Sound therapy: how it is used in cosmetology and rehabilitation

In everyday usage, "sound therapy" refers to anything that uses sound or vibration: from relaxation music to ultrasound procedures. Evidence-based medicine differentiates these approaches because they have different mechanisms of action, different indications, and different levels of evidence. Therefore, it is more accurate to refer to "acoustic methods" and to distinguish distinct groups within them. [1]

The first group is music therapy and other musical interventions. This isn't just a "pretty background" in a room, but rather structured work with music or rhythm to influence emotions, attention, pain, movement, and speech. Neurological music therapy techniques are particularly well-known in rehabilitation, including Rhythmic Auditory Stimulation (RHS) for gait and coordination training. [2]

The second group is vibroacoustic therapy: a combination of low-frequency mechanical vibrations felt by the body and sound or music. It is being studied as a non-drug treatment option for pain, spasticity, and certain neurological conditions, but so far, the heterogeneity of protocols and the need for standardization of research are often emphasized. [3]

The third group is therapeutic ultrasound in physiotherapy and rehabilitation. This is not an audible sound, but rather high-frequency mechanical waves used to influence pain and function in certain musculoskeletal disorders. According to reviews, there is an effect, but it depends on the diagnosis and parameters, and in some conditions, it is considered moderate or short-term. [4]

The fourth group includes cosmetology and aesthetic procedures that utilize ultrasound, shock waves, or a combination of the two. This includes high-intensity focused ultrasound (HIFU) for lifting and contouring, as well as extracorporeal shock wave therapy (ESWT) for reducing the appearance of cellulite. These methods are closer to aesthetic medicine and require particularly careful discussion of indications and risks. [5]

Table 1. The main types of sound therapy and how they differ

Direction	What is used	Typical goal	Where is it most often used?	Level of evidence overall
Music therapy	Music, rhythm, voice, exercises	Anxiety, pain, motivation, speech, movement	Rehabilitation, surgery, psychosomatics	Moderate to good in individual tasks
Rhythmic auditory stimulation	Rhythm, metronome, music with accents	Walking, step symmetry, balance	Stroke, Parkinson's disease	Good in terms of walking parameters
Vibroacoustic therapy	Low frequency vibration plus sound	Pain, relaxation, spasticity	Rehabilitation, chronic pain	Promising, but protocols are inconsistent
Therapeutic ultrasound	High-frequency mechanical waves	Pain, function, tissues	Physiotherapy, rehabilitation	Mixed results, depending on diagnosis
Aesthetic acoustic methods	Focused ultrasound, shock waves	Lifting, contouring, cellulite	Cosmetology, aesthetic medicine	There is evidence of an effect, but the quality of the studies varies.

[6]

How sound therapy is used in cosmetology

The most "gentle" and widespread aspect of sound therapy in cosmetology is stress management and subjective comfort during procedures. Music doesn't directly treat wrinkles, but stress and anxiety do increase the subjective perception of pain, impair sleep, and can interfere with recovery after procedures. In medical situations, musical interventions have been shown to reduce anxiety and pain, and sometimes even the need for analgesics. Therefore, the idea of using music as a supportive component can be considered reasonable and safe, provided the volume is appropriate and individual preferences are met. [7]

Next come cosmetology "hardware" methods, where sound is a physical factor. High-Intensity Focused Ultrasound (HIFU) is used for skin tightening and contouring: energy is focused at a specified depth, creating controlled zones of thermal action, which triggers collagen remodeling. A systematic review of studies from 2010 to 2024 described measurable improvements, particularly in the lower third of the face and neck, with results depending on the device, protocol, and patient selection. [8]

The safety of such procedures is generally considered acceptable when performed by a trained professional, but complications are possible. Reviews mention redness, swelling, and soreness among typical short-term effects, while temporary sensory disturbances or other adverse events are less frequently described, especially if the parameters are chosen incorrectly or the area is poorly chosen. Therefore, qualifications and an understanding of anatomy are key factors in aesthetic ultrasound. [9]

