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Clinical applications of microfocused ultrasound with visualization in dermatology: A comprehensive review
, Milan Muhammed2, Farhanah Fathima1, Murshid Mohamed1, Elisha Cheriyan1, Cinderella Cinderella1
*Corresponding author: Prasamsa Preman, Department of Medicine, Tbilisi State Medical University, Tbilisi, Georgia. prashamsapreman15@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Preman P, Latheef S, Muhammed M, Fathima F, Mohamed M, Cheriyan E, et al. Clinical applications of microfocused ultrasound with visualization in dermatology: A comprehensive review. CosmoDerma. 2026;6:6. doi: 10.25259/CSDM_191_2025
Abstract
Microfocused ultrasound with visualization (MFU-V) is a non-invasive treatment that is effective and comes with minimal risk, because of which its demand has increased over time. It has been approved by the Food and Drug Authority for eyebrow, neck, and submental lifting. However, its uses have grown considerably in body contouring, pore reduction, scar remodeling, and novel applications in pigmentary disorders and rosacea. The technology involves the creation of thermal coagulation points (TCPs) in the deep dermis and fibromuscular layers without epidermal disruption, triggering neocollagenesis and elastogenesis. The feature of real-time visualization enhances its safety and provides the opportunity for patient-specific treatment. MFU-V shows a good safety profile; however, it comes with certain setbacks as well, like mild discomfort and pain. MFU-V is a multifaceted and efficacious technology in modern esthetic medicine, yet it requires further research to study its potential applications and minimize its drawbacks. In this narrative review, we have explored the mechanism, elaborating on clinical applications and the safety profile of MFU-V.
Keywords
Applications of microfocused ultrasound with visualization
Focused ultrasound on skin
Microfocused ultrasound with visualization on skin
rejuvenation of skin
INTRODUCTION
Microfocused ultrasound with visualization (MFU-V) has drawn a lot of attention for skin tightening and rejuvenation within the past decade. Collagen denaturation and the development of new tissue are caused by its capacity to produce concentrated and distinct thermal damage zones. In predetermined layers, this process causes neocollagenesis and elastogenesis, resulting in tightening and revitalizing benefits.[1] Because of MFU-V’s proven efficacy and safety, its use in the dermatology sector is still expanding.[2]
By precisely targeting dermal and subcutaneous tissue at particular focal depths, MFU instruments are non-invasive devices that can heat tissue above 60°C and create distinct thermal coagulation points (TCPs) without having an impact on the papillary dermal and epidermal layers that lie on top.[3] Targeting collagen-rich structures, including the superficial musculoaponeurotic system (SMAS) and deep dermis, at depths of 1.5, 3.0, and 4.5 mm, MFU-V sets itself apart from other modalities. This allows it to achieve therapeutic temperatures between 60°C and 70°C, which are ideal for neocollagenesis.[4] However, it is not a fat-treatment technology.[5]
MFU-V’s real-time ultrasound imaging is a crucial distinction that enables clinicians to see layers of skin while treatment is being administered. Through avoidance of sensitive tissues such as bone and arteries and enabling controlled energy delivery to relevant tissue depths, this optimizes safety and effectiveness, enables patient-specific treatment protocols, and improves consistency and confidence in outcomes.
Because of MFU-V reduction of risk for post-inflammatory hyperpigmentation and avoidance of melanin-rich epidermis, it has a high safety profile during clinical trials and professional consensus, including among Fitzpatrick skin types III–VI patients.[4]
However, the disadvantage of this non-invasive technique is that the heat effect produced by MFU-V may result in pain or discomfort during the process. Patients’ discomfort levels vary, and in certain situations, severe agony has required intravenous sedation.[5]
This narrative review examines the mechanisms and structure, clinical application, contraindications, response to treatment, long-term efficacy, and safety of MFU.
