XERF structural skin tightening
Physician-led XERF in Sacramento, CA
XERF uses multifrequency monopolar radiofrequency to tighten skin and rebuild collagen at every layer, with no needles, usually no numbing, and no time off afterward. Every XERF treatment at Lotus MD is performed by Dr. Sanghera at our Sacramento office.
Medically reviewed by Inderpreet Sanghera, MD on
Radiofrequency skin tightening
What is XERF?
XERF, by Cynosure Lutronic, is a non-surgical radiofrequency (RF) treatment for skin laxity. It is designed to deliver RF energy deeper into the skin than surface-heating RF, reaching the shallow, middle and deep layers where collagen lives and where real change begins.
At Lotus MD, every XERF treatment is physician-performed by Dr. Sanghera, at our Sacramento office at 4250 H Street, Suite #2. The result is a personalized, evidence-based approach to skin health that addresses the structural cause of skin laxity, not just the surface.
No needles, usually no numbing, and no downtime. Just a comfortable treatment designed to build collagen.
We take the time to understand your facial anatomy, your skin and your goals, so the result looks natural.
Multi-depth technology
How XERF works
Skin tightening does not happen at just one level. XERF’s multifrequency monopolar RF delivers controlled energy through three tissue depths in the same treatment, the shallow, middle and deep dermis, triggering collagen and elastin to thicken, strengthen and shorten at every layer.
Single frequency RF and XERF. Illustration: Cynosure Lutronic 
Shallow, middle and deep. Illustration: Cynosure Lutronic 
Before and after XERF. Illustration: Cynosure Lutronic
Three depths at once
Rather than one frequency at one depth, XERF’s multiple frequencies are designed to reach all three layers of the dermis in the same treatment.
Wave Fit™ pulse technology
The pulse system continuously adjusts energy delivery to your skin’s thickness and tissue response, balancing energy at depth with cooling for comfort.
Integrated Cryogen Delivery (ICD)
Each pulse is cooled while your skin temperature is monitored in real time, protecting the upper layers while heat still reaches the deeper tissue.
The result is a treatment that feels warm and comfortable while delivering the deep stimulation that produces lasting tightening.
Your options
How XERF compares to other skin tightening options
| Compared | Face/Neck Lift | Microneedling | XERF |
|---|---|---|---|
| What it does | Surgical procedure that removes excess skin and tightens tissue | Stimulates collagen for mild skin tightening | Stimulates collagen production deep within the skin for tightening |
| Surgical vs. non-surgical | Invasive | Minimally invasive | Non-surgical |
| Anesthesia/numbing | Anesthesia | Numbing | Usually none |
| Procedure time | 3 hours | Under 1 hour | Under 1 hour |
| Downtime | 1 to 2 weeks (swelling, bruising) | 2 to 7 days (swelling, redness) | Minimal (redness) |
| Results appear | Immediately post-op, full results in months | Gradual (1 to 3 months) | Immediate and gradual (1 to 3 months) |
The clinic
Inside Lotus MD
XERF launch day at Lotus MD 
XERF Master Certified 2026 
The front room, with the XERF banner
Candidacy
Who is XERF structural skin tightening for?
Ideal candidates include:
- Adults addressing skin laxity without surgery or significant downtime
- People noticing softening or sagging along the jawline, neck or lower face
- Anyone concerned about crepey texture, loss of elasticity, or fine lines from collagen loss
- Patients interested in non-surgical facial enhancement
- Anyone who wants physician-level expertise and safety
Conditions we address with XERF
- Skin laxity and loss of firmness in the face, jawline and neck
- Jowling and early lower-face sagging
- Fine lines and wrinkles from collagen loss
- Loss of facial definition
- Body skin laxity on the abdomen, inner arms and inner thighs
XERF is best suited to mild to moderate laxity. Candidacy is always confirmed at your consultation, and if a different treatment fits your goal better, we will tell you.
Treatment benefits
What XERF can do
XERF works on the collagen structure under the surface, so results keep building in the months after treatment.
- Reaches the shallow, middle and deep tissue layers in one treatment
- Stimulates collagen and elastin to thicken, strengthen and shorten
- An immediate tightening sensation, with subtle lifting that keeps improving over 1 to 3 months
- No downtime: resume normal activities right away
- No needles, and usually no numbing, just a warming sensation
- Designed for all skin types and tones
- Treatment settings personalized to your skin
The collagen continuum
The science of structural skin tightening
From your mid-20s, your body loses collagen year after year, and that loss shows up as sagging, laxity, fine lines and softer facial definition. XERF stimulates your fibroblasts, the cells that make new collagen, with controlled heat delivered into the layers where collagen lives. Results build over time, not just right after treatment.
Foundation, treatments 1 and 2
Collagen begins forming and organizing. You notice early smoothing and a subtle lift.
Peak improvement, months 3 to 6
Collagen fibers tighten and strengthen, and firmness and contour become noticeable. This is the most visible phase, and a good time to photograph your progress.
Maintenance, ongoing
Without maintenance, collagen production slows again and results soften. Maintenance sessions every 6 months keep collagen building on your results.
It is easier to maintain collagen than to rebuild it.
