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Background: The demand for noninvasive aesthetic procedures has surged, positioning microfocused ultrasound and high-intensity focused ultrasound as foundational modalities for tissue lifting and tightening. While early literature established its basic efficacy, the rapid evolution of clinical protocols, novel combinations, and expanded anatomical indications necessitates a re-evaluation of the evidence. Methods: A systematic critical review was conducted to evaluate recent literature between year 2024 and year 2026 within MEDLINE, PubMed, and Ovid databases.. Data extraction focused on study design, primary clinical outcomes, safety profiles, and methodological limitations. Evidence was synthesized chronologically and thematically, with all included studies were rigorously classified according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence (March 2009) to appropriately stratify the current clinical landscape. Results: Fifty-seven studies met the inclusion criteria. Recent evidence robustly supports the efficacy of microfocused ultrasound for mild-to-moderate facial and cervical laxity. Emerging literature highlights successful integration with injectable biostimulators, dermal fillers, and other energy-based devices. Furthermore, expanded indications, including superficial skin quality improvements and body contouring, show promise. The safety profile remains highly favorable, characterized predominantly by transient erythema and localized edema, though rare reports of significant ocular or neurological complications underscore the importance of anatomical precision. Conclusions: Microfocused ultrasound remains a versatile and highly effective noninvasive modality in aesthetic medicine. While optimal outcomes are consistently observed in lower face and neck lifting, future research must prioritize standardized protocols for novel body indications, long-term follow-up for combination therapies, and rigorous anatomical guidelines to mitigate rare adverse events.

Keywords: ultrasonic therapy; cosmetic techniques; skin aging; rejuvenation; face; dermal fillers