RESEARCH COMMENTARY · COSMODERMA
The short answer
Early treatment of a red surgical scar is not simply a race to begin laser treatment. First, the wound must be fully covered by new skin and clinically stable. If redness remains prominent, we assess the scar's current features and consider whether vascular laser treatment is appropriate. Redness alone does not mean every scar needs a procedure.
Hello, I am Kihwan Bae, MD. In my CosmoDerma perspective article, I discuss how we understand early pulsed dye laser, or PDL, treatment for red, developing scars. The article offers a way of interpreting existing evidence; it is not a new clinical trial or proof that one approach is best for every patient.
A closed wound is still changing
After surgery or an injury, healing continues beneath the surface even when the wound appears closed. Blood vessels and inflammation change, while collagen is produced and reorganized. The scar's color, thickness, and firmness can change along with them. A scar still going through this process is called an immature scar.
Some early redness belongs to normal recovery. Persistent redness, especially with itching or increasing firmness, deserves assessment in context. We need to understand the stage of healing and what is changing, rather than judging the scar from its color alone.
Why I describe this as vascular modulation
PDL uses light absorbed by hemoglobin in blood to target blood vessels. However, blood vessels are essential to wound healing: they supply oxygen and nutrients and support restoration of the skin surface and underlying tissue.
My article distinguishes that useful healing process from vascular activity that persists in a closed immature scar. The latter may be associated with ongoing inflammation and an environment that influences fibroblasts, the cells involved in collagen production.
In this context, vascular modulation means appropriately regulating persistent vascular and inflammatory activity after wound closure. It does not mean broadly suppressing the formation of new blood vessels. That distinction matters because normal healing must be respected, not interrupted simply to make redness disappear.
The wound's condition guides the timing
The number of days since surgery or stitch removal is only part of the assessment. An open wound, incomplete skin coverage, or infection needs wound care first. Reducing tension on the healing wound may also be important. These are not problems to treat as an ordinary cosmetic scar.
Once new skin fully covers the wound and the surface is stable, conservative PDL may be considered for selected scars with prominent redness. The decision also depends on thickness, firmness, symptoms, and other findings. Published studies give reasons to consider earlier intervention in suitable cases, but they do not establish a universal treatment deadline.
A white scar is not just a scar with fewer vessels
Pale or white scars involve more than changes in blood vessels. Pigment-producing cells and pigment transfer, collagen arrangement, scar width, surface texture, and contrast with the surrounding skin can all affect their appearance.
We therefore cannot assume that reducing redness will prevent a white scar, or that PDL alone can solve loss of pigment. A pale scar that is also widened, depressed, or uneven needs assessment of its pigment and structure together. Different features may call for different treatment priorities.
What this means in the consultation room
My starting point is the scar in front of me: what is healing normally, what remains active, and what is most visible or uncomfortable for the patient? The purpose of this perspective is to support that reasoning, not to promise complete scar removal. I explain why a treatment is being considered, the changes we hope to assess, and the limits of the available evidence.
Questions patients often ask
Does every red scar need PDL?
No. Redness may occur during normal healing. The wound's stability, symptoms, firmness, and course over time help determine whether observation, basic care, or a procedure is appropriate.
Does “early” mean immediately after surgery?
No. Complete skin coverage and clinical stability come first. A calendar date alone cannot confirm that a wound is ready for elective scar treatment.
Can PDL prevent a pale or white scar?
PDL alone cannot be said to prevent white scars. Pigment function and structural changes require their own assessment, even when redness has improved.
Original paper and further reading
Bae K. Early pulsed dye laser for erythematous immature scars: Vascular modulation, not anti-angiogenesis. CosmoDerma. 2026;6:122. Perspective. Published 23 October 2026. DOI: 10.25259/CSDM_165_2026.
Adapted from my Korean clinic column and its English edition. Original Korean blog post.
For an individual assessment, contact ELION Clinic in English. This article is educational and does not replace an examination. Treatment suitability and results vary between patients.