Prior energy treatments alter facial tissues and complicate future deep-layer facelifts

A study reveals how microfocused ultrasound and radiofrequency microneedling alter deep tissue planes.

Energy-based tightening treatments like Ultherapy and radiofrequency microneedling leave cumulative, sub-clinical tissue alterations that can complicate subsequent deep-layer facelift and necklift surgeries, which means our non-surgical protocols are reshaping the surgical landscape and requiring more detailed long-term patient counseling. In a paper published online March 11, 2026, ahead of the July 2026 issue of the *Aesthetic Surgery Journal*, authors Tara M. Chadab, MD, MS, Aaron L. Wiegmann, MD, MS, and Rod J. Rohrich, MD, outline how these devices change deep anatomy. Microfocused ultrasound targets tissue depths up to 5 mm, while some parallel beam ultrasound systems reach depths of 8 mm. These devices deliver temperatures greater than 60°C to create small thermal coagulation points of less than 1 mm³.

While highly effective for non-surgical tightening, these thermal injuries can cause persistent tissue stiffness, tethering, and localized volume loss. Facelift surgeons are increasingly encountering these physical alterations during surgical dissection, which can make plane separation more difficult and unpredictable.

As a growing percentage of patients presenting for surgical rejuvenation have a history of prior energy-based treatments, understanding these device-specific changes is crucial for our practices. Rather than discouraging these popular treatments, we should use this data to refine our patient intake, meticulously document the depths and energy levels used during ultrasound and microneedling sessions, and advise patients that these cumulative treatments may influence the planning and dissection of any future surgical deep-plane lifts.

Source: Aesthetic Surgery Journal, https://doi.org/10.1093/asj/sjag057