Laser is a widely accepted tool for tattoo removal, with standardized treatment protocols. Nevertheless, cosmetic tattoo removal may be challenging, because tattoos are performed in proximity of "sensitive" areas and because the ink used in cosmetic tattoos may contain substances that are not standardized and may modify their color at a high temperature. In this case series, we aim to evaluate the effectiveness of Q-switched (QS) Nd:YAG laser for cosmetic tattoo removal. Our study included 20 patients with cosmetic tattoos of lips, eyebrows, and eyeliners treated with QS Nd:YAG laser. Before treatment, an accurate preoperative assessment was performed, taking into account both patient and tattoo characteristics. Complete tattoo removal was obtained in all the cases and no major complications occurred. Adverse events were mild, mostly represented by erythema. All patients reported a high level of satisfaction. Selective photothermolysis enables complete tattoo removal, even in the case of cosmetic tattoos. However, cosmetic tattoos require a personalized treatment based on an accurate preoperative assessment which takes into account both patient and tattoo characteristics. QS Nd:YAG laser may be considered a good choice in the treatment of cosmetic tattoos, because it enables complete removal with acceptable secondary effects.