Systematic review and meta-analysis - microfocused ultrasound treatment for sagging skin

High-Intensity Microfocused Ultrasound (HIFU) applies the high energy of focused ultrasound (US) to penetrate deeply into skin tissue. Despite significant investments in this technology and positive reports from clinical practitioners, scientific discussions reveal substantial controversy regarding its effects. This study aimed to perform a systematic review with meta-analysis to evaluate the evidence on HIFU's effectiveness in improving skin sagging across short, medium, and long-term outcomes, along with its potential adverse effects. A systematic search was conducted across PubMed, Medline, Embase, CINAHL, and the Cochrane Central Library. Out of One hundred and eighteen articles identified after duplicate removal, 99 studies underwent eligibility evaluation, resulting in the selection of 12 articles, including three randomized and nine non-randomized studies. Two randomized studies qualified for inclusion in the meta-analysis. The review indicates that high-intensity microfocused ultrasound shows promising results in improving skin sagging, with a total of 475 participants evaluated (333 women and 142 men). The meta-analysis of two studies on neck skin sagging improvement showed no significant difference between HIFU and RF groups across short-, medium-, and long-term outcomes (CI: 0.19 [-0.84, 0.45]; -0.5 [-0.65, 0.55]; -0.45 [-0.99, 0.09]). Although HIFU therapy appears beneficial for skin sagging, further high-quality, standardized studies are required to confirm these findings and reduce methodological biases.