MATERIALS AND METHODS
The entire evaluation process consisted of searching keywords such as “MFU-V on skin,” “rejuvenation of skin,” “focused ultrasound on skin,” and “applications of MFU-V” in literature search databases including PubMed and Google Scholar. The formal literature search and screening process for this review commenced on August 15, 2025, and concluded on October 18, 2025. A total of 55 potentially relevant papers from the past 10 years were initially reviewed; 20 full-text articles were selected for inclusion in this synthesis. These included a range of evidence types: Systematic Reviews and Meta-Analyses, Narrative Reviews, and Original Clinical Studies, all primarily focused on MFU-V.
RESULTS
This literature review verifies that MFU-V is a highly effective and versatile non-surgical technology, which has been shown to cause profound neocollagenesis and tissue tightening in Food and Drug Administration (FDA)-approved anatomical areas as well as extended uses such as body contouring and pore control. The system’s real-time visualization modality offers unparalleled safety and accuracy. Although MFU-V has a good safety profile, future research needs to work on the enhancement of treatment regimens for minimizing treatment discomfort and on fully utilizing its potential in novel dermatological conditions.
DISCUSSION
Mechanism of action and regenerative process of MFU-V
The non-invasive nature of MFU-V treatment was demonstrated by Ultherapy, the only FDA-approved procedure that uses the technology to successfully generate various inverted cone-like TCPs at precise depths ranging from superficial to deep dermis without compromising the structure and integrity of the epidermis.[3] Focusing on collagen-rich structures such as the SMAS and deep dermis at depths of 1.5, 3.0, and 4.5 mm, MFU-V sets itself apart from other modalities by reaching therapeutic temperatures between 60°C and 70°C.[4] This process is believed to trigger collagen denaturation, contraction, and subsequent neocollagenesis[6] [Figure 1].
- A comprehensive explanation of the physical mechanism and the subsequent biological response, including three phases of wound healing. SMSA: Superficial musculoaponeurotic system.
MFU-V’s regenerative mechanism starts with the delivery of energy and precise denaturation of the local tissue, initiating the creation of TCP, followed by temporary inflammation, cellular proliferation, and tissue remodeling, eventually increasing mature collagen and elastin. This ultrasound treatment bypasses the skin’s surface to deliver energy directly to the collagen-rich dermal and fibromuscular layers, initiating the intrinsic collagen and elastin regeneration processes.[7] With varying effects depending on the application site, focal depth, energy, vectoring lines, and serial treatment plans, MFU-V has emerged as a repeatable procedure for subdermal lifting and skin tightening of the face.[5]
Utilizing collimated ultrasound visuals in real time, precise MFU waves are delivered, which create vibrations causing a rise in temperatures, inducing collagen fibril denaturation and contraction, starting at approximately 57–58°C. The inflammatory part of the healing process is started by the release of DAMPs from the injured tissue. Cytokines and chemokines are then released, attracting a variety of healing-related cell types, including macrophages.[7]
During the proliferative stage of the healing process, fibroblasts and macrophages produce matrix metalloproteinases, which break down denatured proteins and replace them with granulation tissue made of proteoglycans, fibronectin, and immature collagen. Granulation tissue promotes the deposition of mature tissue by providing a scaffold for the migration and differentiation of the cells involved in the healing process. The last stage of the healing process is maturation, also known as remodeling. Collagen type III is changed into collagen type I, and mature elastin and collagen are produced. Through healing mechanisms, this promotes protein regeneration and extracellular matrix (ECM) rearrangement to mimic an ECM environment associated with youth[7] [Table 1].
| Time point | Histological features |
|---|---|
| Day 0 | Hyalinized collagen, eosinophils |
| Day 14 | Fibroblast infiltration, inflammation |
| Day 90 | Collagen 1 formation, elastin deposition |
Clinical applications and expanding uses of MFU-V
Growing demand for non-surgical cosmetic operations has increased, with an emphasis on quick and low-risk outcomes[3,8] [Figure 2].
- Applications of microfocused ultrasound with visualization. MFU-V: Microfocused ultrasound with visualization.
