Pediatric Dermatologist Vs Pediatric Plastic Surgeon and Scar Treatment

Question

My 2 year old daughter fell and hit her forehead 7 weeks ago on a sharp edge of our bed. The cut ran from above her nose just into her eyebrow line. We are looking for advice regarding scar treatment such as pulse dye laser treatment or other options to minimize the scar. I'm interested in determining if it would be best to visit a pediatric dermatologist or a pediatric plastic surgeon for this advice. I am also looking for a doctor recommendations in the north Houston area.See attachment. THX

Larry S. Nichter, MD, MS, FACS · Answer

A pediatric plastic surgeon would have more experience on the nature of the scar and best ways to minimize it including revision. On the other hand for pigmentation issues often pediatric dermatologists are more skilled at scars that are darker or that need specialized lasers.

Vivek Bansal, MD · Answer

I would see both of them, and consider the options. Thank you for your question and good luck with everything.

Steven Turkeltaub, MD · Answer

The scar on your daughter's face appears to be fairly wide. Was it repaired and by what type of physician.

	Typically, one would want to allow this to mature at least a year prior to considering scar revision surgery. In your daughter's situation, it is clear that this scar will always be wide and irregular. The only effective way to treat this would be for surgical scar revision. Therefore, other treatments would be unnecessary, costly, inconvenient and probably further traumatizing for your daughter.

	My recommendation, however, would be to wait until she is a little bit older and can better understand what is going on regarding the scar revision allowing for better compliance and a better result. That could be in a year or more.

Andre Aboolian, MD · Answer

You should allow at least 12 months of healing to see what kind of scar you will be left with (waiting longer would be even better). While waiting some form of scar cream for one or two months would help. I would not do any laser treatment as I don't think it helps. The worse situation is if you don't like the scar at any age, then you can get a scar revision and this should only be done by a plastic surgeon and a good one in Houston is Dr. John Teichgraber.

Mohsen Tavoussi, MD, DO · Answer

The scar should be allowed to mature or heal completely before any revision is done. That means at least 12 months. Scars will widen as the child grows and any revision now will lead a wide scar later in life. I would wait a year or so and reevaluate then. If it is acceptable, then will wait until teen years to do the revision.

Michael G. Brandt, MD · Answer

Hi there.  I hope your daughter is doing better since the accident.  I'd suggest finding an experienced provider in your area.  Specialty matters far less than experience - especially when it comes to treating scars.  You want to have a good rapport with your doctor, especially when it comes to interacting with your 7-year-old.  I'd suggest an experienced Facial Plastic Surgeon, Plastic Surgeon, or Dermatologist - in no specific order. 

	In regards to management, I'd leave that to the discretion of your care-giver.  I would however be cautious about doing anything right away other than looking into a silicone based scar ointment and possibly considering early dermabrasion (if there is a height mismatch) or steroid injections (if it starts to appear heaped up). 

	Leaving things alone for the next 6-12 months will allow things to declare themselves.  Worst scenario is that you don't like the way it heals and you feel it should be revised/re-done - at least we're giving it a chance to heal on its own.  Kids tend to stretch-out/widen their scars - thus leaving things alone until she's in her teen-years or early adulthood and treating it then will likely give her the best appearing scar.

	All the best.

Walter D. Gracia, MD · Answer

Based on the picture that you provided the best result would be to do a scar revision by excising the scar and re closing the wound. No laser would get as good a result. You should seek a Board Certified Plastic surgeon in your area of North Houston, Pediatric Plastic Surgery Specialist are virtually nonexistent and not needed.

Chad L. Prather, MD · Answer

When considering optimal treatments for fresh scars, or thinking about scar revision, it's best to turn to the skin experts who treat scars the most. Dermatologic surgeons treat more scars than any other type of physician, and you would be well served to visit one who specializes in scar treatment and revision. Pediatric and adult scars are treated in the same manner, so a pediatric specialist is not necessary in this instance. Likewise, most plastic surgeons treat scars as well. Either type of physician would be a good choice in this instance.

	Treatments range from short term topicals such as silicone gel to longer term treatments such as pulsed-dye laser, steriod injections, and surgical revision.

	I would recommend Dr. Ryan Ahern in the Houston Area.

Albert Dabbah, MD · Answer

Plastic surgeons have extensive training and experience treating scars. I would recommend consulting with a plastic surgeon. Ask a few of your physicians for recommendations regarding a plastic surgeon in your community.

Edward J. Domanskis, MD (in memoriam) · Answer

I have recommended ScaRxtape for my patients after injury or surgery. It is simple to use, inexpensive and works as well as other more expensive creams. I have patients put it on starting about two weeks after surgery and wear it for several months. It usually stays on through showers for about a week.

Pediatric Dermatologist Vs Pediatric Plastic Surgeon and Scar Treatment

Answers (12)