Microfocused Ultrasound With Visualization for Body Indications: A Global Expert Consensus on Best Practices for Treatment of the Abdomen and Arms

Abstract

Background: Microfocused ultrasound with visualization (MFU-V) is well established for noninvasive lifting of the face, neck, and décolleté. U.S. FDA clearance was recently granted for treatment of the abdomen and upper arms, supported by favorable safety data and emerging evidence of efficacy of its use to address skin and soft tissue laxity in body regions. Guidance on best practices for these additional indications is desirable.

Aims: This consensus aims to provide evidence-based and practice-informed recommendations supporting safe, effective, and reproducible MFU-V treatments for the additional body indications.

Methods: An international, multidisciplinary panel of aesthetic experts developed consensus recommendations for MFU-V treatment of additional body areas based on clinical evidence, expert experience, and structured virtual discussions.

Results: This global expert consensus affirms MFU-V as a safe and effective noninvasive modality for treating mild to moderate skin and soft tissue laxity in the abdomen and upper arms. Three key domains were identified as critical to optimizing outcomes: patient selection, treatment planning, and expectation management. Ideal candidates are those with mild to moderate laxity and target tissues located at treatable depths. Real-time ultrasound imaging was emphasized for accurate targeting, anatomical safety, and treatment precision. The panel developed practical treatment protocols for the abdomen and upper arms, including recommended treatment zones, line densities, and transducer depths tailored to tissue characteristics.

Conclusion: Safe and effective MFU-V outcomes rely on real-time ultrasound visualization, thoughtful patient selection, expectation management, and anatomically guided treatment. Continued research is needed to refine protocols and guide emerging body applications.

Keywords: MFU‐V; body contouring; consensus; energy‐based device; real‐time visualization; real‐world evidence; skin laxity.

FIGURE 1

Treatment maps for the (A) lower abdomen and (B) the peri‐umbilicus region. Treatment zones are delineated using 2 × 4 cm columns, corresponding to the Ultherapy PRIME transducer. Multi‐depth treatment is recommended for both regions, with transducer selection guided by real‐time ultrasound visualization. Both the lower abdomen (A), defined as the area bounded by the umbilicus, hip bones, and pubic area, and the peri‐umbilical region (B), encompassing the area immediately surrounding the umbilicus, are commonly treated using a 12‐column grid. The 4.5 and 3.0 mm transducers are recommended for treating the superficial fascia and retinaculum cutis, respectively. If supported by ultrasound visualization findings and clinical judgment, the 1.5 mm transducer may additionally be used to target the deep dermis in cases of superficial laxity or crepiness, particularly in the peri‐umbilical area. A median of 30 lines is delivered per column per transducer. The umbilicus itself is designated as a no‐treatment zone.

FIGURE 2

Treatment map for the (A) anterior and (B) posterior upper arm. Treatment zones are delineated using 2 × 4 cm columns, corresponding to the Ultherapy PRIME transducer. Treatment is targeted to the middle third of the upper arm, avoiding the proximal and distal thirds (i.e., closer to the shoulder and elbow), and depth targeting should be guided by real‐time ultrasound visualization. The anterior region (A), defined as the front‐facing portion of the upper arm when the arm is raised to shoulder height, the elbow is bent at a 90‐degree angle, and the palm is facing forward, is typically treated using 1.5 and 3.0 mm transducers, with 4.5 mm used selectively based on sufficient depth. The posterior region (B), defined as the back of the upper arm when the arm is relaxed and positioned alongside the body, is treated using 3.0 and 4.5 mm transducers, with occasional use of 1.5 mm for superficial crepiness. Each region is treated using a six‐column grid per arm, with a median of 20 lines delivered per column per transducer.