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Past descriptions of vascular lesions often confused vascular malformations and hemangiomas using interchangeable definitions which led to inappropriate treatment and inconsistency in the medical literature. The work of Mulliken and Glowacki systematically delineated the difference between hemangiomas and the multiple varieties of vascular malformations. Hemangiomas are in fact as the suffix “oma” suggests true tumors exhibiting cellular proliferation on histology. Additionally, treatment has been clouded by numerous reports in the literature of near universal complete spontaneous resolution and conversely arguments that every lesion demands treatment. More recently, thoughtful studies of the natural course of hemangiomas have been completed, algorithms for intervention versus observation proposed, and effective safe treatment plans devised. The following article will be presented in two sections. The first section will review the diagnosis and natural history of hemangiomas as appreciated in modern literature and compare this to a review of historical articles. This information will then be used to describe a rational and thoughtful algorithm for observation or intervention and recommend appropriate treatment options. Special emphasis will be given to surgical technique and several cases of late involuting hemangiomas of the face will be presented.