Abstract : Vascular malformations of the head and neck result in various clinical symptoms, physical appearances, and different degrees of psychosocial well-being. In children most small and superficial venous malformations can be treated easily and effectively; however, management of deep and severe lesions involving numerous anatomical locations remains challenging. We discuss the challenges and a single institution’s experience with pediatric surgical resection of complex vascular malformations in head and neck regions not only were anatomically challenging but also did not resposnd to conservative or sclerotherapy. This case series involved pediatric patients who had undergone operative management of vascular malformation in the head and neck regions in 2022 to 2023. The patients were referred by the dermatology department for surgical excision because of poor response to nonsurgical treatment. Five patients underwent surgical debulking and two children underwent excision of vascular malformations; their ages ranged from 3 months to 8 years. The lesions were located on the scalp, cheek, and neck ; four were lymphatic malformations and two were venous malformations. A single surgeon operated on all seven patients. The surgical incision and approach were individualized in each case to meet the goal of aesthetic and functional outcomes. No recurrence occurred in the follow-up. One patient had transient facial weakness. Early intervention, especially in pediatric cases with rapidly enlarging symptomatic vascular malformations, is vital to prevent complications and ensure the best possible outcomes.