Adjuvant laser therapy of vascular anomalies is based on the principle of selective photo-thermolysis, through targeted destruction of selected chromophores with minimal injury to surrounding tissue. Choice of laser wavelength, treatment parameters, and predicted response to therapy are dependent on the dominant chromophore within the vascular anomaly, lesional location, and target depth, with relatively superficial and mucosal lesions producing the best response to therapy. Lasers can be safely combined with multi-modal approaches for vascular anomalies, including sclerotherapy, surgical excision, and systemic therapy. In this manuscript, we review the laser literature on a range of vascular anomalies, and provide indications, appropriate therapeutic and warning endpoints in the skin, pearls/pitfalls, and multi-disciplinary approaches for pediatric dermatologists pursuing laser as adjuvant therapy for vascular anomalies.