XERF™ Skin Tightening
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Dr. Horton
Emily Sespaniak, MSN, FNP-C
Danielle Bautista, MSN, ANP
What Is XERF™ Skin Tightening?
How Does XERF™ Skin Tightening Work?
Am I A Good Candidate For XERF™ Skin Tightening?
How Does XERF™ Compare To Other Treatments?
How Should I Prepare For My XERF™ Treatment?
What Happens During An XERF™ Treatment?
What Is Recovery Like After An XERF™ Treatment?
When Will I See Results From XERF™?
Why Should I Choose Karen M. Horton, MD For XERF™ In San Francisco?
What Else Do Patients Ask About XERF™?
Curious If XERF™ Is Right For You?
XERF™ is a non-surgical, needle-free radiofrequency treatment that firms loose skin on the face, neck and body by heating tissue at more than one depth in a single pulse.
A softening jawline or a looser neck can bother you long before you’re ready to consider surgery. Our San Francisco practice now offers XERF™, a treatment for patients who want firmer skin without needles, incisions, or numbing cream. It’s performed by both of our Aesthetic Nurse Practitioners – Danielle Bautista, MSN, ANP and Emily Sespaniak, NP, and we only add a new technology once the research behind it holds up.
What Is XERF™ Skin Tightening?
XERF™ is a handheld monopolar radiofrequency device your provider glides across your skin. It delivers gentle heat to the superficial and deeper layers of tissue, which encourages your body’s own collagen to tighten and rebuild over the following weeks. The result is firmer, smoother-looking skin on the face, neck, and body without needles or incisions.
XERF™ was named Best Radiofrequency Skin-Tightening Treatment in NewBeauty’s 2026 Beauty Awards.
The system received FDA clearance in 2025.
How Does XERF™ Skin Tightening Work?
Radiofrequency energy warms the deeper layers of your skin while a cooling system protects the surface. That heat does two things: the collagen fibers you already have contract right away, which is why skin can feel tighter the same day, and controlled heating prompts your body to build new collagen, and elastin and stimulates fibroblasts over the following weeks.
This dual effect is what gives XERF™ both an immediate feel and a gradual, longer-lasting improvement. Research comparing radiofrequency treatments has found new collagen forms in multiple layers of skin afterward. Dr. Horton did a deep dive into learning how this treatment works, and even shared her own treatment experience and results on Instagram.
Am I A Good Candidate For XERF™ Skin Tightening?
XERF™ is a good option if you have mild to moderate skin laxity, such as early jowling, a jawline that has lost its edge, or crepey texture along the neck, and you’d like firmer skin without surgery or downtime.
Because radiofrequency heats tissue rather than targeting pigment, XERF™ can be used across skin tones, though your provider will still tailor settings to your skin.
At your consultation, our Aesthetic Nurse Practitioner reviews your medical history, medications, any implanted electronic devices, and your goals, and helps you decide whether XERF™ is the right fit, or whether another treatment, like a facelift or microneedling, would serve you better.
How Does XERF™ Compare To Other Treatments?
Every treatment we offer is good at something different, and the right one depends on what’s actually bothering you.
These treatments do not compete with each other. They solve different problems, and many patients combine two or three as part of a broader plan. At your consultation, we will recommend the right treatment for you based on your skin, your goals, and what you actually want to change, not a one-size-fits-all protocol.
XERF™ addresses skin laxity: a softening jawline, a looser neck, or skin that no longer bounces back.
Clear + Brilliant™ addresses texture and tone: fine lines, uneven pigment, or an overall dull or rough feel.
M22 IPL addresses pigment and redness: sun spots, broken capillaries, or an uneven skin tone.
Microneedling addresses acne scarring and enlarged pores by stimulating collagen through controlled micro-injury.
BOTOX® addresses dynamic lines caused by repeated muscle movement, like crow’s feet or forehead creases.
Dermal fillers address volume loss: hollow cheeks, thinning lips, or flattened areas that have lost structure over time.
A facelift addresses significant excess skin and deeper structural change that no non-surgical treatment can fully correct.