Core applications: Face, neck, and décolleté
Its applications have expanded beyond its initially approved roles by the United States Food and Drug Administration (FDA) in eyebrow lifting, lifting of lax submental regions, and reduction of décolleté wrinkles.[3,8] The ability to produce TCPs without damaging the epidermis and to promote both elastin renewal and collagen denaturation is the key characteristic employed here.[4,8] MFU-V has demonstrated significant clinical efficiency in improving the laxity of skin across the face, neck, and upper chest.[6] The clinicians using MFU-V can ensure that precise energies are delivered to layers of tissue using its visualization feature to their advantage.[5,7] Various studies have demonstrated a vital increase in elasticity and firmness using MFU-V, along with histological evidence confirming reorganization of fibers and increased dermal collagen post-treatment.[4] Eventually, these under-the-skin changes become evident clinically as smoothened periorbital wrinkles, reduced nasolabial folds, tightening of submental skin, and brow lift.[7]
Body contouring and laxity
The applications of MFU-V extend beyond the face and neck regions to address laxity of skin in the abdomen, arms, buttocks, thighs, and knees. A study by Lin showed significant firmness and abdominal laxity improvement in 21 postpartum women aged between 25 and 40 years. The results were well explained by histological proofs of neocollagenesis and fibrous septae thickening.[9] Such findings highlight the potential role of MFU-V in postpartum body recovery and contouring without the traditional invasive procedures.[10]
Combination and synergistic therapies
For better outcomes, combination therapies are employed. For instance, a study by Juhász et al. demonstrated knee laxity improvement using the MFU-V in conjunction with dilute calcium hydroxylapatite filler.[10] When combined with CaHa, the skin wrinkle depth, roughness, and overall improvement were observed in the anterior thigh and knee laxity.[10] Similarly, when MFU-V is applied within 14 days of hyaluronic acid filler injection, it creates a better rejuvenation outcome and accelerates the HA degradation.[11]
Facial sculpting and pore management
MFU-V has an innovative role in facial sculpting and slimming. Vector-based delivery of energy toward the tragus has shown improvements in the buccinator region and the triangle of Yarbus.[5] This extends the MFU-V utilization from skin tightening to the reshaping of facial features using a non-invasive method. The impact on enlarged facial pores is another crucial application. Research demonstrates that a single MFU-V session significantly reduces pore count, volume, and density, with effects lasting up to 6 months after treatment.[12] Synergistic effects are seen on pore reduction when MFU-V is combined with intradermal incobotulinumtoxin-A, which provides rapid effects to complement MFU-V’s slower, sustained impact.[13,14]
Novel and functional dermatological applications
MFU-V can also be employed in the treatment of pigmentary disorders, yielding even skin tone and improved radiance. In a pilot study, UV-B-induced hyperpigmentation has lightened, and the Melasma Area and Severity Index score showed a reduction after the superficial MFU-V application with minimal adverse events.[14] Furthermore, an effective treatment and durable reduction in erythema scores up to 1 year were observed in erythematotelangiectatic rosacea.[4] Harnchoowong et al. showed the attenuated effect of intradermal botulinum toxin type-A injection (BoNT-A) injection on forehead sweating when used with MFU-V within 14 days of toxin injection.[15] This data emphasizes how crucial treatment scheduling is to avoiding therapeutic interference [Table 2].
