Who Should Treat a Keloid? Dermatologist vs Plastic Surgeon

For a small, early keloid, a dermatologist can often manage it directly with injections or freezing. If it needs surgery, that’s typically a plastic surgeon’s job, and if radiotherapy is part of the plan, they’ll usually coordinate with a radiation specialist. What a general aesthetic or beauty clinic can offer is more limited here than it is for most cosmetic concerns, and it’s worth knowing why before you book anything.

Quick Answer: Who Handles What

• Non-surgical management (steroid shots, freezing, pressure therapy): usually a dermatologist
• Surgery: usually a plastic surgeon
• Surgery plus radiotherapy: a plastic surgeon, coordinating with a radiation specialist for the follow-up sessions

What a Dermatologist Handles

A dermatologist can typically manage the entire non-surgical track: diagnosing the keloid, giving steroid injections or cryotherapy, and adjusting the plan over several visits based on how it responds.

For a lot of smaller or newer keloids, this is genuinely enough on its own, and it never needs to escalate to surgery. A dermatologist is also usually the right person to guide pressure therapy and to monitor for pigment changes at the treatment site, especially on darker skin tones where that risk is higher.

What a Plastic Surgeon Handles

A plastic surgeon performs the excision itself and decides how the wound is closed, since certain closure techniques are associated with a lower chance of the keloid returning than others.

Just as important as the surgery is what happens right after it. Because keloids commonly grow back after excision alone, a plastic surgeon typically builds a follow-up plan into the surgery itself, whether that means steroid injections afterward or coordinating a short course of radiotherapy with a radiation specialist. A surgeon who talks about the surgery without talking about what comes after it is only telling you half the plan.

Why “Aesthetic Clinic” Isn’t the Same as Either of These

“Aesthetic clinic” or “beauty clinic” describes a type of business, not a medical license. Some are run by licensed dermatologists or plastic surgeons, in which case you’re getting the real thing under a different sign. Others are staffed by practitioners whose training is in cosmetic treatments like lasers or injectables for purely aesthetic purposes, without specific medical training in keloids as a condition.

The name on the door doesn’t tell you which one you’re walking into. What matters is the individual practitioner’s actual medical qualification, not how the clinic markets itself.

Questions Worth Asking Before You Book

• Are you a licensed dermatologist or plastic surgeon, and is that your primary medical qualification?
• How many keloids specifically, not just general scars, have you treated?
• If surgery is recommended, what’s the follow-up plan to lower the chance it comes back?
• Do you have experience treating darker skin tones, given the higher risk of pigment changes with several of these treatments?
• If radiotherapy is part of the plan, who provides it, and how is it coordinated with the surgery?

Red Flags

• A provider who promises your keloid is gone for good after a single visit. Keloids are unpredictable enough that no honest provider promises this.
• No mention of recurrence risk at all, as if surgery alone is the whole story.
• Pressure to book immediately without an actual examination or consultation.
• Treating a keloid the same way they’d treat a purely cosmetic scar, without discussing it as the medical condition it is.

If You’re Comparing Options Abroad

When treatment happens away from home, it’s worth understanding upfront how follow-up is planned, since keloid management often isn’t a single visit. Ask what happens if something needs adjusting after you’ve returned home, and whether your records and photos are shared with you in a way a local doctor could pick up later if needed.