Abstract: Embodiments of devices, systems and methods for controlling the focal depth of energy in targeting tissue for performing various treatment and/or imaging procedures, such as cosmetic enhancement procedures. Ultrasound procedures can acoustically couple one or more spacers, offsets, standoffs, bladders, lenses, multiplexed arrays, transducer movement systems, and/or automated therapy deposition depth systems to mechanically modify a focal depth of an ultrasound transducer for treatment of tissue below tissue surface.