This prospective, single-center study evaluates the effectiveness and safety of high-intensity macro-focused ultrasound (HI-MFU) for treating solar lentigo (age spots) in Chinese patients. It also examines the treatment's impact on skin quality, including lightness, elasticity, and barrier function. The findings indicate that HI-MFU significantly lightens pigmentation in both lesional and non-lesional skin, with noticeable improvements at all follow-ups (2, 4, 6, and 8 weeks). Skin elasticity improved over time, and transepidermal water loss (TEWL) decreased, especially by the 8-week mark, indicating better barrier integrity. VISIA® imaging and dermoscopy revealed reductions in erythema and telangiectasia, even in cases of erythematous solar lentigo. Using our 2-photon microscopy product, the authors showed decreased melanin signals, with reduced fluorescence in treated areas by the 8-week follow-up, indicating lower melanin content.