Hypertrophic and keloid scars present significant challenges in surgical recovery and perioperative care, especially in patients undergoing reconstructive procedures or burn treatment. These scars can cause pain, pruritus, and psychosocial distress. There is a higher burden in individuals with skin of color, a term commonly used to describe those with Fitzpatrick skin types IV to VI, due to both increased incidence and limitations of early detection. Traditional treatment approaches often overlook the complex nature of wound healing and the influence of perioperative inflammation and pain control. Recent advances, such as high-frequency ultrasound, shear wave elastography, and artificial intelligence tools, have improved the ability to assess scars objectively and detect changes early. Wearable monitoring systems and personalized therapies are also creating new options to guide treatment. Intraoperative and postoperative strategies, including silicone sheeting and corticosteroid injections, are central to improving outcomes. Anesthesiologists contribute by using regional techniques that reduce inflammation and support recovery. This review explores how surgical, anesthetic, and dermatologic strategies together can improve care and reduce disparities in scar management.