A clinical perspective from Dr. Tina West, Board-Certified Dermatologist at The West Institute, Chevy Chase, MD
Patients in the Washington DC area are some of the most informed, research-driven individuals we see at The West Institute. When a new aesthetic technology enters the market, our patients find it, read about it, and come in with real questions. That is something we genuinely appreciate.
Sofwave and XERF are two technologies that have generated a lot of patient questions recently, and with that has come a fair amount of online noise. As a board-certified dermatologist who has spent over 30 years evaluating aesthetic technologies, I want to offer a straightforward clinical perspective on what actually matters when comparing these two treatments and why The West Institute chose Sofwave.
What Both Technologies Are Trying to Do
Both Sofwave and XERF are non-invasive devices designed to stimulate collagen production and improve skin laxity without surgery. Both deliver controlled energy into the skin to trigger the body’s natural healing and regeneration response. Both promise lifting and tightening results with little to no downtime.
Where they differ is in how they deliver that energy, where it goes, and what the clinical evidence actually shows.
The Science of Depth: Why 1.5mm Is the Right Target
One of the most important questions I ask when evaluating any energy-based device is: where exactly is the energy going, and what is it doing when it gets there?
Collagen is produced in the mid-dermis, at a depth of approximately 1.5mm below the skin surface. This is the productive zone. This is where a skin-lifting treatment needs to deliver its energy to stimulate significant collagen remodeling.
Sofwave’s SUPERB technology, which stands for Synchronous Ultrasound Parallel Beam, was specifically engineered to deliver its energy at exactly 1.5mm. Not deeper. Not broader. Precisely there. The device also features integrated Sofcool technology that cools the skin surface in real time throughout treatment, protecting the outer layer while the ultrasound works at the target depth below.
XERF uses radiofrequency energy that travels to depths of 4mm or more, which takes it through the dermis and into the subcutaneous fat layer and potentially toward the SMAS, the muscular layer beneath the fat. These are the same layers addressed in a surgical facelift.
Here is the clinical concern with that approach: subcutaneous fat is not a neutral bystander. It provides structural volume and facial contour. When heat is delivered to that layer, the risk of unintended disruption to fat increases. In dermatology, volume loss and contour irregularities from energy-based devices are well-documented complications. They can be subtle or significant, and they are difficult to reverse. Going deeper is not inherently better. Precise depth targeting is better.
What the Clinical Evidence Shows
At The West Institute, we do not adopt a technology because it is new or because it is being promoted. We adopt it because the evidence supports it.
Sofwave is backed by published biopsy data. A study by Wat et al. (2022) demonstrated a 68 percent average increase in collagen and a 33 percent average increase in elastin in biopsied tissue following Sofwave treatment. That is not a patient satisfaction survey. That is objective, tissue-level confirmation of the biological response.
Sofwave also holds 7 FDA clearances for aesthetic indications including improvement of facial lines and wrinkles, eyebrow lifting, submental and neck lifting, cellulite reduction, acne scar improvement, and arm skin laxity. It has been used in hundreds of thousands of treatments worldwide across all skin types.
XERF is a newer technology. Its evidence base is still developing, and published biopsy-level data confirming dermal collagen response is limited at this time. That does not mean it cannot produce results, but it does mean the clinical track record is at an earlier stage than Sofwave’s.
A Note on Comfort
Patients sometimes inquire whether Sofwave is uncomfortable. I want to address this directly because it does not reflect what our patients at The West Institute experience.
Sofwave delivers warm, pulsed sensations as the ultrasound energy is delivered into the dermis. We apply a topical numbing cream before every treatment, which significantly improves comfort. The vast majority of our patients tolerate the session well and return to their normal activities immediately afterward.
Is it completely sensation-free? No. The device delivers therapeutic heat to a precise depth in the skin, and you will feel it working. The experience is well tolerated and characterizing it as severely painful is not consistent with what we observe clinically. XERF has a comparable comfort profile. Comfort level alone is not a meaningful differentiator between the two technologies.
What the warmth actually represents is important to understand: Sofwave delivers heat in the range of 65 to 70 degrees Celsius, which is the scientifically established thermal threshold for collagen remodeling. The warm sensation is the treatment working precisely as intended.