| Application area | Outcome |
|---|---|
| Eyebrow Lift | Visible elevation |
| Abdominal laxity | Firmness improvement |
| Knee laxity | Wrinkle reduction |
| Pigmentary disorders | MASI score reduction |
Contraindications
The usage of MFU-V has a comparatively small number of absolute contraindications. These include the presence of active metallic implants, such as pacemakers or defibrillators, in the treatment site, severe or cystic acne that is currently active, and infections and open skin lesions at the target treatment location. Precautions include direct treatment of keloids, permanent dermal fillers, implants, and the presence of substances like smoking that may change or hinder the healing of wounds.[16]
According to specific research, results are positively impacted by reduced body mass index (BMI) values. There were other studies mentioned in Contini et al., which indicated the detrimental impact of a high BMI on treatment outcomes by excluding all patients with a BMI >30 kg/m2.[17] One possible explanation for why a higher BMI has less of a therapeutic impact is that the increased facial volume in these circumstances may result in more skin tension. The skin shrinkage after MFU would then be offset by this increased tension.[17] Another study has also suggested that following a BoNT-A injection, MFU-V treatment should be avoided for at least 14 days.[15]
Outcome and efficacy
MFU MFU-V with real-time visualization is widely used for non-invasive skin lifting because it accurately targets dermal and subcutaneous tissues to create thermal coagulation sites (TCPs).[3] The healing process ends with maturation, also known as remodeling. Type III collagen is changed into type I collagen, and mature elastin and collagen are produced. Localized protein denaturation occurs at the dermal planes when TCPs are created with the targeted application of MFU-V radiation.[7]
The histological evaluation showed time-dependent changes in the TCP area of the skin, with TCP foci being very visible on day 0 along with eosinophil structures and denatured collagen (referred to as hyalinized collagen); after day 14, cell infiltration began to build up at the TCP edges, primarily composed of fibroblasts (referred to as fibroplasia) and a small number of macrophages. On day 14, an unusual number of large cells, T cells, and macrophages were assessed as indicators of inflammation. On day 90, these inflammatory symptoms totally disappeared, and fibroblasts began to gather at the TCPs’ interior and external borders.[3] Collagen density and dermal thickness have been found to significantly increase in studies.[7]
Improvements were observed in criteria such as texture, rhytides, and pores, particularly in the facial and periorbital region, When surface evenness was assessed, improvements were seen in parameters such texture, rhytides, and pores, especially in the facial and periorbital region. Acne scar improvement scale ASIS, ratings from subjects and investigators were in agreement, demonstrating MFU-V’s efficacy for dermal remodeling in acne scarred temples and cheeks.[4]
FDA has approved MFU-V as a non-invasive technique that reduces wrinkles and creases on the upper chest and lifts the eyebrow, submental (under the chin), and neck tissue.[18] MFU-V has a good safety and tolerability profile; the most common side effects are temporary erythema, edema, and pain. Its versatility in esthetic practice is supported by its application across a broad variety of Fitzpatrick skin types and anatomical regions, including the face, neck, submental area, and off-label body areas.[4]
Safety profile, tolerability, and adverse events
The FDA has authorized MFU-V as a safe, effective, and minimally invasive cosmetic therapy. Although moderate bruising, redness, and discomfort were some of the common side effects according to previous studies, no significant adverse effects were observed.[19]
An analysis of 565 patients from 13 studies reported a pain score of 3.8 (2.5–6.1) on average in every location and with every device setting.[6] Treatments in the periorbital and submandibular regions caused more pain and had higher Visual Analog Scale values.[17] Note that the pain was measured following the application of systemic analgesics and/or local anesthetic ointment.[6] Other adverse reactions, such as contact dermatitis, mandibular burns, bruising and stinging, and dysesthesia (numbness or hypersensitivity), were uncommon (2%).[17] In one instance, the incorrect use of the probe resulted in a burn. It is advised that patients should be chosen at the appropriate time, supervised by a trained medical professional, and informed about the duration and anticipated outcomes. A suitable satisfaction assessment must also be implemented.[19]
CONCLUSION
MFU-V has been a non-invasive option for skin lifting, tightening, and rejuvenation over the past decade. It is unique because of the ability to deliver TCPs at controlled depths beneath the skin. Stimulating collagen and elastin production while leaving the surface layers unharmed leads to both structural improvements and clinical results. The use of real-time ultrasound allows practitioners to work more accurately, reduce complications, and customize treatments for each patient. Although best known for facial rejuvenation, its applications now extend to body contouring, scar remodeling, pore reduction, and even support in pigmentary and functional dermatology. When combined with other esthetic treatments, MFU-V often has increased outcomes.
Overall, MFU-V has a safety record across different skin types. The main drawback is treatment discomfort, although research is ongoing to improve pain control. Looking forward, future developments are mostly to focus on refining treatment protocols, managing discomfort, and expanding its work in combination therapies. MFU-V is thus considered the best in modern dermatology, with good results, broad treatment, and lasting patient satisfaction.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
Patient’s consent is not required as there are no patients in this study.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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