Background: Microfocused ultrasound with visualization (MFU-V) has emerged as a safe and reliable means for lifting and tightening lax skin. Although patients may present with similar age-related changes in the skin and connective tissue, MFU-V treatment must be customized for each patient. Objective: The following guidelines were prepared to provide a framework for clinicians to develop a customized treatment plan based on the proper use of ultrasound imaging and key patient characteristics to achieve good clinical outcomes with MFU-V. Methods and Materials: A panel of five expert aesthetic physicians convened to discuss recommendations on the use of MFU-V. Topics included patient factors contributing to favorable outcomes; customizing the number of treatment lines, energy settings, and treatment depths; approaches for restorative vs preventative vs maintenance treatments; and important safety considerations. Results: Ultrasound imaging is important for selecting transducers and treatment depth and planning the number of treatment lines at each depth. Ideal outcomes are associated with higher density treatments. Treatment intervals are tailored to age, with older patients requiring more frequent treatments to maintain results. MFU-V can be applied for both preventative and restorative treatments. Managing patient expectations is essential. Conclusion: Supported by a large body of clinical evidence, a well-characterized mechanism of action, and high patient satisfaction, MFU-V is considered by the expert panel of physicians to be a key foundation of aesthetic treatment and the gold standard for nonsurgical lifting and skin tightening.