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. 2026 Jan 21;8:ojag008. doi: 10.1093/asjof/ojag008

High-Intensity Focused Ultrasound for Facial Rejuvenation and Body Contouring: A Bibliometric Analysis of Efficacy and Safety Studies

Narendra Kumar 1,✉, Guilherme Olavo Olsen de Almeida, Chien Ming Chen, Jean D A Carruthers
PMCID: PMC12926611  PMID: 41737891

Abstract

Bibliometric analysis of published literature helps to characterize scientific productivity, collaboration networks, key research themes, and the life cycle of scientific production and helps in defining the future research agenda. We conducted a systematic search of PubMed, Cochrane, and Scopus for English-language studies involving high-intensity focused ultrasound (HIFU) for facial rejuvenation and body contouring with particular attention to efficacy, safety, and patient-centered outcomes. Bibliometric data were exported to RStudio and analyzed using the bibliometrix package and Biblioshiny. The 27 manuscripts (2007-2025) originated from 11 journals and 144 authors, with a mean of 6.07 coauthors per article and an international collaboration rate of 18.52%, were included in the analysis. The average annual growth rate in publications was 9.35%, and the mean citation count was 21.44 per document. The United States and South Korea dominated both productivity and citations, whereas Brazil, Thailand, Canada, Australia, Turkey, and China contributed smaller but growing outputs. Major themes centered on “subcutaneous fat,” “body contouring,” and “waist circumference,” indicating a strong focus on abdominal and body shaping along with facial rejuvenation. Research on HIFU-based noninvasive body contouring and rejuvenation is still in an early but rapidly expanding stage, driven by a small number of highly collaborative expert centers and concentrated in a few dermatology and aesthetic surgery journals. Although short-term efficacy and safety appear favorable, gaps remain regarding long-term outcomes, standardized treatment parameters, and patient-reported measures.

Level of Evidence: 5 (Therapeutic) Inline graphic

Skin aging involves changes such as wrinkles, laxity, sagging, and the accumulation of subcutaneous fat that alter skin texture and body contour, adversely impacting body image and quality of life.1,2 Consequently, the demand for noninvasive aesthetic procedures for facial and body rejuvenation has notably increased.1,3

In this context, HIFU has emerged as a relevant nonsurgical technology: it is used to tighten skin, reduce sagging, and eliminate localized fat on the face and body.4,5 HIFU stimulates collagen production and induces apoptosis in adipocytes, thus providing an effective alternative to surgery with reduced recovery time.5 HIFU operates by converting mechanical energy into heat at precise focal points within the dermal and subdermal tissue.6-8 At these high-intensity focal points, thermal coagulation occurs, denaturing collagen and initiating a repair response known as neocollagenesis. As a result, tissue remodeling occurs, leading to the formation of new collagen and elastin, which improve skin firmness and smoothness.

There are macro-focal (HI-MFU) and microfocal HIFU (MFU) modalities.5 The microfocused ultrasound with visualization (MFU-V) version incorporates real-time imaging to guide the treatment; this modality was approved by the FDA in 2009 for brow lifting and subsequently expanded to the neck and face. These devices can direct energy to different depths (eg, 1.5, 3, and 4.5 mm) depending on the treatment area (superficial skin, fat, and Superficial Musculoaponeurotic System (SMAS) layer) without damaging the epidermis.5,9

HIFU technology has evolved notably, with the development of multiple devices and the previously mentioned modalities (MFU, MFU-V, and HI-MFU), as well as its study across diverse technological and geographical contexts. To understand this scientific evolution, bibliometric analysis is a key tool, because it allows the identification of leading authors and institutions, mapping knowledge networks, quantifying academic productivity, and detecting emerging trends in scientific literature.10 This bibliometric study aims to comprehensively characterize recent scientific literature on HIFU and its distinct modalities for body and facial rejuvenation.

METHODS

Search Strategy and Data Collection

This study employed a Bibliometric–Systematic Literature Review approach, integrating quantitative bibliometric techniques with the qualitative synthesis characteristic of systematic reviews.11 For the systematic review component, a comprehensive search was performed across 3 electronic databases: PubMed, Cochrane CENTRAL, and Scopus, restricted to English-language publications. Boolean search strategies were tailored to each platform and combined Medical Subject Headings and free-text keywords related to HIFU, facial rejuvenation, and body contouring. The complete syntax is provided in Table 1.

