Precision Skin Tightening: Understanding XERF with Dr. Jacquiline Hakim

Send us Fan Mail

Double board-certified dermatologist and cosmetic specialist, Dr. Jacquiline Hakim, joins Skin Anarchy to explain what actually drives facial aging: bone loss, collagen decline, and the science of radiofrequency skin tightening, including why results take time and who to trust.

Who is Dr. Jacquiline Hakim?

A double board certified dermatologist and cosmetic specialist who leads Divina Dermatology in Beverly Hills. She frames aesthetics as a medical discipline first, not a trend. "It's still medicine. And I think that's such an important factor to hone in on," a lens that shapes her whole approach.

Where does facial aging actually start?

Deeper than the skin, at the bone. Aging happens across multiple tissue planes, with bone loss, the scaffolding, beginning in the 30s, followed by fat pads, connective tissue, and finally skin. "Aging starts all the way down to the bone." Collagen declines about 1 percent a year from the mid 20s.

Why does your face change so suddenly in your 40s?

Because of a sharp estrogen drop in perimenopause. Estrogen receptors in the skin help maintain collagen, so when estrogen falls, collagen does too, sometimes overnight. "I woke up one day and all of a sudden I saw this, and it can be that drastic," Hakim says, noting women can lose 30 to 40 percent of their collagen in this phase.

How does radiofrequency work for the skin?

By using heat and your own tissue to trigger repair. Radiofrequency delivers controlled heat that the tissue resists, setting off a collagen and elastin cascade plus some contraction for tightening. "You're creating a cascade that stimulates collagen and elastin," and modern devices heat precise layers rather than bulk heating the whole area.

Is radiofrequency safe for skin of color?

Yes, in trained hands and with modern cooling. The risk with melanin is post inflammatory hyperpigmentation if the wrong layer is overheated, but newer devices cool the surface as they work. "We say it's even like a colorblind treatment. It's safe for everyone," she says, crediting built in cooling for the leap in safety.

What is XERF and what can you expect from it?

A monopolar radiofrequency tightening device Hakim was among the first in the US to offer. It reaches multiple tissue depths at once and cools the skin with every pulse, making it safer and comfortable enough that patients fall asleep. "It's one of the safest that's currently on the market... doing multiple depths at the same time.

How long until you see results from skin tightening?

About two months, after an early preview. Any collagen stimulation, from energy or injectables, takes roughly two months to fully show. "It takes a true two months to see your actual endpoint," Hakim says, describing a honeymoon glow that fades before real results build. She starts most patients with two sessions.

Why do the neck and hands age faster, and how should you treat them

Because they have far fewer oil glands than the face, and people neglect them. Signs of aging often appear first on the neck and hands, yet most routines stop at the jaw. "Everything you do for your face you can do for your neck," she advises, extending skincare, sun protection, and treatments to both.

When should you start aesthetic treatments, and who should you trust?

Around the mid 20s, when collagen loss begins, and only with a qualified expert. Hakim stresses that good work is invisible and that dermatologists train for years specifically in noninvasive aesthetics. "You have to really have someone that you can trust that's going to be honest with you," including telling patients no when