How Should I Prepare For My XERF™ Treatment?
A few simple steps help your treatment go smoothly:
- Arrive with clean, makeup-free skin in the area being treated.
- Drink plenty of water beforehand. Well-hydrated skin responds better to treatment.
- Share your full medical history and current medications with our Aesthetic Nurse Practitioner.
- Mention any recent IPL treatments, laser sessions, or other skin procedures.
- Let any sunburned or irritated skin heal before your appointment.
- Come with realistic expectations. XERF™ builds results gradually over months as collagen rebuilds.
What Happens During An XERF™ Treatment?
Our Aesthetic Nurse Practitioner cleanses the area and maps the zones she’ll treat, then moves the handpiece across your skin in passes. You’ll feel warmth building with a cool touch at each pulse, more often described as comfortable than uncomfortable.
A session generally runs to 60 to 90 minutes, depending on the area treated. There are no needles, no numbing, and no downtime, so you can reapply makeup and go straight back to your day.
What Is Recovery Like After An XERF™ Treatment?
There isn’t much to recover from. Your skin may look slightly pink or feel warm for the first hour or two, but most patients go straight back to their day, makeup and all. Protect the area from direct sun while it settles, and skip harsh exfoliants or active skincare for a day so your skin can rebuild collagen undisturbed.
When Will I See Results From XERF™?
Many patients notice a tighter feeling right after treatment, as the heat causes collagen to contract. The more noticeable change builds over roughly two to three months, as new collagen forms.
In one published study, 16 women were followed for three months after a single XERF™ session and saw improvement in facial laxity, wrinkle severity, and skin evenness, with high satisfaction and only mild, temporary side effects.
How long results last depends on your age, skin quality, and skincare routine. Since radiofrequency doesn’t pause the aging process, many patients plan on periodic maintenance.
Why Should I Choose Karen M. Horton, MD For XERF™ In San Francisco?
Plenty of offices will sell you a treatment. Fewer will tell you when you don’t need one.
Danielle Bautista, MSN, ANP and Emily Sespaniak, MSN, NP-C both perform XERF™ at our practice. Danielle has been a nurse since 2007 and a nurse practitioner since 2012, trained for five years alongside a San Francisco facial plastic surgeon, and has taken part in clinical research on injectable treatments. Emily is known for her natural, detail-oriented approach to non-surgical treatments, with a strong emphasis on patient education. Both take a conservative, individualized approach: if XERF™ isn’t the right fit for your goals, they’ll say so and point you toward what is.
Danielle and Emily work under the direction of Dr. Karen Horton, an Internationally Board-Certified Plastic Surgeon, so every treatment plan is backed by surgical-level judgment about what non-surgical options can and can’t achieve.
We’re an all-women aesthetic practice, and many patients tell us that changes how these conversations feel. Our philosophy is simple: educate, inform, empower. You should leave a consultation knowing more than when you arrived, whether or not you book.
What Else Do Patients Ask About XERF™?
Cost depends on the areas treated and the number of sessions, so we quote it after an in-person assessment. XERF™ is an elective cosmetic treatment.
Many patients are planned for a short series of two sessions, with the second about 4 to 6 weeks after the first to let new collagen form. After that, annual maintenance sessions are typically recommended to sustain results. Our Aesthetic Nurse Practitioner can confirm the right plan for you at consultation, based on how much looseness you start with.”
Yes. XERF™ addresses skin laxity, a different concern than the fine lines BOTOX® softens or the texture and tone Clear + Brilliant™ improves. Many patients pair XERF™ with one of these, or with a medical-grade skincare regimen to support results between sessions.
The face and neck are where XERF™ is most commonly used and where the published evidence sits. If your concern is looseness elsewhere, raise it at consultation and we will tell you whether XERF™ or another approach fits better.
Curious If XERF™ Is Right For You?
If a softer jawline or a looser neck has started bothering you and surgery feels like too much, XERF™ is worth a conversation. We will look at your skin, explain what radiofrequency can and cannot change, and tell you plainly whether you are a good candidate.
Schedule a consultation for XERF™ skin tightening in San Francisco.
