The 1064nm Nd: YAG laser has proved to be one of the most useful light sources for the treatment of deep vascular lesions and spider veins. A deeper penetration and a lower absorption by haemoglobin make this wavelength highly effective for thick vascular lesions, more so traditionally used shorter wavelengths (KTP, pulsed dye, IPL, diode). Adequate absorption of this wavelength is achieved by haemoglobin, a system able to control the depth of penetration through appropriate spot selection. With variable pulse duration to adjust to different vessel diameters, high fluences, and optimal cooling systems to avoid pain or burning, Nd YAG lasers can theoretically treat any vascular lesion, superficial, deep or thick. Additionally, variable spot sizes, highly-variable pulse duration and high fluences (CoolGlide Vantage, Cutera) have been evaluated for the treatment of a wide spectrum of vascular lesions. Results are especially noticeable on rosacea, leg veins, facial spider veins, cherry angioma (ruby point), and thick hemangiomas venus lake. Moderate pain was reported on deeper or thicker lesions, but was decreased with longer or additional cooling with ice packs.