Table 1.

Search Strategies

Database Full search strategies by database
PubMed (“Abdomen” [MeSH Terms] OR “Subcutaneous Fat” [MeSH Terms] OR “Body Composition” [MeSH Terms] OR abdomen [Title/Abstract] OR abdominal [Title/Abstract] OR trunk [Title/Abstract] OR torso [Title/Abstract] OR thigh [Title/Abstract] OR thighs [Title/Abstract] OR flank [Title/Abstract] OR flanks [Title/Abstract] OR buttock [Title/Abstract] OR buttocks [Title/Abstract] OR arm [Title/Abstract] OR arms [Title/Abstract] OR “upper arm” [Title/Abstract] OR “body area” [Title/Abstract] OR “body region” [Title/Abstract]) AND (“Ultrasonic Therapy” [MeSH Terms] OR “High-Intensity Focused Ultrasound Ablation” [MeSH Terms] OR HIFU [Title/Abstract] OR “high intensity focused ultrasound” [Title/Abstract] OR “high-intensity focused ultrasound” [Title/Abstract] OR “focused ultrasound therapy” [Title/Abstract] OR “focused acoustic energy” [Title/Abstract] OR MFU [Title/Abstract] OR “microfocused ultrasound” [Title/Abstract] OR “micro-focused ultrasound” [Title/Abstract] OR MFU-V [Title/Abstract] OR “microfocused ultrasound with visualization” [Title/Abstract]) AND (“Esthetics” [MeSH Terms] OR “Rejuvenation” [MeSH Terms] OR “Skin Aging” [MeSH Terms] OR “Subcutaneous Fat” [MeSH Terms] OR rejuvenation [Title/Abstract] OR “body contouring” [Title/Abstract] OR “body sculpting” [Title/Abstract] OR “body shaping” [Title/Abstract] OR “fat reduction” [Title/Abstract] OR “fat thickness” [Title/Abstract] OR “circumference reduction” [Title/Abstract] OR “skin tightening” [Title/Abstract] OR “skin laxity” [Title/Abstract] OR “adipose reduction” [Title/Abstract]) AND (humans [MeSH Terms]) AND (English [Language])
Cochrane CENTRAL abdomen.ti,ab. OR abdominal.ti,ab. OR trunk.ti,ab. OR torso.ti,ab. OR thigh.ti,ab. OR thighs.ti,ab. OR flank.ti,ab. OR flanks.ti,ab. OR buttock.ti,ab. OR buttocks.ti,ab. OR arm.ti,ab. OR arms.ti,ab. OR “upper arm”.ti,ab.) AND (exp Ultrasonic Therapy/OR exp High-Intensity Focused Ultrasound Ablation/OR HIFU.ti,ab. OR “high intensity focused ultrasound”.ti,ab. OR “high-intensity focused ultrasound”.ti,ab. OR “focused ultrasound therapy”.ti,ab. OR “focused acoustic energy”.ti,ab. OR MFU.ti,ab. OR “microfocused ultrasound”.ti,ab. OR “micro-focused ultrasound”.ti,ab. OR MFU-V.ti,ab.) AND (exp Rejuvenation/OR exp Esthetics/OR exp Skin Aging/OR “body contouring”.ti,ab. OR “body sculpting”.ti,ab. OR “body shaping”.ti,ab. OR “fat reduction”.ti,ab. OR “adipose reduction”.ti,ab. OR “fat thickness”.ti,ab. OR “circumference reduction”.ti,ab. OR “skin tightening”.ti,ab. OR “skin laxity”.ti,ab. OR rejuvenation.ti,ab.)
Scopus TITLE-ABS-KEY (abdomen OR abdominal OR trunk OR torso OR thigh OR thighs OR flank OR flanks OR buttock OR buttocks OR arm OR arms OR “upper arm”) AND TITLE-ABS-KEY (HIFU OR “high intensity focused ultrasound” OR “high-intensity focused ultrasound” OR MFU OR “microfocused ultrasound” OR “micro-focused ultrasound” OR “focused ultrasound therapy” OR “focused acoustic energy”) AND TITLE-ABS-KEY (“body contouring” OR “body sculpting” OR “body shaping” OR “fat reduction” OR “adipose reduction” OR “fat thickness” OR “circumference reduction” OR “skin tightening” OR “skin laxity” OR rejuvenation) AND PUBYEAR > 2014 AND PUBYEAR < 2026 AND (LIMIT-TO (LANGUAGE, “English”))
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HIFU, high-intensity focused ultrasound; MeSH, Medical Subject Headings; MFU-V, microfocal HIFU with visualization.

