Optimizing Patient Outcomes by Customizing Treatment With Microfocused Ultrasound With Visualization: Gold Standard Consensus Guidelines from an Expert Panel

May 2019 | Volume 18 | Issue 5 | Original Article | 426 | Copyright © May 2019

Sabrina G. Fabi MD,a John Joseph MD,b Julia Sevi MD,c Jeremy B. Green MD,d Jennifer Deaver Peterson MDe

aGoldman Fitzpatrick Butterwick Groff & Fabi, San Diego, CA bClinical Testing Center of Beverly Hills, Beverly Hills, CA cAesthetic Health, Leeds, UK dSkin Associates of South Florida, Coral Gables, FL eThe Pearl Dermatology, Houston, TX

Background: Microfocused ultrasound with visualization (MFU-V) has emerged as a safe and reliable means for lifting and tightening lax skin. Although patients may present with similar age-related changes in the skin and connective tissue, MFU-V treatment must be customized for each patient. Objective: The following guidelines were prepared to provide a framework for clinicians to develop a customized treatment plan based on the proper use of ultrasound imaging and key patient characteristics to achieve good clinical outcomes with MFU-V. Methods and Materials: A panel of five expert aesthetic physicians convened to discuss recommendations on the use of MFU-V. Topics included patient factors contributing to favorable outcomes; customizing the number of treatment lines, energy settings, and treatment depths; approaches for restorative vs preventative vs maintenance treatments; and important safety considerations. Results: Ultrasound imaging is important for selecting transducers and treatment depth and planning the number of treatment lines at each depth. Ideal outcomes are associated with higher density treatments. Treatment intervals are tailored to age, with older patients requiring more frequent treatments to maintain results. MFU-V can be applied for both preventative and restorative treatments. Managing patient expectations is essential. Conclusion: Supported by a large body of clinical evidence, a well-characterized mechanism of action, and high patient satisfaction, MFU-V is considered by the expert panel of physicians to be a key foundation of aesthetic treatment and the gold standard for nonsurgical lifting and skin tightening.

J Drugs Dermatol. 2019;18(5):426-432.


The ability of microfocused ultrasound (MFU) to create discrete thermal injury zones within the facial superficial musculoaponeurotic system (SMAS) and denature collagen to induce shrinkage and tissue tightening was demonstrated more than 10 years ago.1 Since that time, numerous clinical studies have confirmed the safety and effectiveness of this technology.2 Coupled with ultrasound visualization, microfocused ultrasound with visualization (MFU-V; Ultherapy® System; Merz North America, Inc., Raleigh, NC) has emerged as a safe and reliable means for tightening and lifting lax skin.3 MFU-V is currently approved for the lifting and tightening the skin of the brow, lower face, and submentum, and improving lines and wrinkles of the décolleté. MFU-V has also demonstrated beneficial effects when used together with other aesthetic treatments.4-7

Mechanism Of Action

The SMAS is an extracellular matrix consisting of collagen and elastin fibers8,9 closely associated with specific facial muscles including the platysma, orbicularis oculi, occipitofrontalis, zygomatici, and levator labii superioris.10 Since normal aging is associated with a 5% decrease in skin collagen with each passing decade,11 decreased collagen content in the dermis and SMAS may lead to undesirable skin sagging, wrinkles, and folds.12,13MFU-V is capable of heating tissue to >60°C, producing small (14 The delivery of MFU-V to targeted areas in the SMAS and platysma