Twenty years of laser dermatology has resulted in current technology which allows variable spot sizes, different wavelengths, and a variety of effective cooling devices. These developments have made the treatment of cutaneous pigmented and vascular lesions safe and efficacious by targeting selected chromophores while minimizing damage to the surrounding tissue. Vascular lesions are targeted by a variety of wavelength lasers including the KTP (532 nm), pulsed dye (585-595 nm), and the Nd:YAG (1064 nm) laser systems. Pigmented lesions may be treated with a wide variety of lasers due to the broad absorption spectrum of melanin. Intense pulsed light (IPL), with its widely adjustable parameters, has established itself as a useful adjunctive for the treatment of a variety of pigmented and vascular lesions. The purpose of this review article is to present the current treatment options for the common aesthetic complaints of pigmented and vascular lesions.