## 4 Discussion
Another complication of HIFU treatment is neurologic, which is very rare, benign, and self-resolving [21]. No study has linked HIFU with any serious or permanent adverse effects. The risk of adverse outcomes is significantly increased if the treatment is not performed according to established guidelines. Factors contributing to complications include the following: (a) incorrect device settings--if the ultrasound energy level is too high or improperly adjusted, it may cause excessive heating, leading to unintended tissue damage; (b) improper application techniques--the operator must have an in-depth understanding of facial anatomy to ensure precise placement of ultrasound pulses and avoid unnecessary exposure to sensitive areas; and (c) failure to adhere to established treatment protocols--HIFU is a technology-sensitive procedure, and deviations from standard treatment parameters can increase the likelihood of complications. Each esthetic procedure, whether invasive or non-invasive, presents its own set of benefits and potential risks. A key determinant of HIFU treatment safety is the expertise of the operator. Operators lacking adequate education, professional training, or specialized knowledge in esthetic medicine are significantly more likely to cause treatment-related complications. Ensuring that HIFU is performed by certified and experienced professionals is essential for reducing risks and optimizing treatment results [22; 23]. Also, before a HIFU treatment, it is important that medical professionals conduct a comprehensive assessment of the patient's medical history, obtain a signed consent form, and take before-and-after photographs at multiple intervals. These are valuable tools for assessing the effectiveness of the procedure, managing patient expectations, and ensuring transparency in results [1; 3; 9]. As previously mentioned the full transformative effects of HIFU do not appear immediately but develop gradually over a period of several months. By the two- to three-month mark, significant tightening and lifting effects should become noticeable, with final results reaching their peak by approximately six months after treatment. In order to ensure optimal treatment outcomes and minimize risks, the following key factors must be considered: (a) careful selection of a reliable and approved HIFU device--using high-quality, clinically tested equipment is critical for maintaining consistency in treatment results and minimizing the likelihood of adverse effects; (b) precise parameter adjustments tailored to individual patient needs--since each patient has unique skin characteristics, adjusting the device settings according to the treatment area, skin thickness, and desired outcome is necessary for achieving optimal results; and (c) application of the procedure by highly trained and specialized professionals--proper execution of HIFU requires a strong understanding of skin physiology, ultrasound physics, and facial anatomy to ensure the accurate delivery of energy to targeted tissues [23]. Also, patients should wait an appropriate amount of time between esthetic treatments. If they have had Botox injections, a waiting period of at least three to four weeks is required. In cases of previous dermal filler treatments, the recommended interval is at least three to four months to prevent interactions between the ultrasound energy and the filler material. Products containing vitamin A derivatives, such as retinol and retinaldehyde, as well as high-concentration acids like glycolic and salicylic acid, should be avoided for at least three days before and three days after the procedure to prevent skin irritation, inflammation, or hypersensitivity. Excessive exposure to UV radiation, including direct sun exposure, sunbathing, and tanning beds, should be avoided for at least one week before the procedure. Even mild sunburn or skin irritation can increase sensitivity, potentially leading to redness and an elevated risk of complications following treatment [8; 10].