Dermatologist or plastic surgeon: who should treat a scar?

If you are looking into scar treatment, one of the first questions is whether to see a dermatologist or a plastic surgeon. The answer matters less than you might think. Both treat scars, often with the same tools. What matters more is how seriously, and how often, a clinic treats scars. Here is how to judge that.

Both specialties use the same treatments

Scars are treated with vascular lasers, fractional lasers, corticosteroid injections, and revision surgery, in which the scar is cut out and the wound closed again. No specialty owns any of these. Some plastic surgery clinics, ours among them, take laser treatment as seriously as surgery, and some dermatology clinics cut out and re-close scars. The familiar division of labor, with plastic surgeons operating and dermatologists using lasers, does not hold up in practice. The specialty alone will not tell you what a clinic actually offers.

Non-surgical treatment comes first

The evidence on this is clear. An international expert panel concluded that the treatments with the strongest evidence for problem scars are non-surgical: silicone gel or sheets, and corticosteroid injections (Mustoe 2002, PMID 12142678). Any clinic that treats scars should have these in daily use, and the shift toward non-surgical care has only grown since. A deep, sunken, or misaligned scar may still need revision surgery. You are more likely to find that at a plastic surgery clinic, where surgery is routine, though some dermatology clinics offer it too. Here again, experience counts for more than the specialty.

Three things to look for in a clinic

Range of tools. Redness, discoloration, uneven texture, and thickness each call for a different device. A clinic with a single device can treat only some kinds of scars.

A plan, not a single procedure. Few scars are finished with one treatment. After revision surgery, for example, a course of combined laser sessions starting two weeks after the operation improved the scars (Song 2021, PMID 33704997). At a consultation, you should hear what starts now, what comes later, and what changes if the scar thickens.

Experience with scars. Two clinics can own the same device and get different results. The settings, the intervals between sessions, and the right combinations come from having treated many scars.

In the end, the question is not which specialty, but how seriously the clinic takes scars.

References

1. Mustoe TA, et al. (2002). International clinical recommendations on scar management. Plast Reconstr Surg. PMID 12142678 (opens in new window).
2. Song WJ, et al. (2021). The effectiveness of early combined CO2 ablative fractional laser and 595-nm pulsed dye laser treatment after scar revision. J Craniofac Surg. PMID 33704997 (opens in new window).