A separate area is non-invasive reduction of localized fat deposits using unfocused low-intensity ultrasound or technologies where the mechanical effect is associated with cavitation. Current clinical data show that some protocols can reduce the thickness of the superficial subcutaneous fat layer without serious adverse effects, but studies are often small, and the duration of the effect and optimal parameters are still being refined. A 2025 publication described significant changes in the superficial fat layer after 6 weeks of treatment and the maintenance of the effect in some areas after 2 months of follow-up, with no serious complications in the study group. [10]

Cellulite is a special topic because it's not simply "fat," but a combination of connective tissue barriers, microcirculation, and skin structure. Reviews emphasize that there is no universal, non-invasive way to "remove cellulite permanently," but extracorporeal shockwave therapy shows promising results: a 2015 meta-analysis indicated improvement in cellulite severity with both radial and focused devices, most often with courses of 6-8 treatments 1-2 times per week, although the quality of studies and protocols varies significantly. [11]

Finally, what is often referred to as "ultrasonic peeling" and "sonopenetration of cosmetics" occupies a middle ground between skin care and medical technology. The mechanisms of ultrasound-induced skin permeability are described in detail in scientific reviews on sonopenetration and transdermal delivery: ultrasound can temporarily increase the permeability of the stratum corneum, but the practical effect depends on frequency, intensity, contact environment, and the properties of the substance, and clinical studies in cosmetics are often less rigorous than in medicine. [12]

Table 2. Cosmetology: where sound is truly a healing factor

Task	Method	What is really expected	What is often promised in advertising?	Commentary on evidence
Relaxation, reduced anxiety	Music during procedures	Comfort, less anxiety, subjectively less pain	Rejuvenation by Sound	Good data for anxiety and pain in a medical context
Skin tightening, contouring	High-intensity focused ultrasound	Moderate improvement of laxity, the effect depends on the initial condition	"Minus 10 years in one session"	There are systematic reviews, protocols are important
Localized fat	Low-intensity or unfocused ultrasound	Minor changes in the volume and thickness of superficial fat	"Spot weight loss without restrictions"	There is clinical data, the long-term period is being clarified
Cellulite	Extracorporeal shock wave therapy	Decreased severity, more often after a course	"Complete disappearance forever"	There are meta-analyses, but the protocols are heterogeneous
Introduction of products into the skin	Sonopenetration	Potential enhancement of penetration of individual substances	"Any cream works 10 times better"	The mechanism has been proven, the clinical effect depends on the formula and parameters

[13]

How sound therapy is used in rehabilitation

In rehabilitation, sound is used not as a "pleasant addition," but as a tool for training the nervous system. The most well-known example is Rhythmic Auditory Stimulation (RAS): a person is given an external rhythm to which the brain synchronizes movement. Randomized trials and reviews show improvements in gait parameters, and clinical guidelines for stroke rehabilitation include RAS as a useful supplement to gait training for some patients. [14]

In practice, it works like this: first, the basic speed and stability of walking are assessed, then a rhythm is selected that slightly structures the stride without overloading it. Options include a metronome, music with a distinct beat, or special programs. An important point is that sound does not replace exercise, but rather improves the "quality of repetitions" and helps maintain a stable pace, which is especially helpful when walking automatism is impaired. [15]

Music therapy is also used for speech and cognitive functions. Research describes approaches where rhythm and melody assist speech training in aphasia, as well as attention and memory exercises during the recovery period after brain injury. A Cochrane review of music interventions for acquired brain injury emphasizes the potential for impact on various functions, but also notes the limitations of some of the evidence due to heterogeneity of studies and small sample sizes. [16]

Another major area of research is the impact of music on pain and anxiety, particularly in the perioperative period and in situations where it is important to reduce stress. Meta-analyses show reductions in anxiety and pain in adult patients with musical interventions around surgical procedures, making music an attractive, safe component of comprehensive rehabilitation, including the early stages of recovery. [17]

