The SW1 XERF Lift Protocol

A considered approach to facial contour, skin firmness and the way a face ages

When people talk about facial ageing, they often begin with wrinkles. But for many faces, the change that makes them look less rested is not a single line. It is a gradual softening of contour: the cheek looks less supported, the lower face feels heavier, or the jawline is less clearly defined.

That is why, at SW1 Clinic, we look at facial ageing as a whole. Skin texture matters. So do expression lines, volume, support and the way the face is changing over time. There is no one feature that defines an ageing face, and no single treatment that suits everyone.

Why contour matters

Studies of how people perceive faces suggest that facial appearance influences impressions of age and attractiveness. In one study, 483 observers rated photographs of 13 patients before and after facelift surgery. After surgery, observers perceived the patients as an average of 3.69 years younger and rated them more attractive. This was a study of selected surgical outcomes; it does not tell us what a non-surgical treatment will achieve, or prove that lifting alone accounts for perceived attractiveness. It does, however, show that changes to facial contour can influence how a face is read by others. [1]

Even infants have been found to look longer at faces that adults had rated as attractive when shown pairs of faces. That finding is about visual preference and looking time, not a baby’s understanding of beauty. It is a small reminder that facial impressions begin early—and are shaped by more than the presence or absence of wrinkles. [2]

At SW1, our aim is not to make every face look lifted in the same way. It is to understand what has changed, what matters to the patient, and which parts of the face are suitable for treatment.

Asian faces are not one ageing pattern

It is tempting to describe Asian skin or faces as if they age in one predictable way. The evidence does not support that kind of neat division. A comparative study of Japanese and Caucasian women found differences in the pattern of wrinkles and sagging across age groups; a larger study of German, Chinese and Japanese women also found that visible signs varied by ethnic background, age and facial site. Neither supports a rule that one group universally develops more sagging or heavier jowls. [3][4]

In our clinical experience at SW1, many of the Asian patients we see are particularly concerned by lower-face heaviness, early jowling or a softer jawline. That is an observation from our practice, not a claim about every Asian face or a conclusion that skin thickness or oiliness is the sole cause. Individual anatomy, age, weight changes, sun exposure, facial structure and skin quality all play a part.

This is why our assessment starts with the person in front of us—not an ethnic label or a device menu.

Why we think in more than one layer

A face is not a flat surface. Skin, connective tissue, fat compartments and deeper support structures all contribute to how it looks. Different energy-based technologies interact with tissue in different ways and at different depths. A treatment that addresses one component may not address another.

We sometimes explain this as a multi-layer cake: each layer contributes to the whole, but adding more treatment to one layer does not automatically improve the entire result. The practical lesson is not that everyone needs several devices. It is that treatment should be selected according to the concern, the anatomy and the patient’s suitability.

Research on combining energy-based treatments is still limited. Small studies have reported changes after combined radiofrequency and focused-ultrasound treatments, but they do not establish that every combination is better than one well-chosen treatment. In one 22-person split-face study, adding radiofrequency to focused ultrasound improved some skin measurements but did not produce greater facial lifting than focused ultrasound alone. [5]

We therefore treat a multi-step approach as a considered clinical strategy—not a guarantee of a superior result.

The SW1 XERF Lift Protocol

At SW1 Clinic, XERF Lift is designed as a protocol rather than a device name on its own. For suitable patients, our sequence is:

1. A doctor-led assessment and treatment plan. We consider the patient’s facial structure, areas of concern, medical history and suitability before recommending treatment.
2. A comprehensive XERF treatment. XERF is a radiofrequency platform that uses two frequencies, 6.78 MHz and 2 MHz. Published clinical evidence is still early, with small studies and limited follow-up; the exact response varies between patients. [6]
3. LDM Triple ultrasound immediately after XERF. We include this as a complementary step in our SW1 protocol. The available research on LDM and the evidence for this exact immediate XERF-plus-LDM sequence are limited. We do not present it as proven to add a specific amount of lift; it reflects our clinical approach and experience.
4. A skin-illuminating mask to finish. This is a finishing step for surface comfort and hydration. We do not claim that a mask stimulates collagen or creates a lifting effect.

The order matters to us because it makes the treatment intentional: assess first, treat the relevant concerns, then finish with appropriate skin care. The protocol is not simply “more steps”. Each step has a defined place, and not every patient will be suitable for every component.

A protocol should still be personal

The best treatment plan is not the one with the most impressive list of technologies. It is the one that matches the patient’s anatomy, priorities and tolerance for treatment. Some patients may benefit from XERF as part of a broader plan; others may need a different approach, or no energy-based treatment at all.

At SW1, we use the XERF Lift Protocol to bring a more considered, multi-step approach to selected patients concerned about facial contour and skin firmness. Our first step is always a doctor’s assessment and a conversation about what treatment can—and cannot—reasonably do.

If you would like to understand how XERF compares with other radiofrequency devices, we have written separately about Thermage, Sylfirm X, Morpheus8 and XERF.

Results may vary. Treatment is subject to the doctor’s assessment.

References

1. Nellis JC, Ishii M, Bater K, et al. “Association of Face-lift Surgery With Social Perception, Age, Attractiveness, Health, and Success.” JAMA Facial Plastic Surgery. 2017. pubmed.ncbi.nlm.nih.gov/28301645
2. Langlois JH, Ritter JM, Roggman LA, Vaughn LS. “Infant Preferences for Attractive Faces: Rudiments of a Stereotype?” Developmental Psychology. 1987. doi.org/10.1037/0012-1649.23.3.363
3. Tsukahara K, Sugata K, Osanai O, et al. “Comparison of age-related changes in wrinkling and sagging of the skin in Caucasian females and in Japanese females.” International Journal of Cosmetic Science. 2004. pubmed.ncbi.nlm.nih.gov/15386027
4. Vierkötter A, et al. “Extrinsic skin ageing in German, Chinese and Japanese women manifests differently in all three groups depending on ethnic background, age and anatomical site.” 2016. pubmed.ncbi.nlm.nih.gov/27289339
5. Byun JW, Kang YR, Park S, Hong W. “Efficacy of radiofrequency combined with single-dot ultrasound for skin rejuvenation: A non-randomized split-face trial with blinded response evaluation.” Skin Research and Technology. 2023;29(9):e13452. pubmed.ncbi.nlm.nih.gov/37753689
6. “Clinical Outcomes Following Dual-Frequency Noninvasive Monopolar Radiofrequency Treatment for Facial Laxity and Lower Face Lifting: A Prospective Multicenter Study.” Prospective multicentre study of 39 subjects. 2026. pmc.ncbi.nlm.nih.gov/articles/PMC13040610