Aesthetic Efficacy and Safety of Combined Microfocused Ultrasound with Visualization and Calcium Hydroxylapatite Treatment: A Systematic Review of Human Evidence

Although microfocused ultrasound with visualization (MFU-V) and calcium hydroxylapatite- carboxymethylcellulose (CaHA-CMC) have their individual strengths and have demonstrated effectiveness in aesthetic improvement and improving skin laxity, a combined treatment may sometimes be required to achieve comprehensive aesthetic enhancements that meet patients' needs and preferences. This review systematically summarizes the available evidence on combined MFU-V and CaHA-CMC treatment. A comprehensive search was conducted in Embase, MEDLINE ALL (Ovid), Web of Science Core Collection, and Cochrane Central. We included studies conducted in adults that examined the effectiveness, safety, and/or mechanism of action of combined MFU-V and CaHA-CMC treatment. Out of 4019 references, 11 studies, mainly pre-post studies, were included in this analysis. Overall, regardless of the area treated, improvements in global aesthetic scales, skin quality parameters, and patients' satisfaction following combined treatment, accompanied by mild to moderate adverse effects, were found. In addition, histological studies indicated increased neocollagenesis and elastin synthesis posttreatment. Our review highlights promising outcomes from combined MFU-V and CaHA-CMC treatment. Nevertheless, due to the limited number of studies, further research is essential to gain a deeper understanding of this combined treatment's efficacy, safety, and applicability.