BACKGROUND Cavernous hemangiomas are benign vascular lesions which are apparent at birth or soon thereafter. Although hemangiomas involute spontaneously, cosmetically unacceptable results or life-threatening complications may occur, necessitating early therapy. METHODS Thirty-four patients with facial cavernous hemangiomas were treated with a cw-neodymium:YAG laser. Before, during, and after the treatment the skin was cooled with ice. The quartz fiber was used in contact or non-contact technique, and in very large hemangiomas we used interstitial treatment. RESULTS In all patients a clear reduction of the tumor size was achieved. In 26 cases the tumor disappeared completely. Usually there is considerably swelling of the tumor immediately after treatment which decreases within some days. Side effects include local hyperemia and slight burns. Scarring was seen in only two cases. CONCLUSIONS Facial cavernous hemangiomas can be treated satisfactory by the neodymium:YAG laser. Safe, active intervention with this laser is possible in most, if not in all, cases and it provides an alternative to other treatment modalities including the neglect of these lesions.