De-duplication and Study Selection

A total of 172 records were retrieved: 71 from PubMed, 39 from Cochrane CENTRAL, and 62 from Scopus. The remaining records were then transferred to Rayyan, where a second de-duplication step was performed. A total of 118 articles were excluded because they did not meet the inclusion criteria (eg, inadequate study design, interventions unrelated to HIFU, or duplication). Thus, 54 articles proceeded to full-text review, of which 27 studies ultimately met the inclusion criteria and were retained for bibliometric analysis.

Bibliometric Analysis

In parallel, a bibliometric analysis was conducted on the scientific literature related to recent research output on HIFU and its modalities for body and facial rejuvenation. The final dataset was exported in CSV format and processed in R Studio (v4.3.2) using the bibliometrix package and its graphical interface, biblioshiny.12

The bibliometric information was obtained exclusively from Scopus and analyzed through several complementary approaches. Scientific performance metrics were assessed, including annual publication and citation trends, as well as the most productive countries, institutions, and authors. Scientific mapping techniques were applied to construct coauthorship networks at the author, institutional, and country levels, along with reference co-citation and keyword co-occurrence analyses. A thematic analysis was conducted to identify emerging topics and conceptual evolution using clustering methods in R Studio. Additionally, the Life Cycle of Scientific Production was explored through a biblioshiny logistic growth model applied to annual publication data.

RESULTS

A total of 27 documents published between 2007 and 2025 were analyzed, spanning 11 different publication sources.7,13-38 The average annual growth rate in scientific output was 9.35%, indicating a sustained and increasing academic interest in HIFU technologies for aesthetic applications. The documents included contributions from 144 authors, with a mean of 6.07 coauthors per paper. The international collaboration rate was 18.52%, and the average number of citations per document was 21.44. The average age of the publications analyzed was 6.26 years, reflecting a predominance of research conducted in the second half of the time window.

Geographical Distribution

The analysis of a country's scientific production reveals a distinct hierarchy in global contributions. The United States is the leading producer of research in this field, with steady increases in output since 2007 and the highest number of citations (410) (Figure 1). South Korea emerged as the second-most productive country, with a notable acceleration in publication volume beginning around 2016. Other significant contributors include Brazil, Thailand, Australia, and China. Regarding collaboration patterns, the United States and South Korea exhibit the highest levels of both Single Country Publications and Multiple Country Publications, with the United States showing the most significant volume of international collaboration among nations (Figure 2).

Figure 1.

Figure 1.

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Countries’ productivity.

Figure 2.

Figure 2.

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Corresponding author's countries.

Authors

A total of 144 authors contributed to the selected documents. The analysis of the most relevant authors identified Jeffrey S. Dover and Robert A. Weiss (Figure 3) as the top contributors, each with 3 research articles. They are followed by a group of authors, including Bajaj Shirin, Richard A. Baxter, Pamela Chayavichitsilp, Sun-Young Choi, Sue Ellen Cox, and Lisa M. Donofrio, who each contributed 2 research articles.

Figure 3.

Figure 3.

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Authors’ productivity over time.

The network reflects a collaborative research environment, as evidenced by a mean of 6.07 coauthors per paper, with no single author heavily monopolizing the scientific output. The coauthorship rate of 6.07 authors per paper supports the presence of moderately sized research groups, likely involving clinical investigators, technical developers, and imaging or biomedical specialists (Figure 4).

Figure 4.

Figure 4.

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Collaboration network authors.

Sources of Publication

The 27 documents analyzed were published across 11 scientific journals, showing a clear concentration in specialized literature. Dermatologic Surgery was the most relevant source, publishing 8 research papers. This was followed by the Journal of Cosmetic Dermatology, which published 6 research papers. Other sources contributing 2 documents each included Dermatologic Therapy, the Journal of Cosmetic and Laser Therapy, Lasers in Surgery and Medicine, and Plastic and Reconstructive Surgery (Figure 5).

