Introduction: Fractionated resurfacing has been demonstrated in case reports to notably improve the cosmetic outcome of surgical scars. The aim of this study was to compare fractionated resurfacing (fractional photothermolysis [FP]) with the pulsed dye laser (PDL). If novel minimally invasive therapies such as FP are proven to be safe and effective for the treatment of surgical scars, patients receiving cutaneous surgery will be significantly allayed in their concern about the cosmetic outcomes of their surgical scars. Materials and Methods: Randomized, double-blinded split scar study in 15 scars in a total of 12 patients after Mohs surgery for nonmelanoma skin cancer on the face, neck, chest, or back. Patients were treated on one-half of the scar with 1550-nm erbium doped fiber laser and on the contralateral half with the 595 nm V-Beam PDL. Patients were treated with each laser device on half of the scar for a total of 2 treatment sessions at 2-week intervals. Results: After a series of 2 treatments, greater improvements were noted in the portion of surgical scars treated with FP than with PDL in overall cosmetic outcome (FP, mean improvement = 59.7%, range = 40–80% vs PDL, mean improvement = 47.9%, range = 20–60%; P= .05). In pigmentary variation (FP, mean improvement = 47.2%, range = 20–80% vs PDL, mean improvement = 28.5%, range = 0–40%; P<.05); scar thickness (FP, mean improvement = 71.4%, range = 40–80% vs PDL, mean improvement = 35.4%, range = 0–60%; P<.05); and scar texture (FP, mean improvement = 64.3%, range = 40–80% vs PDL, mean improvement = 43.4%, range = 20–60%; P< .05). A total of 4 scars with significant hypopigmentation had improvements in pigmentation after treatment with FP (mean improvement = 45.0%, range = 20–80%) with no improvement after treatment with PDL (0%) (P < .05). There was no incidence of dyspigmentation, ulceration, or scarring with either device. Conclusions: To the authors' knowledge, this is the first study to compare the outcome of treatment with PDL with FP in terms of pigmentary variation, textural change, and overall cosmetic improvement. The data presented herein suggest that FP results in significantly greater improvements in surface pigmentation, textural variation, and scar thickness relative to PDL. Similar to previous case reports, FP was uniquely successful in improving hypopigmented scars. The greater depth of penetration and significant skin remodeling induced with FP likely account for its greater improvement in textural change and thickness of surgical scars. Both FP and PDL appear to be highly safe modalities for the treatment of surgical scars with minimal discomfort and no adverse effects.