It does use a 120MM fan. It would be nearly impossible to make it any quieter. In fact, adding a more powerful high CFM fan to it would probably make it more effective. As for efficient, this cooler is not geared towards overclocking, especially with a Quad core. This cooler is perfect for the people wanting to run stock or slightly overclocked in near silence.
Intel E6300/Nouctua NH-9U w/dual 92mm Panaflos
XFX 680i LT
Patriot PC2-6400 2X2GB LL
2 X BFG 8800GTX in SLI
Enermax Revolution 620W PSU
ASUS 24X DVD/Seagate 250GB SATA 2/THermaltake A90/Windows 7 Ultimate 64