Microfocused Ultrasound With Visualization: A Systematic Review of Adverse Events and Risk of Subsequent Facelift Compromise

BACKGROUND Plastic surgery colleagues have expressed unconfirmed concerns regarding the deleterious implications of noninvasive energy-based therapies for skin laxity, such as microfocused ultrasound with visualization (MFU-V), on preexisting facial fat or subsequent surgical facelifts. OBJECTIVE The authors conducted a systematic review to summarize treatment-related adverse events (TRAEs) following MFU-V and elucidate their impact on future rhytidectomies. MATERIALS AND METHODS The authors performed a PubMed/MEDLINE search using the keywords “MFU-V,” “fat loss,” “adverse events,” “facelift,” and their derivatives. In addition, the authors searched the manufacturer and user facility device experience (MAUDE) database using the brand name “Ulthera.” RESULTS Nineteen articles with data on 506 patients were identified. Transient edema, erythema, and postprocedural pain were observed most often. Instances of significant TRAEs were limited in the scientific literature, apart from 1 case of subcutaneous atrophy. Data from 106 records were extracted from the MAUDE database. Notably, lipoatrophy, neurologic sequelae (including nerve damage, focal numbness, dysesthesia, and ptosis), and scarring were reported with the most frequency. There was 1 report of facelift compromise. CONCLUSION While the scientific literature lacks supporting evidence regarding the impact of MFU-V on subsequent facelift procedures, anecdotal, largely unverified reports exist. Hence, peer-reviewed literature detailing such occurrences would be valuable in understanding the potential ensuing risks.