Figure 5.

Figure 5.

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Sources of publication.

Keyword Co-occurrence

The keyword co-occurrence analysis identified 48 unique author keywords. Among the most frequently used were terms such as “high-intensity focused ultrasound,” “body contouring,” “subcutaneous fat,” “waist circumference,” “ultrasound therapy,” “ultrasonic therapy,” “esthetic surgery,” and “skin aging.” These results demonstrate a strong conceptual focus on both facial and abdominal applications of HIFU, including skin tightening and fat reduction. Keywords related to safety and clinical study design, such as “patient safety,” “randomized controlled trial,” and “adverse event,” also featured prominently, indicating a trend toward structured clinical evaluation (Figure 6).

Figure 6.

Figure 6.

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Keyword co-occurrence.

Trending Topics

Temporal analysis of term usage revealed a clear evolution in focus. From 2016 to 2019, dominant terms included “cosmetic techniques,” “body mass,” and “middle-aged,” suggesting early interest in HIFU's body-shaping applications. Between 2020 and 2023, newer terms such as “follow-up,” “cutaneous parameters,” “devices,” and “skin aging” began to appear more frequently. This reflects an increasing emphasis on outcome measurement, technical device specifications, and the application of HIFU in older populations. The appearance of “prospective studies,” “clinical trials,” and “adverse events” indicates a trend toward more rigorous methodological designs in recent years (Figure 7).

Figure 7.

Figure 7.

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Trend topics.

Thematic Analysis

The thematic map identified 4 quadrants of conceptual development. “Motor themes” included clusters such as “subcutaneous fat,” “body contouring,” and “waist circumference,” reflecting the consolidation of HIFU in shaping body silhouette and reducing localized fat. “Basic themes,” such as “human,” “adult,” and “humans,” formed a stable foundation of general clinical interest. “Niche themes” were underrepresented, suggesting that research remains focused on core applications rather than peripheral or exploratory directions. “Emerging or declining themes” included “randomized controlled trial,” “follow-up studies,” and “controlled study,” indicating either recent emergence or inconsistent presence in the literature (Figure 8).

Figure 8.

Figure 8.

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Thematic map.

Factorial Map

The factorial map analysis revealed 3 primary conceptual blocks. The first, a clinical block, centered on terms such as “ultrasound therapy,” “clinical article,” and “ultrasonic therapy,” reflecting foundational evidence and treatment literature. The second was a body-contouring block, encompassing “subcutaneous fat,” “waist circumference,” and “body contouring,” suggesting a distinct thematic focus on fat reduction and noninvasive reshaping. The third, a less densely developed zone, involved “patient satisfaction,” “adverse event,” and “procedures,” suggesting early-stage exploration of patient-reported outcomes and safety monitoring (Figure 9).

Figure 9.

Figure 9.

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Factorial map.

Life-Cycle Analysis

The life-cycle modeling analysis revealed that the scientific production on nonablative ultrasound technologies remains in an early yet rapidly expanding stage, with only 27 publications observed by 2025, equivalent to 10% of the projected saturation level of 270 studies. Although the logistic model demonstrated moderate fit (R2 = 0.134), it identified 2045 as the anticipated peak year of annual output, with an estimated maximum of 5 publications per year, consistent with the highest observed values in 2021 and 2025 (Figure 10). Overall, the model indicates that research on these technologies is in a rapid growth phase and will likely continue to increase steadily before entering a long maturation trajectory extending into the latter half of the century.

Figure 10.

Figure 10.

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(A, B) Life cycle of scientific production plots.

DISCUSSION

This bibliometric review provides a structured overview of the scientific activity and publications. HIFU-based technologies for skin rejuvenation and body contouring from 2007 to 2025, with particular emphasis on clinical outcomes, safety, and patient experience. Overall, the field is small but highly collaborative, shows a clear pattern of early exploratory work followed by consolidation in a few specialist centers, and remains dominated by studies from high-income countries, particularly the United States and South Korea.

