Non-ablative skin textural improvement is based on the theory of delivering a suitable packet of photo-thermal damage (coagulative and biostimulating) to dermal layers beneath a cooled epidermis. In this paper, a new Nd:YAG laser pulse duration modality is introduced which is perfectly suited for this purpose. This new, super long, PIANO modality, which extends the Nd:YAG pulse durations to the seconds regime, is much longer than the thermal relaxation time of the epidermis or any other skin structures, and does not cause high initial temperature peaks in the epidermis. It is therefore indicated for treatments where overall homogeneous, bulk heating of the dermis is desired. Based on the in-vivo study of the thermal effects of the PIANO mode on human skin, clinical protocol guidelines for laser skin remodeling, skin tightening and laser-assisted wound healing are developed. The PIANO modality may be of benefit also when considering treatments that combine the non-ablative Nd:YAG laser skin remodeling with the Er:YAG laser fractional skin resurfacing.