In this step, it is important to ensure patient comfort, that the treatment goes as planned, and that the patient is satisfied. Photography is important to demonstrate that MFU-V was effective with realistic results.50 It also serves as a quality control tool. Currently available 3D cameras that standardize light exposure and facial position can be used for the face, neck, and chest.
Pain control is an important part of the experience. In some publications, patients evaluated the procedure poorly despite good aesthetic improvements because of the treatment-related pain.24,42,51 There are different protocols described for pain control, and very few publications on what is most commonly used (Table 3).39,42,51 Although not mentioned in most publications, in the authors' opinion, after using the device for 7 years, the most efficient and easy methods of pain control are a topical paste containing lidocaine and tetracaine 7%/7% (Pliaglis®, Galderma Laboratories) applied 40 minutes prior to the procedure, oral ketorolac 10mg applied 10 minutes prior to the procedure, and good conversation and energy adjustment during the procedure.
An important safety factor during treatment with MFU-V is to be sure the gel coat being used is not too thick, thus interfering with ultrasound penetration that could possibly cause a burn injury.52 The distribution of the lines needs to be correct. A certain amount of overlap is acceptable, but stacking treatment lines is not acceptable because it could also cause burns.52 Before every pulse, be sure the transducer is targeting the right layer to guarantee not only efficacy but also safety, and to avoid adverse events such as nerve damage.52,53
Finally, it is important to contact the patient for further evalution in 3, 6, and 12 months. Published data show that due to lack of estrogen, especially in some older patients, treatment response can be slow, and it is important to be in close contact with the patient to manage expectations and results.20,24
2. Haar GT, Coussios C. High intensity focused ultrasound: physical principles and devices. Int J Hyperthermia. 2007;23:89-104.
3. Izadifar Z, Babyn P, Chapman D. Mechanical and biological effects of ultrasound: a review of present knowledge. Ultrasound Med Biol. 2017;43:1085-1104.
4. Suh DH, Shin MK, Lee JS, et al. Intense focused ultrasound tightening in Asian skin: clinical and pathologic results. Dermatol Surg. 2011;37:1595–602.
5. White WM, Makin IR, Slayton MH, et al. Selective transcutaneous delivery of energy to porcine soft tissues using intense ultrasound. Lasers Surg Med. 2008;40:67–75.
6. White WM, Makin IR, Barthe PG, et al. Selective creation of thermal injury