Vascular anomalies comprise a broad spectrum of lesions resulting from abnormal vascular development. The 2018 International Society for the Study of Vascular Anomalies (ISSVA) guidelines divide vascular anomalies into proliferative vascular tumours and non-proliferative vascular malformations. These lesions can have an impact functionally and psychosocially. Important advances have been made over the past several decades in the treatment and management of such lesions, including that of laser therapy. After Albert Einstein first postulated the concept of stimulated emission in 1916, it wasn’t until 1960 that the first laser was constructed through using a cylinder of synthetic ruby. The following year, Charles Campbell and Charles Koester made first clinical use of laser therapy in the treatment of a patient with a retinal tumour. Seven years later, Goldman and Eckhouse reported the first application of laser in treating vascular lesions specifically. Subsequent revolution in this field constituted the construction of a flashlamp-pumped pulsed dye laser, specifically designed for cutaneous vascular lesions. This was developed following significant work from Anderson and Parrish who originally proposed the theory of selective photothermolysis in 1982. Continuous progress has been made since this time, leading to the development of laser therapies that allow for more specific treatment according to the known biology of various vascular lesions, including pulsed dye, CO2, and Nd-YAG laser therapy, with fewer adverse effects. By expanding our understanding of the biology of vascular lesions, and laser technology, we can continue to enhance the provision of optimal management of vascular malformations with fewer side effects.