BACKGROUND The Q-switched neodymium (Nd):YAG laser with quadruple frequency is very effective for the treatment of tattoos, pigmented lesions, and vascular, benign lesions. It is also an option for treating rhytides, scars, and facial pigmentations. OBJECTIVE This paper is based on a series of patients with periocular and perioral rhytides, postacne scars, and melanic and vascular eyelid pigmentation who were treated with the Q-switched Nd:YAG laser with quadruple frequency. METHODS The patients were divided in three separate groups: facial wrinkles, postacne scars, and eyelid pigmentation. All were biopsied before and after the laser treatment. Different wavelengths (1064, 650, 585, and 532 nm) were used in order to study the clinical improvement and the histological changes that occurred several weeks following the laser treatment. Additionally, these biopsies aided in observing specific histological characteristics related to applying the different wavelengths by evaluating them along with the clinical results. RESULTS Very good results were achieved in the 22 facial wrinkle cases with two treatments. Excellent results were achieved in the 28 postacne patients, and the outcome of the 16 patients with pigmentation of the eyelids were considered good. CONCLUSIONS The Q-switched Nd:YAG laser with quadruple frequency can be classified as a valid alternative for facial resurfacing. The results obtained are comparable to those with the pulsed carbon dioxide lasers, plus it has the advantage of being effective on vascular lesions.