The Nd:YAG laser, with its 1,064-nm wavelength, is a mainstay for treatment of vascular lesions. What it may sacrifice in absorption by hemoglobin, it makes up for in depth of penetration. The long-pulsed Nd:YAG laser has been the ideal choice for lesions off the face and for thick or deep vascular targets, although newer short-pulsed high-energy (650-μs) devices are showing high efficacy and safety on facial vessels as well. Common uses include leg veins, port-wine stains, blue vessels, and venous lakes. Care must be taken to use adequate cooling during treatment. The Nd:YAG laser is a versatile wavelength with many possible uses for both pigmented and vascular indications. © 2014 S. Karger AG, Basel Vascular lesions, such as port-wine stains and hemangioma of infancy, have been the first and most evident uses for cutaneous lasers in dermatology. However, there are many other uses for these lasers, some vascular in nature and some using the same target, but for a different purpose. The shorter wavelength vascular lasers, including the pulsed dye laser, were the initial lasers implemented for these indications. Over the past 20 years, advancements including using other wavelengths, such as 532 nm [KTP (potassium-titanyl-phosphate)], 755 nm (alexandrite), and 1,064 nm [Nd:YAG (neodymium:yttrium-aluminum-garnet)] have expanded available treatments for these and other vascular conditions. The Nd:YAG laser has become a vital wavelength in treating many cutaneous conditions, including hemangiomas of infancy, port-wine stains, leg veins, venous lakes, telangiectasias scars and photorejuvenation.The first reports of the Nd:YAG laser being used for vascular lesions was in the early 1980s [1,2]. Parkin and Dixon [1] used an Nd:YAG laser to successfully photocoagulate intranasal telangiectasias in patients with Osler-Weber-Rendu syndrome. In 1986, the Nd:YAG was used on hypertrophic port-wine stains [3]. The fluence used was very high with no epidermal cooling, resulting in coagulation at a great depth, but with posttreatment necrosis of the epidermis and scarring [4]. Histologic investiga-