COCO Clinic Named an Official XERF Heavy User

COCO Clinic has been named an official XERF Heavy User.

When people hear "Heavy User," they usually think of total usage volume. As a small clinic, we may not qualify on total volume. On a per-physician basis, however, I believe I am likely one of the doctors who has performed the most XERF treatments.

Here is the selection criterion stated by the manufacturer, Cynosure Lutronic:

"This award recognizes the clinic as a Heavy User for sustained treatment of more than 30 XERF cases per month throughout 2025." — President, Korea & Japan, Cynosure Lutronic (February 2026)

It isn't a one- or two-month spike — it's a certification you can only earn by treating consistently, every month, for a full year. To me, what matters more than the plaque itself is what it represents: that I have worked deeply with XERF.

What is XERF?

XERF is a monopolar radiofrequency (RF) lifting treatment that stimulates collagen deep in the skin without surgery. Using Cynosure Lutronic's device, RF heat acts on collagen in the dermis and subcutaneous layer — first producing immediate firmness right after treatment as collagen contracts, then gradual lifting over the following 2–3 months as new collagen builds up.

• It is performed in shot units — typically 300 / 600 / 900 shots, with a dedicated Eye XERF for the eye area.
• Downtime is minimal; aside from slight redness right after, you can return to daily life the same day.

Theory and know-how built from the start

I have attended most of the major symposiums since XERF first launched. Building on that theoretical foundation and the know-how accumulated in real practice, I continue to perform XERF treatments actively today.

RF lifting is a treatment where results can vary greatly by operator, even with the same device. Skin thickness differs across facial areas, and how you distribute power and shot count according to age, degree of sagging, and skin condition determines the outcome. The feel built up over many repeated cases shows precisely here — the judgment of where to add more energy and where to hold back.

2025 The Year of the XERF Clinic — Heavy User award (Cynosure Lutronic).

Why XERF is special, part one — 6.78MHz & 2MHz dual frequency

XERF breaks from the single-wavelength (6.78MHz) approach long treated as "standard" in RF lifting, adding a 2MHz wavelength for dual-frequency operation. RF penetrates deeper at lower frequencies (penetration depth is inversely proportional to the square root of frequency), and XERF uses this principle to divide the roles of its two wavelengths.

• 6.78MHz concentrates heat locally along the fibrous septa of the dermis and subcutis, refining firmness and skin texture across a broad area.
• 2MHz penetrates deeper and wider, heating volumetrically into the subcutaneous fat layer.

Using both together extends the thermal reaction to the dermo-subcutaneous junction, expanding the remodeling of structural proteins like collagen and elastin into the deep dermis and fibrous septa. Because it re-fills layer by layer — from surface texture to the deep structural scaffold — unlike ultrasound (HIFU), which stimulates in points, it leads to overall facial firmness. This is exactly what XERF calls structural tightening.

This characteristic is confirmed in research on the XERF device itself. In a recent study using a minipig skin model and computational simulation (Ko et al., Lasers in Medical Science, 2025), the dual-frequency approach induced more pronounced collagen and elastin remodeling across the dermis and fibrous septa — and deeper into the dermis — than single frequency; the changes grew more pronounced over time, from day 7 to day 15 to day 30. At the same time, adipocytes were preserved without damage, indicating that it firms the structure without harming the fat layer.¹

Why XERF is special, part two — Wave Fit Pulse: low pain, high energy

On top of this, XERF introduces the Wave Fit Pulse concept, greatly reducing pain during treatment — a major advantage.

You might wonder whether "less pain" simply means lower intensity. But the key with XERF is that it keeps energy intensity and volume high while removing the momentary energy peak, lowering only the pain. Because you receive it comfortably — just a warm sensation — while ample energy is still delivered, satisfaction with results exceeds that of conventional treatments.

How many shots are appropriate?

The official guideline is 600 shots per session. That said, there is no single right answer.

• Younger patients with limited sagging: 300 shots can be enough for a clear effect.
• Those in their 40s–50s or older, or with some progressed sagging: we generally recommend 600 shots.
• For tightening a wide area from the forehead to the neck: up to 900 shots may be needed.

The recommended interval is one to two times per year at 600 shots. Sufficient shots and energy are needed for a full effect, but as noted above, we do not recommend more than necessary.

Living up to the name "premium treatment"

If I had to name a downside of XERF, it is that, from the doctor's side, the treatment takes a little longer. With Wave Fit Pulse lowering the energy peak and pain, the time per shot has increased.

But for the person receiving it, this is actually a good thing — it means the doctor treats shot by shot, with care. It fits the name "premium treatment" well.

This column is for general informational purposes; treatment effects and satisfaction vary by individual.

References

1. Ko K, Ryu HG, Park J, Kim W, Kim S, Ko J, Cho SB. Computational modeling and histologic analysis of 6.78- and 2-MHz monopolar radiofrequency-induced thermal reactions. Lasers in Medical Science. 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12662868/