Is it better to see a dermatologist or a plastic surgeon to treat a keloid scar? (Photo)

Question

Hi, I've had three different dermatologists treat a stubborn keloid scar on my chest over 10 years. I've had multiple rounds of steriod injections into my keloid scar and all that has happened is that it's trippled in size and is still painful and itchy. I've read steriod tapes with injections might work but my current dermatologist refuses to prescribe it. What other options are there? Should I see a plastic surgeon instead, are they more experienced at treating scars?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

Keloid scars can be challenging to treat, and your experience with multiple rounds of steroid injections without satisfactory results is not uncommon. Both dermatologists and plastic surgeons can treat keloid scars, but their approaches and expertise can differ. Here's a breakdown to help you decide the best course of action:

Dermatologist vs. Plastic Surgeon
**Dermatologists:**
- **Expertise:** Dermatologists specialize in skin conditions and are often the first line of treatment for keloids. They are well-versed in non-surgical treatments such as steroid injections, silicone sheets, and other topical treatments.
- **Treatment Options:** Besides steroid injections, dermatologists might offer cryotherapy, laser therapy, or topical treatments like silicone gels or sheets.

**Plastic Surgeons:**
- **Expertise:** Plastic surgeons are skilled in surgical and non-surgical techniques to improve the appearance and function of skin and tissue. They often handle more complex cases that may require surgical intervention.
- **Treatment Options:** Plastic surgeons can offer surgical removal of the keloid, followed by adjunct therapies to minimize recurrence, such as radiation therapy, steroid injections, or pressure dressings.

Additional Treatment Options
Given your history and the persistence of your keloid, exploring other treatments might be beneficial. Here are some options:

1. **Laser Therapy:** Pulsed dye lasers can reduce the redness and size of keloids by targeting blood vessels within the scar.
2. **Cryotherapy:** Freezing the keloid with liquid nitrogen can help reduce its size, especially when combined with other treatments.
3. **Radiation Therapy:** Low-dose radiation therapy after surgical removal of the keloid can help prevent recurrence.
4. **Silicone Gel Sheets:** These can be worn over the scar to flatten and soften it over time.
5. **Steroid Tape:** Although your current dermatologist is reluctant to prescribe it, this approach combines the benefits of occlusion and steroid therapy and might be worth discussing with another specialist.
6. **Intralesional Injections:** Injections of other agents such as 5-fluorouracil (5-FU) or bleomycin can be considered if steroid injections have failed.
7. **Pressure Therapy:** Wearing pressure garments can help flatten keloids, though this is more commonly used for larger areas like after burns.

What to Do Next
Given your history of unsuccessful treatments with dermatologists, consulting with a plastic surgeon could be a reasonable next step. They can evaluate whether surgical removal followed by adjunct therapies might offer better results. Additionally, a plastic surgeon might be more open to combining treatments in a multi-modal approach, which can sometimes be more effective.

Both dermatologists and plastic surgeons have valuable expertise in treating keloid scars, but given your prolonged and unsuccessful treatment history, seeing a plastic surgeon might provide new perspectives and options. They can assess whether surgical intervention combined with other therapies might be more effective for your stubborn keloid. Always ensure to discuss all potential risks, benefits, and expected outcomes with any specialist you consult.

Is it better to see a dermatologist or a plastic surgeon to treat a keloid scar? (Photo)

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Is it better to see a dermatologist or a plastic surgeon to treat a keloid scar? (Photo)

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Everything you need to know about Scar Removal

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