Annual scientific production shows a low but progressive increase in publications, with sporadic output before 2012 and clearer growth after 2017. Despite this upward trend, the corpus remains limited to 27 documents over nearly 2 decades, underscoring that HIFU and related nonablative modalities represent a relatively narrow niche within aesthetic dermatology and plastic surgery.

The descriptive indicators reinforce this picture of a small yet active community. A total of 144 authors contributed to the 27 publications, with an average of 6.07 coauthors per paper and only one single-authored article. This points to an intensely collaborative pattern, often involving multidisciplinary teams (dermatologists, plastic surgeons, and industry or device-development partners). International coauthorship, however, is moderate (18.5%), suggesting that collaboration occurs predominantly within national or regional networks rather than through multinational collaboration.

The country-level analysis confirms the United States’ predominance, accounting for the most publications and an overwhelming share of citations (410). South Korea is the second-most influential country by citation count, followed by Brazil, Canada, and Thailand. This geographic imbalance has implications for generalizability; most evidence comes from high-income settings with specific aesthetic standards, device availability, and patient expectations, which may not be directly transferable to other regions.39

Keyword co-occurrence, trend analysis, and the thematic map shed light on how research questions have evolved. Basic and highly central themes such as “human,” “adult,” and “female” indicate that the typical study population comprises adult women undergoing cosmetic procedures, with middle-aged and aged groups frequently represented.3 Motor themes with high centrality and density, particularly “subcutaneous fat,” “body contouring,” and “waist circumference,” confirm that a significant focus of the literature has been abdominal and body shaping rather than exclusively facial rejuvenation. These terms cluster with “body mass” and “cutaneous parameters,” reflecting the quantification of circumferential reduction, fat thickness, and skin characteristics as primary outcomes.27

Implications for Clinical Practice and Research

Taken together, these findings portray a research field that has established the technical feasibility and short-term efficacy of nonablative ultrasound-based body contouring in selected adult populations, but where evidence on long-term outcomes, comparative effectiveness, and patient-centered measures is still limited. The heavy concentration of studies in a small number of expert centers may introduce selection biases, as these clinics typically treat highly motivated patients and have substantial procedural experience, which may not reflect real-world performance in more general settings.

Future research would benefit from greater methodological standardization, including uniform reporting of treatment parameters, validated scales for aesthetic improvement and satisfaction, and systematic registration of adverse events and follow-up beyond 6 to 12 months. Multicenter prospective cohorts and randomized controlled trials across diverse geographic and cultural contexts are needed to strengthen external validity.

Strengths and Limitations of This Bibliometric Review

This study's strengths include the use of a structured bibliometric workflow, multiple complementary indicators (productivity, impact, collaboration, and thematic evolution), and visual mapping of author and institutional networks, which together provide a comprehensive picture of how the field has evolved. However, the analysis is limited by the relatively small number of documents and by reliance on indexed literature from the selected databases, which may exclude gray literature, conference abstracts, or non-English publications. Citation-based metrics also favor older articles and may not fully capture the impact of the most recent studies. Despite these limitations, the present bibliometric synthesis highlights clear patterns and gaps in the literature on nonablative ultrasound-based rejuvenation and body contouring. It provides a structured framework that can inform the design of future clinical studies, support guideline development, and guide clinicians and researchers toward the most influential authors, journals, and research themes in this evolving domain.

CONCLUSIONS

This bibliometric analysis demonstrates that scientific research on HIFU for body contouring and facial rejuvenation remains limited in volume but is steadily expanding. Current evidence is concentrated in a small number of high-income countries and expert clinical centers, with modest international collaboration and a strong predominance of body-shaping indications, particularly subcutaneous fat reduction and circumference improvement. Although the included studies consistently report short-term efficacy and favorable safety profiles across diverse anatomical areas, the literature reveals substantial methodological gaps. Long-term outcomes, standardized treatment parameters, comparative effectiveness designs, and patient-reported experiences remain insufficiently explored. Because interest and technological innovation continue to increase, this review provides a foundational scientific map to guide future investigations and support informed clinical and research decision making in the evolving field of noninvasive ultrasound aesthetic medicine.

Disclosures

Dr Kumar is a consultant for Jeisys Medical Inc. (Seoul, Republic of Korea) and receives a fee from the company. The other authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

Jeisys Med Inc. (Seoul, Republic of Korea) funded the Open Access publication of this manuscript.

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