Contact Nd:YAG laser surgery offers a new method of delivering laser energy to a target tissue site. Nd:YAG, a near-infrared laser, can be transmitted through an optical fiber delivery system to a synthetic sapphire probe. This sapphire probe can be used as a surgical scalpel to cut, vaporize, or coagulate tissues. The contact laser scalpel offers many advantages over conventional steel scalpel surgery and the system overcomes many of the limitations encountered with noncontact Nd:YAG lasers. A review of the history, biophysics, and experimental studies is presented. Clinical oculoplastic applications are reviewed.