Vibroacoustic therapy in rehabilitation is most often viewed as a method for pain and spasticity relief, as well as for relaxation. A 2022 review of adults with pain conditions describes a wide range of protocols and outcomes and concludes that this approach is promising but requires standardization and higher-quality comparative studies. A 2023 meta-analysis of similar vibration therapy methods for post-stroke spasticity shows a reduction in spasticity and pain and an improvement in motor function, although the effect on gait parameters was less clear. [18]

Therapeutic ultrasound is most often used in rehabilitation for diseases and injuries of the musculoskeletal system, but the scientific evidence is mixed. For example, for knee osteoarthritis, a systematic review and Cochrane data indicate that ultrasound can reduce pain and improve function, but the magnitude and sustainability of the effect depend on the regimen and concomitant therapy, and it is not a universal solution. Therefore, the modern approach typically focuses on exercise, education, and load-bearing activities, with physical factors added as supportive measures for selected indications. [19]

Table 3. Rehabilitation: for what purposes is sound most often used?

Sphere	Method	Target	What is usually measured?	What is important for the effect?
Walking after a stroke	Rhythmic auditory stimulation	Speed, symmetry, stability of step	Walking speed, stride length, cadence, balance tests	Regular training, choosing the right rhythm
Parkinson's disease	Rhythm and musical cues	Unlocking walking, rhythm of movements	Freezing episode frequency, speed, stability	Individual tempo adjustment
Aphasia	Melodic rhythmic techniques	Speech initiation, fluency, articulation	Speech therapy scales	Combination with speech therapy
Pain and anxiety	Musical interventions	Reducing anxiety and pain	Pain, anxiety, and analgesic needs scales	Human preferences, volume, duration
Spasticity	Vibration and vibroacoustic methods	Decreased tone, pain, improved movement	Spasticity scales, functional tests	Course, combination with active rehabilitation

[20]

Safety: Contraindications, Risks, and Common Mistakes

The musical component of sound therapy is generally safe, but it does have its limits. Excessively loud sounds increase the risk of hearing damage and can trigger headaches, while for some people, certain sounds increase anxiety or cause sensory overload. In rehabilitation, it is important to adhere to the principle of controlled load: sound should support training, not turn it into a stress factor. [21]

Vibroacoustic methods and vibration stimulation require caution in individuals with a high risk of thrombosis, acute inflammatory processes, severe instability, and certain neurological conditions where stimulation may exacerbate symptoms. Research often emphasizes that protocols vary, making it difficult to describe a "universal safe regimen," and that the course of treatment should be tailored to the clinical objective and tolerability. [22]

Ultrasound and aesthetic acoustic methods are closer to medical procedures, so safety requirements are higher. For high-intensity focused ultrasound, the depth of focus and treatment area are important: errors in anatomy and parameters increase the risk of severe pain, swelling, and rare complications. Complication reviews emphasize that most adverse events are short-lived, but the skill of the operator remains crucial. [23]

Extracorporeal shock wave therapy for cellulite has generally been well-tolerated in studies, but soreness, redness, bruising, and increased skin sensitivity are possible. It's also important to remember that studies vary in quality and protocols, so it's safer to avoid aggressive "maximum power" treatments for quick results, especially if you're prone to bruising and vascular fragility. [24]

For home cosmetology devices, the key risk is the combination of a weak evidence base and strong marketing. Home devices often promise results comparable to those in a clinic, but the user doesn't have the same precise control over parameters as a professional and may overdo it with the frequency of treatments, skin pressure, heat, or treatment of undesirable areas. When choosing a device, it's more useful to focus on clinical studies of a specific technology and contraindications rather than on advertising claims. [25]

