BACKGROUND: The 650-ms, 1064-nm Nd:YAG laser device may provide superior efficacy and tolerability for the treatment of acne vulgaris over conventional treatments. AIM: To evaluate the efficacy and tolerability of a 650-ms laser for the treatment of mild to severe facial acne vulgaris. PATIENTS/METHODS: Records of 225 subjects with mild to severe facial acne vulgaris and treated with a 650-ms laser were reviewed. RESULTS: Subjects required a median of 3 treatments to achieve clearance. Clearance was achieved in 108/225 (48%) subjects. Adverse effects were limited to acne flare-ups and dryness. Treatment with isotretinoin was not required in 180/209 (80%) of subjects. A variety of topical and oral medications and non-laser procedures may be used in conjunction with the 650-ms laser without adverse effects. At the 6-month follow-up visit, the median Investigator Global Scale (IGA) score was 1.0 (almost clear). For most IGA-rated parameters differences between white patients and patients with skin of color were not statistically significant. CONCLUSION: The 650-ms, 1064-nm Nd:YAG laser provides a safe and efficacious treatment of mild to severe acne in patients with white skin and skin of color.