The industrial objective of lowering the mass of mechanical structures requires continuous improvement in controlling the mechanical properties of metallic materials. Steel cleanliness and especially control of inclusion size distribution have, therefore, become major challenges. Inclusions have a detrimental effect on fatigue that strongly depends both on inclusion content and on the size of the largest inclusions. Ladle treatment of liquid steel has long been recognized as the processing stage responsible for the inclusion of cleanliness. A multiscale modeling has been proposed to investigate the inclusion behavior. The evolution of the inclusion size distribution is simulated at the process scale due to coupling a computational fluid dynamics calculation with a population balance method integrating all mechanisms, i.e., flotation, aggregation, settling, and capture at the top layer. Particular attention has been paid to the aggregation mechanism and the simulations at an inclusion scale with fully resolved inclusions that represent hydrodynamic conditions of the ladle, which have been specifically developed. Simulations of an industrial-type ladle highlight that inclusion cleanliness is mainly ruled by aggregation. Quantitative knowledge of aggregation kinetics has been extracted and captured from mesoscale simulations. Aggregation efficiency has been observed to drop drastically when increasing the particle size ratio.