Table 4. Frequent contraindications and reasons for caution by methods

Method	When usually avoided or acted with particular caution	Why
Musical interventions	Intolerance to loud sounds, severe sensory overload	Increased anxiety, headache
Vibroacoustic therapy	Acute inflammation, high risk of thrombosis, unstable condition	Risk of worsening symptoms, unpredictable tolerability
Therapeutic ultrasound	Acute infections in the area, suspected tumor in the area, severe sensory disturbances	Risk of tissue trauma, dosing errors
High-intensity focused ultrasound	Incorrect depth selection, questionable skills, high-risk areas	Pain, swelling, rare complications in case of errors
Extracorporeal shock wave therapy	Tendency to bruise, clotting disorders, severe pain	Pain, bruising, skin irritation

[26]

Choosing an Approach: Practical Course Plans and Evaluation

The choice of sound therapy begins not with the "method," but with the goal. In cosmetology, there are typically three goals: improving well-being and comfort, moderately improving skin quality and contours, and reducing the appearance of cellulite or localized fat deposits. In rehabilitation, the goals are more often functional: walking, balance, speech, reducing pain and anxiety, and reducing spasticity. The more specific the goal, the easier it is to select a technology with an adequate evidence base. [27]

For courses in aesthetic medicine and cosmetology, realistic expectations are important. Reviews of non-invasive contouring emphasize that the effects are usually moderate, and cellulite is influenced by many factors, so lasting results often require a combination of procedures with physical activity and lifestyle changes. For shockwave therapy, studies often use 6-8 treatments, and for some ultrasound treatments for adipose tissue, protocols of approximately 6 weeks with dynamic evaluation are common. [28]

In rehabilitation, sound should almost always be integrated into training. For example, rhythmic auditory stimulation works as a supplement to walking exercises: regularity, gradual difficulty, and connection to real-world tasks are more important than a perfect musical track. This is consistent with the logic of modern recommendations for post-stroke rehabilitation, where the foundation is repetitive functional tasks, and additional methods are considered to enhance the effect. [29]

Results must be measurable. In cosmetology, this includes photos taken under identical lighting, measurements of circumference or fat fold thickness, cellulite severity scales, and subjective satisfaction. In rehabilitation, this includes walking speed, balance tests, pain and anxiety scales, speech therapy, and functional scales. This approach helps quickly determine whether it's worth continuing the course or whether a different strategy is best. [30]

A useful guide is the "red flags" of marketing: promises of guaranteed results in one session, claims of "suitability for everyone," the absence of contraindications, and attempts to replace basic treatments with sound therapy. Modern reviews of aesthetic ultrasound and non-invasive contouring show that the effect depends on patient selection and protocol, and that some problems are better addressed with a comprehensive plan. [31]

Table 5. Course benchmarks: how often and how long research methods are typically taught

Method	Frequency in studies and reviews	When to evaluate the effect	Comment
Music interventions for anxiety and pain	Sessions before, during or after the procedure, sometimes in a course	After each session and by amount	The choice of music and volume are important
Rhythmic auditory stimulation for walking	Regularly as part of training	Every 1-2 weeks	Works as part of rehabilitation, not instead of it
Extracorporeal shock wave therapy for cellulite	Often 6-8 procedures 1-2 times a week	After the course and after 1-3 months	The data is heterogeneous, the protocols differ
Low-intensity, non-focused ultrasound for localized fat removal	In one of the protocols for 6 weeks in a row	In 1-2 months	The effect is more often on the surface layer
High intensity focused ultrasound for lifting	Depending on the device, often 1-2 sessions	In 2-3 months	The effect increases as remodeling progresses.

[32]

Table 6. Common myths about sound therapy and what is closer to reality

Myth	Reality according to research data
"Sound heals everything, you just need to find the right frequency."	Mechanisms depend on the method, target and dosage; there is no universal “treatment frequency” [33]
"Ultrasound removes cellulite completely"	Cellulite has a complex nature, improvement is possible but not guaranteed and is usually moderate [34]
"If the procedure is non-invasive, there are no risks."	The risks are lower, but they exist: pain, swelling, bruising, parameter errors [35]
"Music is just background"	For anxiety and pain, music interventions have been shown to be effective in a range of conditions [36]
"In rehabilitation, sound replaces exercise"	Most effective as a supplement to training, especially for walking and rhythm of movements [37]