If removal of a specific infantile hemangioma is not achievable in 1 stage without the use of adjunctive complex techniques, we present serial excision as a viable alternative. We believe primary linear closure of the defect, whether it be in 1 or several stages, is preferable to the use of the aforementioned techniques. Serial excision of other benign pediatric lesions, such as congenital melanocytic nevi,10- 12 has been used successfully for decades and has served as the motivation for application of the technique to hemangiomas. What makes this technique possible in the treatment of hemangiomas are the known surgical planes, which either exist or can be created, and what is known of the qualities of the tumor during proliferation and involution. Dissection is possible between the superficial and deep components of the hemangioma, within the deep component, or between the deep component and normal tissues. Each of these planes can be approached as necessary with careful sharp and microunipolar dissection. Dissection within the substance of the tumor is easily performed, and hemostasis is readily achieved with bipolar cautery. An avascular plane invariably exists between the deep component and the surrounding normal tissue (Figure 1). Most serial excisions are performed during the involutional stage when the tumor is being replaced by fibrofatty tissue. However, judicious resection during late proliferation can be performed as well. The first stage of elliptical excision is performed completely intralesionally, sparing normal skin (Figure 2). The purpose of this and each subsequent excision is to reduce the size of the lesion leading to eventual primary closure. The elliptical excision is planned along the axis of the eventual final scar—along relaxed skin tension lines or at the junction of facial subunits. After this subtotal excision of the tumor, the edges are sutured under moderate tension to promote creep. Absorbable sutures are typically used in the intermediate stages, and meticulous wound closure techniques with tissue adhesives and nonabsorbable skin suture materials are used for the final stage. Enough time between stages is allowed to develop enough laxity of the surrounding tissues to enable reduction of the size of the residual lesion by subsequent advancement of the excision edges. The main objective is to eventually obtain a tension-free primary closure of the normal skin in the final stage. Absolute, complete removal of the tumor is not necessary or always desirable. Often, the deep component is sculpted or removed subtotally in order to not create a contour defect. Likewise, if complete removal of the superficial component in the final stage would require excision of enough skin to make closure difficult, it is left behind to continue involuting or treated with the pulsed-dye laser.