ABSTRACT: Nevus of Ota and freckles are common pigmentary disorders that may coexist; however, their differing depths of pigmentation present a therapeutic challenge. Nevus of Ota is a dermal melanocytic hamartoma requiring deeply penetrating wavelengths, whereas freckles (ephelides) are superficial epidermal lesions that respond best to low-fluence visible-light therapy. A combination of a 1064 nm Q-switched Nd:YAG (QSNY) laser and a 660 nm ruby laser-like treatment, targeting pigment at different skin depths, may provide a complementary approach for simultaneously addressing both conditions. This report describes a 54-year-old woman diagnosed with type II unilateral nevus of Ota and freckles. The patient underwent 23 treatment sessions using a 1064 nm QSNY laser and a 660 nm ruby laser-like treatment over two years. Progressive improvement of both nevus of Ota and freckles was observed from the 8th session onward compared with baseline. The nevus of Ota showed significant lightening, while freckles demonstrated marked superficial clearance by the 23rd session. No recurrence of pigmentation was observed at the 6-month follow-up after the last treatment. Adverse effects were minimal and limited to transient erythema and frosting after each session, which resolved spontaneously. The patient reported high satisfaction with the treatment outcome. The combination of 1064 nm Q-switched Nd:YAG laser and 660 nm ruby laser-like treatment may offer a safe and effective treatment approach for patients with concurrent nevus of Ota and freckles. Further studies with larger patient cohorts are required to validate these findings and optimize treatment parameters.