Microfocused ultrasound: brows rose 0.47–1.7 mm, and 42% of patients said they saw a change

The 2023 systematic review screened 693 studies and kept 16. The inclusion criteria took randomised trials, controlled trials, cohorts — and case series of 10 or more.

The objectively measured values: brow lift 0.47–1.7 mm, and a 26–45 mm² reduction in submental area on lateral photographs.

It matters to look at those numbers as they are. A millimetre or so is a real change, but it is not the size that advertising photographs imply. This is the honest scale of the procedure.

The limits are equally clear. Some of the 16 are uncontrolled case series, every included study was in women only, and device settings and energies varied between studies. The authors noted that results decline with greater laxity and with a BMI above 30.

The same review pooled two satisfaction scores separately.

Physician-rated (IGAIS, n = 337): 92% were classed as improved at day 90.

Patient-rated (SGAIS, n = 81): 42% at day 90, rising to 53% at day 360. The authors described the improvements as mild.

The same people, the same time point, and the scores split 92% against 42%. That does not mean one side is wrong. It means what you choose to measure can more than double the apparent size of the same procedure. This is exactly why this site shows the endpoint next to the evidence grade.

The same problem as on the radiofrequency page. Every randomised trial we read used either a different setting of the same device or a different device as its control. None compared against doing nothing.

The 16 studies in the systematic review also include uncontrolled case series. A change measured against baseline cannot be separated from time, lighting, posture, or knowing you were treated.

The review's authors wrote that future work should focus on objective outcome measures — which is another way of saying that the evidence so far leans heavily on subjective assessment.

The 2021 trial randomised 30 people with upper-arm laxity to a single depth on one arm and two depths on the other. The 2020 trial used the same structure on the abdomen in 30 people, of whom 28 finished.

In both, single-plane and dual-plane came out the same. Arm circumference fell modestly on both sides.

Look at the design again: both sides were treated. So the question these trials answered is 'are two depths better than one', not 'does microfocused ultrasound work'.

One detail in the abdominal trial stands out. Participants who had given birth scored significantly higher on both physician and patient ratings, and their waist reduction was significant too. The sample is too small to settle anything, but it is a signal that who is treated moves the result a great deal.