Evidence-Based Management Recommendations for Microfocused Ultrasound With Visualization (MFU-V) Complications

BACKGROUNDMicrofocused ultrasound with visualization (MFU-V) is a widely used noninvasive modality for skin tightening and lifting. Despite its favorable safety profile, transient and occasionally severe complications necessitate evidence-based management protocols, which remain underdeveloped in current literature.

OBJECTIVEThis narrative review synthesizes existing evidence to develop stepwise recommendations for managing MFU-V-related complications, emphasizing rapid recognition, severity stratification, and targeted interventions.

METHODSFollowing PRISMA guidelines, a systematic search of PubMed and Scopus (January 2015–April 2025) was conducted. A reproducible search strategy was employed. A total of 133 articles were identified, and after screening, 26 studies met the inclusion criteria. Data extraction focused on complication types, anatomical variations, and management strategies. A risk-of-bias assessment was performed using the Joanna Briggs Institute (JBI) checklist.

RESULTSAdverse events were predominantly mild and transient, including erythema (48-h resolution), edema (8-day resolution), and bruising (20-day resolution). Facial and neck regions exhibited higher rates of self-limiting urticarial reactions and dysesthesia, while nonfacial areas (abdomen, knees) reported rare cases of scarring or burns linked to technical errors. Severe complications, such as motor neuropraxia (4–6-week resolution) and postinflammatory dyspigmentation (Fitzpatrick IV–VI skin types), were infrequent but clinically significant. Key risk factors included improper transducer coupling, operator ergonomics, and pulse stacking. It is also critical to have correct training in visualization.

RECOMMENDATIONS FORMULATIONA severity-based management framework was formulated, integrating multidisciplinary consensus and retrospective clinical case analysis. For mild complications (e.g., erythema), topical steroids and sun protection were prioritized. Moderate–severe events (e.g., neuropraxia) required physical therapy, steroids, or adjunctive procedures. Preventive strategies emphasized standardized approaches, real-time ultrasound imaging, and adherence to “no-go zones” near critical nerves.

CONCLUSIONWe present stepwise recommendations intended to support the management of MFU-V complications at the point of care. The framework draws on published evidence and on retrospective cases reviewed by the author group and is offered as a working reference that can be refined as further prospective data become available.

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