before it reached North America, so that is about as close to the source as this conversation gets. What follows is what it means for anyone sitting in our chair in San Gabriel.
First, what a “pulse” actually is
If you have been reading about XERF, you have probably run into numbers like 600 and 900 without anyone explaining them.
A pulse is one delivery of radiofrequency energy into the skin. XERF is unusual in that each single shot sequentially delivers two frequencies, 6.78 MHz followed by 2 MHz, which is what lets one pulse reach more than one depth. The applicator, called an effector, comes in different sizes: a large one measuring 20 by 30 millimeters for the lower and middle face, and much smaller ones for the forehead, temples, and the delicate area around the eyes.
A full face treatment generally runs around 600 pulses. Add the neck and you are at roughly 900. So when you see those numbers quoted, they are describing coverage area, not quality.
Here is the thing nobody tells you: 900 pulses is a budget, not a recipe.
What we learned about faces
The core of our conversation was simple and, once you hear it, obvious.
A slimmer face and a fuller face do not need the same treatment. Neither do a younger face and a more mature one. Even when two patients describe the identical goal, in the identical words, the depth, the pulse distribution, and the treatment zones should all be different.
Think about what that means physically. A fuller face has more tissue volume between the surface and the structures underneath, so energy needs to travel differently to reach what matters. A slimmer face has less, which changes both the depth setting and how much energy any one zone can comfortably take. A younger face is usually treated to preserve and reinforce structure that is still largely intact. A more mature face is being asked to do more rebuilding, often concentrated along specific vectors where support has given way.
Same device. Same pulse budget. Four different treatment maps.
Where the pulses go is the treatment
The published clinical technique for XERF involves two distinct motions. There is a gliding pass, where the applicator moves continuously across the area, and a stamping pass, where pulses are placed deliberately one at a time along specific vectors. The upper face and the area around the eyes are treated separately with the smaller applicators, because the anatomy there demands it.
That structure gives a provider real choices. How many pulses go to the jawline versus the midface. Whether the priority is the deep fascial layer or the more superficial tissue. Which vectors get reinforced. Where to spend extra pulses and where to be economical.
Leading XERF practitioners have gone further and built protocols around facial anatomy itself, concentrating early pulses on the retaining ligaments and the fibrous network that anchors facial tissue, establishing support before addressing laxity more broadly. The principle underneath all of it is the same one Dr. May Lee described to us: anatomical precision beats a standardized pass.
A clinic that gives every patient the identical sequence is technically delivering XERF. They are just not delivering the best XERF results.
What this looks like in our treatment room
Every XERF treatment at Eve starts with the face in front of us. Not a template, not a protocol sheet, and not what we did for the patient before you.
We are looking at four things: your facial structure, how tissue is distributed across it, where and how much laxity is present, and which areas matter most to you. That last one is not a courtesy question. If your jawline is what bothers you every time you see a photo of yourself, that should change where the pulses go, and it does.
This is also where our complimentary Aura 3D imaging scan earns its place. A photo-realistic three-dimensional capture that analyzes facial structure, skin quality, and volume change is a far better planning document than a mirror and a conversation. It also gives us something objective to compare against three months later.
| Consideration | What we assess | What it changes |
|---|---|---|
| Facial structure | Bone structure and overall facial shape | Which vectors we treat along and where support is built |
| Tissue distribution | Whether the face is fuller or slimmer, and where volume sits | Depth setting and how energy is delivered to reach target layers |
| Degree of laxity | How much, and in which specific zones | Pulse distribution and where the budget is concentrated |
| Your priorities | What actually bothers you when you look in the mirror | Which zones get treated first and most generously |
Why no numbing is part of this, not a separate perk
XERF is a no-needle, no-numbing treatment, which usually gets sold as a convenience. It is also a clinical advantage, and the two are connected.
The device uses Wave Fit pulse technology, which adapts to skin thickness, alongside integrated cryogen cooling that protects the surface with each pulse, and real-time temperature monitoring. Because your skin surface stays protected while energy goes deeper, the treatment is tolerable without anesthesia.
Which matters for customization, because you can tell us what you are feeling as it happens. A numbed patient cannot give feedback. You can, and we use it. A treatment that adapts in real time needs a patient who is present for it.
Practically, it also means no forty-five minutes sitting in a room with a face full of lidocaine before anything begins.
The evidence behind it
XERF is not a device looking for validation. It launched in Korea in May 2024, reached North America in June 2025, and passed 2,000 installations worldwide in under two years, with the second thousand arriving roughly three times faster than the first.
A peer-reviewed retrospective study published in Lasers in Medical Science evaluated patients after a single XERF session using validated FACE-Q instruments. It found statistically significant improvements, a measurable reduction in perceived age, high patient satisfaction, and only mild, transient side effects.
In 2026 the platform picked up awards from SHAPE and NewBeauty, and coverage in outlets including Oprah Daily, The Wall Street Journal, Allure, ELLE, Forbes and TODAY.
All of which is reassuring. None of which substitutes for the person holding the applicator deciding where your 900 pulses should go.
Why we were in that conversation at all
Eve was among the first clinics in the United States to offer XERF, working directly with Cynosure Lutronic as a flagship treatment location in the Los Angeles area. We have now completed hundreds of XERF treatments.
That relationship is why we get to sit down with the people developing the clinical protocols in Korea rather than reading a brochure, and it is why our treatment planning reflects how the device is actually meant to be used rather than how it is easiest to use.
Our registered nurses plan every treatment individually. We are open seven days a week from 9:30 am to 7:30 pm, and our team cares for patients in English, Mandarin, and Cantonese. Patients come to us from Pasadena, Arcadia, Alhambra, Temple City, Monterey Park, and San Marino.
Frequently asked questions
What is a pulse in a XERF treatment?
A pulse is one delivery of radiofrequency energy into the skin. Each XERF pulse sequentially delivers two frequencies, 6.78 MHz and 2 MHz, allowing a single shot to reach multiple depths. Pulse counts describe how much area is covered, not how good the treatment is.
What is the difference between a 600 and 900 pulse XERF treatment?
Roughly, coverage. A full face treatment generally uses around 600 pulses, while approximately 900 covers the full face plus the neck. The right number depends on which areas you are treating, which is determined at consultation rather than chosen from a menu.
Do more pulses mean better XERF results?
Not by itself. Pulse count reflects area covered, while results depend on depth settings, pulse distribution, and which zones are prioritized for your particular face. A well-planned treatment outperforms a larger but generic one.
Why would my XERF treatment differ from my friend’s?
Because your faces are different. Facial structure, tissue distribution, degree and location of laxity, and personal priorities all change the treatment map. Two patients with identical goals and identical pulse counts can correctly receive quite different treatments.
How long does a XERF session take?
Plan on roughly 30 to 90 minutes depending on how many areas are treated. Because XERF requires no numbing, there is no waiting period before treatment begins, so total time in the clinic is shorter than comparable tightening treatments that need anesthetic.
Can XERF treat the area around the eyes?
Yes. The upper face and periorbital region are treated with smaller applicators designed for that anatomy, applied outside the orbital rim. These areas are planned separately from the lower and middle face because the tissue and the technique differ.
Come find out what your face needs
You cannot plan a treatment from a webpage, which is somewhat the point of this entire article. Consultations are complimentary and include the Aura 3D scan.
Book your complimentary XERF consultation
Individual results vary. Pulse counts, depth settings, and treatment areas are determined by your provider during consultation based on individual assessment. This article is general information and not medical advice.