With the recent serendipitous discovery of propranolol’s effect on hemangiomas, beta-blockers have become the treatment of choice for hemangiomas. Although efficacy varies for each individual, propranolol can significantly shrink or even control the growth of hemangiomas. With its increasing use in children with hemangiomas, its safety has been proven with significantly fewer adverse effects than hormones. Although it has been suggested that initial administration requires hospitalization to monitor for possible hypoglycemia and cardiovascular-respiratory complications, an increasing number of scholars are favoring outpatient treatment (OUTPATIENT TREATMENT). The most difficult decision for the clinician is which hemangiomas require treatment. We suggest that any haemangioma which is rapidly proliferating in an area which is likely to impair function, ulcerate or cause disfigurement should be considered for early treatment with propranolol (Any haemangioma which is rapidly proliferating in an area which is likely to impair function, ulcerate or cause disfigurement). ulcerate or cause disfigurement should be considered for early treatment with propranolol). Facial hemangiomas, including lip hemangiomas, may not severely impair function even with deferred treatment, but may require a second-stage procedure to improve facial aesthetics. We believe that early treatment of these cases with propranolol may reduce the number of multiple surgeries, general anesthesia, and improve the final cosmetic outcome. In some cases, the pain of surgery and the resulting scarring may be spared. Propranolol works well in early proliferative hemangiomas and is also effective in regressive cases. There is still controversy over beta-blockers for the treatment of hemangiomas, and given their clear immediate efficacy and fewer adverse effects, what is our rationale for not using them as first-line treatment for hemangiomas with possible complications? Do we also need to consider treating most fast-growing hemangiomas of the face to minimize aesthetic problems later in life, regardless of their functional impact or potential for ulceration? Topical application of timolol ointment to treat superficial hemangiomas in the early stages of proliferation has also yielded favorable results. Do we therefore consider initiating topical medication at the time of the patient’s visit to minimize any potential proliferative complications. We believe that based on the limited evidence available, more patients with hemangiomas should be considered for treatment with propranolol, including rapidly proliferating hemangiomas of the face and perineum. Several questions need to be answered and emphasized in the future; the mechanism of beta-blocker therapy for hemangiomas is unknown, and several mechanisms of action are postulated. Blockade of catecholamine β-receptor-induced vasodilatation leads to decreased NO synthesis and vasoconstriction. In addition, VEGF and angiogenesis may be downregulated. Other beta-blockers may be more specific, more effective than propranolol, and have fewer adverse effects. The dosage and regimen of treatment are also currently not standardized. We recommend the formation of a multidisciplinary treatment team so that children presenting with hemangiomas are diagnosed early and treated appropriately and safely. This area of clinical practice is undergoing rapid change, and clinicians interested in treating these cases should keep abreast of new developments in the field.