Sofwave vs. XERF: Side by Side
|
|
Sofwave |
XERF (Radiofrequency) |
|
Energy Type |
Synchronous ultrasound (SUPERB) |
Radiofrequency (electrical) |
|
Target Depth |
1.5mm — mid-dermis |
4mm+ — beyond dermis into fat/SMAS |
|
Collagen Zone |
Precisely targets where collagen is made |
Passes through the collagen zone |
|
Surface Cooling |
Integrated Sofcool real-time cooling |
Varies by device and technique |
|
Fat Layer Risk |
Minimal — stays above fat layer |
Higher — deeper energy can affect fat |
|
FDA Clearances |
7 aesthetic clearances |
Electrocoagulation and hemostasis |
|
Biopsy Data |
68% avg collagen increase (Wat et al., 2022) |
Limited published biopsy data |
|
Comfort Level |
Warm pulses, well tolerated with numbing |
Similar warmth, variable by device |
|
Downtime |
Little to none |
Little to none |
|
Results Timeline |
8 to 12 weeks, full results at 3 to 6 months |
Variable |
|
Longevity |
Up to 12 months or longer |
Varies |
What Results Look Like and When
Sofwave stimulates collagen production, which is a biological process that unfolds gradually. Patients at The West Institute can expect:
- Weeks 1 to 4: Some patients notice early changes in skin texture and firmness
- Weeks 8 to 12: Noticeable lifting and tightening as new collagen matures
- Months 3 to 6: Full collagen remodeling and the most visible stage of improvement
- 12 months and beyond: Results from a single treatment can last a year or longer
Most patients achieve their goals with a single session. Annual maintenance is recommended as part of a long-term approach to skin quality, not because results wear off, but because the skin continues to age naturally.
Who Is a Good Candidate?
Sofwave is well suited for patients with mild to moderate skin laxity who want meaningful improvement without surgery or downtime. At The West Institute, we use Sofwave for:
- Jawline definition and lower face laxity
- Neck and submental (under-chin) tightening
- Eyebrow lifting and upper face support
- Fine lines and early wrinkles
- Arm, thigh, and body skin laxity
- Acne scar improvement
- Cellulite reduction
Because Sofwave targets the dermis precisely while the Sofcool system protects the surface, it is safe for all skin types and tones, including darker skin tones that require extra consideration with energy-based devices.
Why The West Institute Chose Sofwave
We have been evaluating and offering energy-based aesthetic technologies since 2000. The criteria we apply have not changed: the science needs to support the mechanism, the clinical evidence needs to be objective and peer-reviewed, the safety profile needs to protect our patients, and the results need to be consistent and reproducible.
Sofwave meets all of those criteria. The depth precision, the biopsy-confirmed collagen response, the 7 FDA clearances, the integrated cooling system, and the real-world track record across hundreds of thousands of patients worldwide gave us confidence that this is a technology we can stand behind.
We are proud to offer Sofwave to our patients in Chevy Chase, Bethesda, Washington DC, and Northern Virginia.
Frequently Asked Questions
Most patients describe warm, pulsed sensations that are well tolerated, particularly with topical numbing cream applied beforehand. The warmth reflects the therapeutic heat working at the precise depth needed for collagen remodeling. The experience is manageable and patients return to normal activities immediately after treatment, without any evidence of redness, swelling, or bruising.
Because 1.5mm is precisely where collagen is produced in the mid-dermis. That is the productive zone for collagen remodeling. Delivering energy deeper than that does not increase collagen production and introduces risk to subcutaneous fat and other structures that are not the intended treatment target.
Sofwave holds 7 FDA clearances covering facial lines and wrinkles, eyebrow lifting, submental and neck lifting, cellulite reduction, acne scar improvement, and arm skin laxity. These are specific aesthetic indications supported by clinical evidence.
Early improvement is sometimes visible within the first few weeks. The most noticeable lifting and tightening typically appears between 8 and 12 weeks, with continued improvement through 3 to 6 months as new collagen matures.
Little to none. Patients return to normal activities the same day. Mild redness may occur but typically clears within a few hours.
Yes. Sofwave is safe for all skin types and tones. The integrated Sofcool cooling system protects the skin surface throughout treatment, and ultrasound-based energy does not carry the pigmentation risks associated with some laser and light-based devices.
Both are non-invasive collagen stimulation technologies. Sofwave targets the mid-dermis precisely at 1.5mm with published biopsy-level evidence supporting its mechanism. XERF delivers radiofrequency energy at deeper levels and has a developing evidence base. The depth difference is clinically meaningful when considering the risk to subcutaneous fat and facial structure.
Most patients achieve their goals with a single Sofwave session. Annual maintenance treatments are recommended to sustain results as natural aging continues.
Sofwave is designed to deliver ultrasound energy at approximately 1.5mm, targeting the mid-dermis above the subcutaneous fat layer. Its mechanism focuses on collagen remodeling rather than fat disruption. Based on its depth of penetration, mechanism of action, and clinical use to date, Sofwave is not intended to affect facial fat or volume.
Depth of energy delivery is an important consideration in aesthetic treatments. Technologies that deliver energy deeper into the tissue, approaching or reaching the subcutaneous fat layer (e.g., ~4mm or beyond), have been associated in published literature and case reports with unintended fat atrophy in some cases. Because subcutaneous fat contributes to facial volume and contour, disruption to this layer may impact aesthetic outcomes.
Schedule Your Sofwave Consultation at The West Institute
If you are considering Sofwave and want a clinical perspective grounded in 30 years of experience in cosmetic dermatology, we would be glad to meet with you. Dr. West and her team serve patients throughout Washington DC, Chevy Chase, Bethesda, Rockville, and Northern Virginia.
Schedule your consultation at The West Institute today.
5530 Wisconsin Avenue #925, Chevy Chase, MD 20815
(301) 986-9378 | westskinlaser.com