Microfocused ultrasound with visualization (MFU-V) is an advanced, noninvasive cosmetic procedure widely performed for skin lifting and tightening. We performed a systematic review and meta-analysis to evaluate the aesthetic effectiveness, patient satisfaction, skin quality, and safety profile of MFU-V treatment. A comprehensive search of 5 bibliographic databases up to 2023 was conducted. Pooled effect estimates with random effects models and corresponding 95% confidence intervals were calculated. Out of 4019 references, 42 studies were included. Meta-analysis showed 89% of patients (95% CI: 81%-94%
I2: 63%, n = 411) demonstrated some degree of global aesthetic improvement, as assessed by investigators. Similarly, 84% of patients (95% CI: 73%-91%
I2: 64%, n = 312) reported improvement following treatment. Satisfaction of any level was reported by 84% of patients (95% CI: 61%-94%
I²: 52%, n = 326), and 62% (95% CI: 37%-82%
I²: 3%, n = 172) when "neutral" as a response option was provided for patients. Skin quality (eg, wrinkles, texture) also improved. Patients reported a pooled mean pain score of 4.85 (95% CI: 4.35, 5.35
I2: 97%, n = 785), indicating moderate pain. Common adverse events included erythema, edema, swelling, bruising, and tenderness, all of which were generally mild to moderate in severity. Overall, our analysis demonstrated a notable increase in global aesthetic improvement and patient satisfaction following MFU-V treatment, accompanied by moderate pain and a generally favorable safety profile. However, the potential misclassification of neutral responses as positive may result in an overestimation of the treatment's efficacy. These findings highlight the need for well-designed trials to further explore MFU-V's clinical applications.