Background Vascular lesions still present a major problem, and the search for a good treatment continues. The use of inappropriate treatment methods, can occasionally cause unwanted side effects. Even when the method used is appropriate, the result can be disappointing. It is important to choose an appropriate laser, and where laser treatment is not effective, we must select the most appropriate conventional treatment or combination of treatments. My treatment program is as follows; a 532 nm diode laser is the first choice for telangiectasias; the flashlamp-pumped dye laser for port wine stains and strawberry marks; and the Nd:YAG laser with a cooling device for 1 - 3 mm leg veins of the reticular and web type. For leg veins over 3 mm, surgery is required. The diode pumped 532 nm laser is excellent for superficial telangiectasias. Good effects with the pulsed dye laser are limited to vessels in the upper layers of the dermis, thus the penetration depth of the laser must thus be optimized combined with epidermal cooling. We must always avoid side effects in laser treatment of vascular lesions. Development of new wavelengths and adaptation of existing wavelengths are currently being investigated.