Non invasive devices for fat reduction have become increasingly popular over the past decade. High-intensity focused ultrasound (HIFU), already in use for nearly half a century for the noninvasive treatment of tumors, has only recently been evaluated as a method for the selective ablation of adipose tissue. HIFU works by focusing high-intensity ultrasonic waves at the level of the subcutaneous adipose tissue, causing focal coagulative necrosis with contraction and thickening of adjacent collagen bundles while sparing the overlying tissue. Several studies reveal the safety and efficacy of HIFU for fat reduction in the abdomen and flanks. These studies show a consistent reduction in the abdominal circumference of at least 2cm after a single treatment. Adverse events are limited to mild, transient procedural and postprocedural discomfort, erythema, bruising, and edema. HIFU is a safe and effective method for focal fat reduction.