Background: Consistent reproducible aesthetic results are a desired component of laser/intense pulsed light (IPL) treatment of lower extremity blood vessels. In this regard, shorter wavelengths may be used to treat fine red telangiectases, whereas longer wavelengths may be used to treat larger diameter blue venulectasia and small reticular veins. Objective: The purpose of the present study was to demonstrate that a bimodal wavelength approach to laser/IPL source treatment for lower extremity vessels up to 8 mm in diameter produces results superior to previously described photothermolytic approaches for eradication of unwanted lower extremity blood vessels. Methods: Fifty female patients (mean age, 37 years) were treated in a private practice setting with class I-III red telangiectasia, blue venulectasia, and reticular veins (0.1-4.0 mm in diameter) on the inner or outer thighs. A combined approach of laser/IPL treatment was used; patients had up to 3 treatments at 6-week intervals on a 5-cm² surface area of vessels with the use of an IPL source wavelength of 550 nm, fluence of 40 J/cm², for treatment of red telangiectases less than 1 mm in diameter, while a 1064-nm Nd:YAG laser at a fluence of 140 J/cm² was used to treat venulectases and reticular vessels that were 1.0 to 4.0 mm in diameter. Results were analyzed by macrophotographic imaging, double-blinded observer evaluation, optical chromatography, and a patient evaluation scale. Results: An average of 2½ patient sessions produced significant clearing (75%-100%) in 80% of patients. The mean erythema index showed significant lightening (35.3+dl) in the study population. Finally, 76% of patients reported great satisfaction with the treatment results. Conclusion: A bimodal wavelength approach utilizing both short and long wavelengths produces significant clearing of the variably colored, multiple-diameter/depth array of vessels, which commonly presents a therapeutic challenge to the vascular laser surgeon. (J Am Acad Dermatol 2002;46:66-72.)