Introduction: Microfocused ultrasound (MFU) is a heat technology that is developed from focused ultrasound (FU) used in a high intense mode to generate heat (HIFU). Patient assessment is very complex and involves more than just addressing complaints. It is a challenge to evaluate, decide on options, and give treatments that guarantee the best outcomes. In order to facilitate the process, the authors divided the protocol into five steps: Assess (expectations, features); Decide (which depth to customize); Select (choose a number of lines to achieve the objective); Plan (combination, if needed); Treat (documentation, safety, and comfort). Methods: The PubMed search engine was used to search all publications from 1900–2019 that mention HIFU. The information collected was then grouped into the five protocol steps. Discussion: MFU is a focused ultrasound device that, at certain energy levels, produces heat over 55ºC at the focal point, which leads to thermal coagulation points (TCPs) in the target tissue. The creation of TCPs leads to a healing cascade, ending with neocollagenesis and neoelastogenesis. At different levels, this can bring about either a lifting effect or skin tightening, depending on the structure targeted. Therefore, the two most important tools for precision and efficacy of treatment are visualization with ultrasound and real-time evaluation of severity and structural changes (such as bone or fat loss). Conclusion: MFU-V is a well-known and, based on the evidence, an effective tool for non-invasive lifting and skin tightening. The secret to successful use of the device is to assess adequately patient needs and expectations and plan ahead for the combination of other treatment if necessary to achieve the desired outcome. J Drugs Dermatol. 2019;18(11):1075-1082.