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Review
. 2025 Sep;24 Suppl 4(Suppl 4):e70364.
doi: 10.1111/jocd.70364.

Microfocused Ultrasound With Visualization in Skin Quality: A Narrative Review

Tatjana Pavicic  1 , Jeremy B Green  2 , Je-Young Park  3 , Gabriela Casabona  4 , Vasanop Vachiramon  5 , Julieta Spada  6 , Jennifer Levine  7 , Mariana Muniz  8 , John Akers  9 , Alec McCarthy  9 , Matthew J Jackson  9
Affiliations
Review

Microfocused Ultrasound With Visualization in Skin Quality: A Narrative Review

Tatjana Pavicic et al. J Cosmet Dermatol. 2025 Sep.

Abstract

Background: Skin quality is a multidimensional concept encompassing four emergent perceptual categories (EPCs): firmness, surface evenness, tone evenness, and glow. Microfocused Ultrasound with Visualization (MFU-V; Ulthera System) is a non-invasive device FDA-cleared for lifting and tightening of the skin in specific areas. Through the generation of thermal coagulation points at defined depths, MFU-V initiates neocollagenesis and elastin remodeling, which may support improvements in features related to overall skin quality.

Aims: To evaluate clinical and preclinical evidence for the impact of MFU-V across the four EPCs of skin quality, including firmness, surface evenness, tone evenness, and glow.

Patients/methods: A structured narrative review was conducted across PubMed, Google Scholar, and Cochrane databases. Of 703 unique records screened, 67 studies met inclusion criteria. Eligible studies evaluated MFU-V, alone or in combination, reporting outcomes mapped to one or more EPCs of skin quality.

Results: MFU-V demonstrated consistent improvements in firmness (n = 52 studies), including elasticity and tautness, with sustained effects beyond 6 months. Improvements in surface evenness (n = 35) included wrinkle reduction, pore refinement, and scar remodeling. Effects on tone evenness (n = 4) were observed in melasma and erythema models, with good tolerance in Fitzpatrick skin types III-VI. Glow (n = 4) was indirectly supported by improved texture and structure. Combination protocols involving MFU-V and fillers or neuromodulators reported positive outcomes. Adverse events were rare and transient.

Conclusions: MFU-V provides a safe and versatile platform for enhancing multiple aspects of skin quality. Its effects are well supported in firmness and texture, with emerging evidence for tone and glow. The integration of EPC-based outcomes may inform individualized treatment planning and future research.

Keywords: MFU‐V; Ultherapy; emergent perceptual categories; energy‐based devices; microfocused ultrasound with visualization; skin quality.

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Conflict of interest statement

Drs. Akers, Jackson, and McCarthy are employed by Merz Aesthetics, Inc. (Raleigh, NC). Dr. Vachiramon serves as a speaker for Merz Aesthetics, Beiersdorf, and L’Oreal, and as an advisory board member for Beiersdorf, and L’Oreal. Dr. Pavicic is a consultant, investigator, and lecturer for Merz Aesthetics Inc. Dr. Casabona is a consultant for Merz Aesthetics. Dr. Green is a clinical researcher, advisory board member, and speaker for Allergan Aesthetics. Dr. Levine is a consultant and speaker for Allergan and BTL, a consultant and advisor for Galderma and Merz, and a speaker for RVL. Dr. Park serves as a consultant of Merz Aesthetics. Dr. Spada has received personal compensation for consulting, serving on a scientific advisory board, speaking, professional travel/accommodation stipends, or other activities with Merz Pharma. Dr. Muniz is a medical consultant and speaker for Merz Aesthetics. No compensation was given for authorship of this manuscript.

Figures

FIGURE 1
FIGURE 1
MFU‐V transducers targeting various skin layers (SMAS, reticular/papillary dermis) at specific depths (4.5, 3.0, 1.5 mm), demonstrating precise depth‐controlled thermal coagulation. DS, DeepSee. Figure reproduced from: Vachiramon et al. J Cosmet Dermatol. 2025; 24 (2):e16658. Licensed under CC BY 4.0.
FIGURE 2
FIGURE 2
Common aesthetic concern areas of the face and chest.
FIGURE 3
FIGURE 3
Periorbital lines. (A) At baseline 0. (B) At 90. (C) At 180 days. Assessor rated this case as “much improved” at day 90 and “exceptionally improved” at day 180. Figure reproduced from: Lowe, Plast Reconstr Surg Glob Open. 2021; 9:e3662. doi:10.1097/GOX.0000000000003662. Licensed under CC BY‐NC‐ND 4.0.
FIGURE 4
FIGURE 4
Measurement of changes in submental areas. Pretreatment (A) to posttreatment (B) changes are spatially indicated in areas highlighted in green. Figure reproduced from: Corduff and Lowe, Plast Reconstr Glob Open. 2023; 11:e5184. doi:10.1097/GOX.0000000000005184. Licensed under CC BY‐NC‐ND 4.0.
See this image and copyright information in PMC

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