Use of High-Intensity Focused Ultrasound in the Periorbital Rejuvenation: A Systematic Review.

Background: Periorbital aging represents one of the earliest manifestations of facial aging, resulting from structural changes across cutaneous, adipose, and muscular layers of the periocular region. Although high-intensity focused ultrasound (HIFU) is increasingly used for noninvasive rejuvenation, evidence on periorbital outcomes remains scarce. Objectives: To synthesize the effectiveness and safety of HIFU technologies for periorbital rejuvenation in adults. Methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. MEDLINE/PubMed, Scopus, Cochrane CENTRAL, and Google Scholar were searched for studies published between January 2015 and November 2025. Randomized trials and prospective or retrospective cohort studies evaluating HIFU applied to the periorbital region were included. Outcomes included wrinkle severity, skin elasticity, texture, lifting effects, patient satisfaction, and adverse events. Risk of bias was assessed. Results: Ten studies involving 10 to 191 participants were included. Across included studies, HIFU demonstrated significant improvements in periorbital wrinkle severity, biomechanical skin elasticity (Cutometer R2, R5, and R7), surface topography (PRIMOS Ra and Rz), and eyebrow or eyelid contour. Greater improvement was observed with multiple treatment sessions. Adverse events were generally mild and transient, including erythema, edema, and pain; rare complications (<1%) occurred without permanent sequelae. Conclusions: High-intensity focused ultrasound appears to be a safe and effective noninvasive option for periorbital rejuvenation. However, the certainty of evidence is very low due to nonrandomized designs and heterogeneity, highlighting the need for well-designed randomized controlled trials with standardized protocols. Level of Evidence 3 Therapeutic: