Hemangiomas are benign vascular tumours that slowly involute over many years. Therefore most hemangiomas do not require treatment. However approximately 38% of hemangiomas can be complicated depending on their subtype, location, and size. Straightforward indications for treatment include ulceration, interference with vital functions, or large size. Risk of disfigurement can be a more controversial indication. Since 2008, propranolol has dramatically changed the treatment of hemangiomas and is considered first-line treatment in complicated infantile hemangiomas (IH). In these years of clinical use, together with the results of a multicenter randomised clinical trial we have gained insight on efficacy and safety. Propanolol is highly effective and is usually given in a dose range of 2–3 mg/kg in BID for 6 to 9 months. Rebound after stopping treatment is possible in 15–19% of patients. Type of monitoring before initiating therapy has been modified over these past years and after the results of the clinical trial it is recommended a good physical exam with cardiac auscultation and control of blood pressure and cardiac frequency. Because its efficacy and safety risk of disfigurement has become a common indication to treat. There are several factors of the hemangioma itself and location that may help to predict or anticipate the residuum after involution of the hemangioma is completed.