The question that one often asks when starting a practice is “what laser/light/energy” source should I choose that will benefit most clinical indications? Often, devices are touted as “one size fits all,” where one laser or light source may have a myriad of clinical indications. While this is an ambitious goal, it is far from realistic. The majority of devices do one or two things well, and other indications are suboptimal at best. Therefore, the first question one must ask is “What procedure do I foresee being the most in demand in my practice?” For example, in a dermatology practice, a significant number of patients seek care for vascular and pigmented lesions. In a plastic surgery practice, the emphasis is placed more on rhytids and laxity. Thus, the initial device that may be most optimal may reflect the specialty of the physician, as well as the clinical demographics of the practice. Vascular and pigmented lesion treatments are also often highly gratifying, as clinical improvement of these entities is quite remarkable with excellent photographic documentation showing efficacy. Examples of “workhorse” devices for vascular lesions include pulsed dye lasers, pulsed KTP lasers and pulsed light sources. Examples of “workhorse” devices for pigmented lesions include Q-switched lasers (532, 694, 755 nm) and pulsed light sources. Newer generation pulsed light sources and newer generation pulsed dye lasers are effective for the treatment of both vascular and pigmented lesions, and, therefore, may be a more cost-effective method for integrating a single device, as opposed to investing in multiple devices. Resurfacing devices include non ablative fractional lasers, ablative fractional lasers and traditional ablative lasers. For plastic surgery practices, resurfacing lasers are most likely the first device of choice. While traditional ablative resurfacing is highly effective, the downsides such as prolonged erythema, risks of hypopigmentation and limitation to facial areas, make these devices less popular in the twenty-first century. The advent of fractional laser resurfacing has reduced some of these risks. Thus, a fractional laser resurfacing device is often the ideal first device for a plastic surgery practice. After investing in the initial device, expansion to other devices in a systematic fashion is optimal. For dermatologists, a resurfacing device, should be the second device to integrate into a practice and for plastic surgeons, a vascular/pigmented lesion device fits this role. Afterwards, other devices can be integrated in a step wise fashion based on economic returns on the first two. These include skin tightening devices, acne devices and body contouring devices. The question of hair reduction devices remains dubious. While this procedure is highly effective, it has now become much more commoditized and thus, should be considered as an adjunctive procedure in both dermatology and plastic surgery practices. Moreover, the advent of home held hair removal devices is further clouding the issue.