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

Tissue Targeting

Participants indicated that they often target the subcutaneous fat layer, particularly if they are trying to achieve a sculpting effect. For example, if a patient has prominent jowls, targeting the fat may reduce the volume slightly, thus improving the overall appearance of the lift. Another anecdotal observation was that MFU-V may also help to thicken the fibrous septae in the fat layer, contributing to the lifting effects. Moreover, there are small connective tissue fibers connecting the skin to the superficial fascia (SMAS/platysma), therefore energy delivered superficial to the fascia could potentially induce lifting and tightening.Subcutaneous fat may also be targeted if a patient has a particularly deep SMAS secondary to high BMI. If the fat layer is targeted during the initial treatment, it may thin the fat layer making the deep SMAS accessible to the 4.5 mm transducer during a follow-up treatment. One participant noted that most of their patients who request MFU-V require improvement primarily in the jawline and neck areas. Therefore, they concentrate delivery of lines in this area, noting “lines of energy are a precious commodity, so I focus it where it is needed most,” typically delivering 1000 lines to this area (omitting the brow/ upper face areas) with excellent outcomes.Regarding the question of whether the fascia is the best target for treatment, or perhaps that the contributions of more superficial layers of the skin are underappreciated, it was agreed that the relative contribution of skin tightening, and fascia tightening may vary according to certain patient factors and merits further investigation.

Positioning MFU-V in Clinical Practice

One participant almost never discusses the lifting ability of MFU-V, preferring to approach discussions from the biostimulationperspective, ie, stimulating collagen formation. MFU-V is used as monotherapy in only 5-10% of patients and that proportion is declining. Most patients are receiving MFU-V as an adjunct to toxins, fillers, or laser treatments. MFU-V can also be positionedas a valuable method for maintaining results of face lifts. The most satisfied patients are those with little overall cost barrier who can invest in a comprehensive treatment plan with multiple modalities. All agreed that the provider needs to educate their patients to the best of their ability, and if patients are looking for something dramatic, they should provide other options.


Supported by a large body of clinical literature, a well-characterized mechanism of action, and high reported patient satisfaction,MFU-V is considered by the expert panel of physicians to be a key foundation for aesthetic treatment and the gold standard for nonsurgical lifting and skin tightening. The consensus guidelines presented here extend the available clinical data to provide a framework for physicians to fully customize their approach to treating patients with MFU-V, leading to excellent outcomes that are integral to a patient’s overall aesthetic treatment plan. These guidelines are summarized in Table 2.


All authors are consultants for Merz North America.


The authors would like to acknowledge the case studies that Dr. Gabriela Casabona presented during the panel discussion andthe valuable content that she provided. The authors acknowledge the editorial assistance of Dr. Carl S. Hornfeldt, Apothekon, Inc., with financial support from Merz North America, Inc. This activity was sponsored by Merz North America, Inc., Raleigh, NC.


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Sabrina G. Fabi MD SFabi@gbkderm.com