ReviewAesthetic plastic surgery2026
Demystifying Pain During Microfocused Ultrasound: A Narrative Analysis of Facial Layer Sensitivity and Its Possible Correlation with Treatment Efficacy.
Review in Aesthetic plastic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
2 authors.
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Abstract
backgroundMicrofocused ultrasound (MFU) is a noninvasive technology for facial tightening that induces neocollagenesis through focal thermal coagulation. Although generally safe, pain during MFU remains a major limitation, with intensity varying by facial region and treatment depth. This variability may reflect intrinsic differences in neural density across facial layers.
objectivesTo analyze the anatomical and physiological basis of facial sensitivity and explore whether pain intensity during MFU could indicate accurate energy delivery to the subdermis or SMAS, which are histologically and functionally more innervated.
methodsA narrative review was conducted using PubMed, Scopus, and Web of Science databases (2009-2025). Keywords included facial innervation, cutaneous nociception, subcutaneous adipose tissue sensory innervation, SMAS anatomy, microfocused ultrasound, and pain perception. Eligible articles described facial anatomy, sensory physiology, or pain during MFU procedures.
resultsFacial layers show distinct sensory profiles: The skin, SMAS, and periosteum are densely innervated, while subcutaneous fat contains few nociceptive fibers. Energy delivered to the subdermis or SMAS produces higher pain scores than treatment restricted to adipose tissue. Visualization-guided MFU (MFU-V) enhances targeting precision and is associated with increased discomfort, likely reflecting more accurate energy deposition.
conclusionPain during MFU mirrors the neuroanatomical distribution of sensory fibers. The coincidence between highly innervated planes and optimal clinical outcomes suggests that moderate discomfort may represent a physiological marker of treatment accuracy rather than merely an adverse effect. Further clinical and histological studies are needed to validate pain as a surrogate indicator of effective energy delivery. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.