Facial Skin Tightening With Microfocused Ultrasound and Dermal Fillers: Considerations for Patient Selection and Outcomes

November 2019 | Volume 18 | Issue 11 | Original Article | 1075 | Copyright © November 2019

Gabriela Casabona MD and Kai Kaye PhD

Ocean Clinic, Marbella, Spain 

Also, it is very important in this step to plan if the procedure(s) will be done the same day. Carruthers et al published a consensus on the combination of MFU-V and other procedures with experts recommendations regarding best timing.46 According to this consensus, it is best to treat in single procedures separated by 15 days to allow recovery from possible adverse effects; however, patients may prefer to have several treatments on the same day. Devices such as MFU-V should be used first, followed by injectables such as fillers, biostimulators, and toxins, followed by superficial treatments such as peels, microneedling, and creams.46,47,48 One recent publication by Yutskoskaya (2019) showed that combining MFU-V and CaHa on the same day is superior to other timings for combination treatment.49

5. Treat
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


The aim of this article was to give an updated overview of the history and changes of this procedure as seen through an experienced physician’s eye. Through this review, it has become clear that in last 7 years since use of the first MFU-V device was approved, the treatment assessment and protocols have changed. However, some retrospective studies make it very clear that patient satisfaction is related not only to the result itself but also to the whole experience of physician-patient interaction, especially regarding expectations, pain, and follow- up.


Gabriela Casabona MD is a consultant for Merz Global. Kai Kaye PhD does not have any conflicts.


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