The appointment
What to expect: your XERF visit at Lotus MD
Consultation, 45 minutes
A full skin analysis, your goals, your medical history and past treatments, realistic expectations, and a personalized XERF plan: how many sessions, how far apart, and any complementary treatments.
Preparation
Facial cleansing and photos for your record, and a review of your treatment zones and settings. No numbing or topical anesthetic is needed in most cases.
Treatment, 30 to 45 minutes in all
XERF energy delivered systematically across each treatment area, with Wave Fit™ pulses and ICD cooling for comfort and real-time impedance feedback monitoring your skin, then calming and protective aftercare.
Recovery
XERF recovery and results timeline
Most patients get their best results from a series of 2 sessions spaced 4 to 8 weeks apart, followed by a maintenance session every 6 months. Dr. Sanghera recommends your plan after your consultation and first treatment.
| When | What you’ll notice |
|---|---|
| Right after | A “tighter feeling” in the treated skin. Mild warmth and slight redness usually fade within 1 to 2 hours, and you can resume normal activities right away |
| Weeks 1 to 4 | Early collagen production begins and skin starts to feel firmer. Some patients see better skin quality within the first few weeks |
| Months 1 to 3 | Progressive tightening and lifting as new collagen forms and strengthens. The biggest visible changes usually appear in this window |
| Months 3 to 6 and beyond | The full structural result as collagen remodeling matures. On a maintenance schedule, results keep building with each treatment |
Clinical results
Before and after
These are clinical photos from Cynosure Lutronic, the maker of XERF. They are not Lotus MD patients.
Clinical photo courtesy of Cynosure Lutronic. Individual results vary. 
Clinical photo courtesy of Cynosure Lutronic. Individual results vary. 
Courtesy of Jordan Wang, MD, and Cynosure Lutronic. Individual results vary.
Founder and Medical Director
Dr. Inderpreet Sanghera
- MD, licensed physician
- Board certified, ABFM
- Certified, CPSO
- Certified aesthetic injector
- XERF Master Certified 2026
- Nearly two decades in medicine
Dr. Sanghera is a licensed medical doctor (MD), board certified by the American Board of Family Medicine and certified by the College of Physicians and Surgeons of Ontario. She is a certified aesthetic injector trained in Botox, Dysport and Xeomin, is XERF Master Certified (2026), and spent much of her career caring for veterans at the VA. She performs every XERF treatment at Lotus MD herself, and founded the practice to bring evidence-based medicine and an artist’s eye to aesthetic care.
About Dr. SangheraQuestions
XERF questions, answered
Still unsure? Book a consultation and ask us in person.
How is XERF different from other RF treatments?
Most RF devices deliver energy at a single frequency and depth. XERF uses multiple frequencies with Wave Fit™ pulse delivery, designed to reach all three layers of the dermis in the same treatment for deeper, more structural collagen stimulation than surface-level RF.
Does XERF hurt?
XERF is designed with comfort in mind, and treatments feel warm throughout. Integrated Cryogen Delivery (ICD) continuously monitors your skin temperature and balances the energy with cooling. There are no needles, and numbing is not needed in most cases.
How long does a XERF treatment take?
A session typically takes about 30 to 45 minutes, depending on the areas treated. Many patients book a treatment over a lunch break and go straight back to their day.
When will I see results?
Most patients feel an immediate “tighter feeling” after the first treatment. Over the following weeks and months, collagen keeps rebuilding, improving firmness and tone. The biggest visible changes usually appear 1 to 3 months after you complete your treatment series.
How long do XERF results last?
Results can last 12 to 18 months or longer. Because your body keeps breaking down collagen, maintenance sessions every 6 months help sustain and build on your results.
Is there any downtime?
No. You may have mild redness in the treated area that usually fades within a few hours, and you can resume all normal activities right after treatment.
How many sessions will I need?
Most patients get their best results from 2 sessions spaced 4 to 8 weeks apart, followed by a maintenance session every 6 months. Dr. Sanghera assesses your skin and recommends a personalized plan after your consultation and first treatment.
Is XERF safe for all skin types?
XERF uses radiofrequency energy rather than light or laser, and it is designed for use across all skin tones and Fitzpatrick skin types. Your skin is assessed at your consultation before any treatment is planned.
Can XERF be combined with my other treatments?
Yes. XERF can be combined with complementary treatments such as Botox and medical-grade skincare. Dr. Sanghera builds a plan around your skin concerns and goals so every treatment works together.
How does XERF compare to a surgical facelift?
XERF is a non-surgical option best suited to mild to moderate skin laxity. It will not replicate the results of surgery, but it gives meaningful, natural-looking structural improvement without a surgical recovery. Some patients choose XERF to put off surgery, or to help maintain the results of a past procedure.
Your next step
Ready to start building collagen that lasts?
Your XERF consultation at our Sacramento office includes a skin analysis and laxity assessment, a personalized treatment plan, a clear explanation of the process, timeline and expected results, combination options, clear pricing with no surprises, and detailed aftercare instructions.
Sacramento: 4250 H Street, Suite #2 · Thursday to Saturday, 9:30 am to 4:30 pm