Dermatologist or Plastic Surgeon?

Updated on July 03, 2019
J.N. asks from Lubbock, TX
13 answers

I’m not sure who I should consult with. I have scaly brown patches on my skin - mostly chest. I’m not sure who I need to see about removal. I assume that a laser will be needed. Perhaps freezing will work.

I had a skin check a couple of years ago and was given the all clear.

If I go to a plastic surgeon do they have the expertise to send my to a dermatologist if something is suspicious?

I understand this is a medical question. I will be going to a doctor, but I need to know where to start.

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answers from Miami on

Absolutely dermatologist. They need to be assessed. These patches could have changed since a year ago. A dermatologist is excellent at laser and freezing.

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answers from Portland on

First you need a diagnosis to know what those brown patches are from a dermatologist.
The dermatologist will then refer you to the person who can help you if he can't. I suggest you will not need a plastic surgeon. Removing spots is a part of dermatology.

I have raised brown spots all over my body. So did my grandfather and father. I saw a dermatologist many years ago when they started to appear. She gave them a name which I've forgotten. She said they could not be removed. More spots appeared over the years. My primary care doctor monitors them. They are not cancerous and cannot be removed. Now I have light brown age spots that continue to increase in numbers. If I'd been able to have all of them removed, I'd be covered with scars.

If you haven't asked your primary care doctor, I suggest you start with seeing him or asking him who you should see. If you don't have good insurance coverage for specialists, know that specialists usually charge more than primary care doctors.

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answers from Norfolk on

I'd start with a dermatologist.
My worry would be that this might be something that would come back after having it removed and that's assuming it's something that could be removed in the first place.
I really hope it's not some sort of skin cancer that's developed since your last skin check.
Use a good sunscreen in the mean time.

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answers from Dallas on

Why would you go to a plastic surgeon for a dermatologist's job?

I could see potentially going to a plastic surgeon if surgery caused some sort of scarring you wanted to repair but you need to see a dermatologist first so they can use their specialty to diagnose and care for you properly.

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answers from San Francisco on

I always start with my primary care doc and get referrals from there (in fact, some insurance requires that.)

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answers from Springfield on

We have an HMO, so we are required to begin with our primary care physician. The insurance won't pay for a specialist unless our PCP refers us. So I'm already in the habit. Still, that's a good place to start. I would just call your PCP and ask. Usually the nurse asks me a few questions and tells me what she thinks the doctor will say. Then she calls back a little later (after she's had a chance to speak with the doctor) and lets us know for sure.

Your PCP is the one who will know for sure the best place to begin.

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answers from Minneapolis on

Dermatologist for sure. Are you aware that “skin checks” should be done yearly?

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answers from San Francisco on

You need to start with a dermatologist, just to be sure that nothing is cancerous. Also, depending on what your condition is, a dermatologist might be able to suggest remedies for the scaliness. One thing you might try first is Retin A, which will peel your skin and definitely improve it over time. You will need to be consistent with sunscreen.

If the above doesn't work, a plastic surgeon's office can offer chemical or laser peels, which should definitely help; there are a number of other treatments such as microneedling that might take care of this. Dermatologists can often offer these things as well though, so start there. You should definitely be able to at least minimize your problem with the right treatment.

Beware though, I suggest you thoroughly research anything that is suggested by a plastic surgeon. There are numerous treatments that sound great but that in the wrong hands can cause worse problems. I'm recalling some kind of radio wave treatment (or something like that, can't remember exactly) that sounded non-invasive and fabulous, but when I researched it there were numerous complaints of permanent pock marks that appeared on people's skin after treatment.

But for sure try Retin A. It can't hurt you and the results are proven.

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answers from Washington DC on

there's no way i'd go to a plastic surgeon without having everything thoroughly checked out by a dermatologist first.

i'd hoped my dermatologist would say 'oh, that's no biggie' and snip off some barnacles and give me a nice cream for my scaly bits. turns out most of 'em aren't fixable and need to be watched.

remember, surgeons do surgery. it's unusual to go to a surgeon and have them NOT recommend it. if you've got a hammer, everything looks like a nail.


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answers from Boston on

I think you start with a dermatologist. It's possible surgery isn't needed, and you'd be surprised by what a dermatologist can do in the office, from removals to biopsies (since you're concerned about something more ominous). Besides, you need to get to the bottom of what's happening, perhaps in the dermis (the next layer below the thin epidermis).

You may need a referral from your PCP to the dermatologist since it's been a few years, but most surgeons would require a referral anyway before they'd see you, and your insurance probably won't cover things if you skip that step.

And yes, if you have surgery, the samples go to pathology and a report goes back to the referring physician (dermatologist) as well as the surgeon. You can make sure they have all the info to make this a smooth process, but that's how it works.

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answers from Miami on

A lot of dermatologists are able to perform surgical procedures, such as laser removal, wart freezing, or stretch mark removal, as well as melanoma removal. You may have skin cancer, a precursor to it (which definitely needs a dermatologist for monitoring), or a form of keratosis. If he/she is unable to remove it and it is necessary to remove the patches, then I'm sure there are specific plastic surgeons they will recommend, who have expertise in this area, rather than the type who specialize in implants or lip injections. Definitely start with the dermatologist, to rule out anything dangerous, and see what they recommend, if it's something they cannot remove and should be removed.

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answers from Washington DC on

I would start with the dermatologist. You need to know what the brown scales are BEFORE They are removed. A plastic surgeon can remove them - but don't you want to know WHAT they are? Just because you were given the "all clear" years ago - doesn't mean you're all clear now.

Start with a dermatologist.



answers from Portland on

I've been to both for different things, and I also go to a laser treatment center for other things - like for veins and also for hair removal. When I had my vein done, it was done by a doctor (I don't think it was actually either a plastic surgeon or dermatologist but called something else) - who was specialized in lasers. There was also a woman very trained in lasers, who was not a doctor. So if it's just unsightly, and not necessarily medical in nature, but more 'cosmetic' but not requiring cosmetic surgery or dermatological process, there are procedures out there now that can be performed by some of these very professional type spas/treatment facilities by accredited personnel. It really depends on what you have.

Cosmetic surgery ... when I had it, I went through my doctor who sent me for a referral. I did the same for a dermatologist. One for skin stuff (dermatologist) and the surgeon was more for stuff that was far more than skin deep. Think massive surgical procedures. To me this does not sound like that.

I have seen dermatologists for large mole removals when they were on my face and would leave me kind of disfigured (possibly) when my skin was still stretching/growing in very prominent places and they weren't sure what kind of mole they were.

Hope that helps.

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