Solutions to age-related changes, such as wrinkling, skin loosening, loss of skin strength and elasticity, are continuously being developed and improved by researchers. While many new technologies have been brought to the market and clinical practice, many still lack guidelines and standards of use for dermatologists to rely on. Micro-focused ultrasound with visualization<> (MFU-V, Ultherapy) is one such relatively novel therapy, which has been deemed a safe and effective treatment for skin laxity. Originally popularized as a minimally invasive skin rejuvenating procedure, its uses are growing quickly as positive results have spurred a growing body of research on potential further indications.
 The efficacy of MFU-V has been demonstrated in numerous clinical studies as well as in daily practice. The therapy itself has been found to be generally well-tolerated; it does not alter the epidermal barrier function or physiology of the skin, yet significantly increases skin elasticity weeks after a single treatment. However, treatment plan and patient demographic recommendations have been unclear to date. In order to provide dermatologists with guidance and ultimately optimize patient outcomes, an expert panel of physicians discussed the guidelines for use of MFU-V, concluding that the therapy is a key foundation for aesthetic treatment and the gold standard for nonsurgical lifting and skin tightening. Â
 Gold Standard Consensus Guidelines
 A panel of 5 expert aesthetic clinicians gathered to discuss standards of MFU-V use and evaluate a host of treatment-related specifications at the 2018 American Academy of Dermatology’s Annual Meeting. Their aim was to provide a framework for clinicians to develop customized treatment plans based on the proper use of ultrasound imaging and key patient characteristics to achieve optimal outcomes. The panel examined patient factors that contribute to poor and favorable outcomes, the customization of treatment, different need-based approaches to treatment, and important safety considerations.Â
Published as consensus guidelines in the Journal of Drugs in Dermatology, their conclusions established MFU-V as the gold standard for nonsurgical lifting as well as skin tightening, and emphasized the importance of treatment customization for achieving optimal patient outcomes.Â
 Optimizing Patient Outcomes with Customized MFU-V Treatment
 Due to its ability to select transducers, accurately determine treatment depth, and plan the number of treatment lines, microfocused ultrasound with visualization allows clinicians to tailor each session to a patient’s specific needs. With the use of this device, dermatologists may customize the number of treatment lines, energy settings, and treatment depths, leading to improved short-term and long-term patient outcomes.Â
 The treatment is effective for lifting tissue, improving skin laxity, and promoting collagen production, according to experts, who agreed that the device’s energy setting should be set at the highest tolerable level to achieve ideal outcomes. Consensus guidelines indicate that MFU-V can be used both as a preventative measure and as a restorative method, however, investigators place a heavy emphasis on the importance of educating patients on the capabilities of the device in order to manage expectations and ensure a positive patient experience.Â
 MFU-V delivery to targeted areas results in immediate contraction of denatured collagen, stimulating collagen remodeling. As such, noticeable changes may be achieved in a relatively short course of treatment, however, further sessions may be necessary for maintenance.Â
The amount of time between treatments should be tailored to age, with older patients requiring more frequent treatments to maintain desired results.Â
 According to the panel, contraindications for treatment include open wounds and/or lesions, severe or cystic acne, active implants, or metallic implants in the targeted area. MFU-V treatment is otherwise considered safe and well-tolerated.
 With numerous clinical trials supporting the safety and efficacy of microfocused ultrasound with visualization, a well-defined mechanism of action, and high levels of patient satisfaction, MFU-V may soon become the preferred method of treatment. Currently, MFU-V is used as an adjunct therapy to fillers and laser treatments in the majority of patients – only 5% to 10% are treated with just MFU-V. It has beneficial effects when used in conjunction with other aesthetic procedures, especially for the improvement of atrophic acne scars, stretch marks, and cellulite. Although, the new consensus guidelines and gold standard designation may prompt increased usage among physicians.
