Vulvar lichen sclerosus (VLS) is a chronic, recurrent dermatosis predominantly affecting postmenopausal women. It is characterized by atrophic and sclerotic changes in the vulvar skin, often causing severe discomfort and functional impairment. Although potent topical corticosteroids remain the primary treatment, high-intensity focused ultrasound (HIFU) emerges as a promising alternative in recurrence cases. This study reports the case of a 73-year-old woman with VLS treated using HIFU, aiming to assess the safety and efficacy of this novel therapeutic approach. The patient presented with significant discomfort due to VLS and had a history of limited response to previous treatments. HIFU therapy was applied using the System ONE-M device operating at 20 MHz, targeting specific lesions. The dermoscopic evaluation was performed pre- and post-treatment to assess the treatment response. Immediate post-procedural whitening of tissues was observed, followed by gradual healing over five months. The patient experienced significant symptom relief, including reduced pain and itching, with minimal adverse effects. The treated areas displayed nearly normal skin color, texture, and improved function within five months post-treatment. This case illustrates the potential of HIFU as an effective and precise non-invasive treatment for VLS, offering significant symptom relief while sparing healthy tissue. Further research is needed to refine treatment parameters and explore the broader clinical applicability of HIFU for VLS management.