How Burn Scars Are Treated

After a burn has healed, you’ll likely be left with a scar—especially if it is a second or third-degree burn. The severity of scarring you’ll see depends on the depth of the burn and how it was initially treated and managed. While It may not be possible to completely eliminate burn scars, this doesn’t mean you can’t treat them and reduce their appearance. Treatments for burn scars generally fall under four main categories: over the counter topical treatments, non-surgical specialist procedures, laser therapy, and surgery.

The appropriate treatments for you, out of the many available options, will largely depend on your answer to this question: Are your burn scars merely aesthetic or do they come with contractures that affect your ability to move the muscles and joints in the area?

burn scar treatment
Illustration by Brianna Gilmartin, Verywell

Over-the-Counter Topical Treatments

Moisturizers and Emollients

Constant itchiness is a common issue with burn scars. This happens because burns impair or destroy oil glands in the affected area, creating dry and itchy skin.

While no treatment may be able to completely get rid of the itchiness, there are a number of moisturizers and emollients that can help. The ideal thing to do would be to ask your doctor to recommend good brands, but if you'd rather select them yourself, opt for unscented/fragrance-free creams to avoid skin irritation.

You should apply moisturizers carefully and gently when the burn scars are still new. As the scars get older and become less fragile, you can apply more pressure when applying the moisturizers to help prevent scar stiffness and loosen up the area.

Silicone Gel Sheets

These are thin pieces of medical grade silicone that are worn around the skin to help with scarring. They are widely used in treating burn scars and are accepted as one of the best non-surgical options for burn scars.

Silicone gel (whether in sheet form or not) has been proven to help reduce the thickness of burn scars. It also diminishes any itchiness and pain you may feel at the site of the scar. For maximum effectiveness, you should keep silicone gel sheets on your skin for at least 12 hours daily. Silicone gel sheets can be used on your scars even if they aren't merely aesthetic.

When using this treatment, it is important that you keep your skin clean to avoid skin rashes, irritations, or infections, especially if you live in a hot or warm weather area. You also shouldn't use silicone over any unhealed skin or in combination with antibiotic skin ointments. While allergic reactions to silicone gel are rare, if you suspect you’re experiencing one, you should stop applying it immediately and go see your doctor.

Massage Therapy

Massage therapy is used to reduce the pain, skin sensitivity, and sometimes very serious itchiness that usually comes with burn scars. Additionally, it can reduce the height and appearance of your burn scars. And because it involves manipulating the scar tissue that’s under your skin, massage therapy lessens the tightness and restriction of movement you’re probably experiencing if your burn injury was extensive. So, if you’re having trouble moving the affected areas freely and fluidly, properly administered massage therapy will be effective.

There are different kinds of massage techniques used in burn centers, including kneading, skin rolling, stretching, and stroking. Your doctor or occupational therapist should instruct you on how to perform these techniques at home along with the right time to start. If you need help, there are massage therapists trained and/or experienced in dealing with scars whose services you can use.

You shouldn’t massage skin that’s infected, not fully healed, or still fragile as that could actually worsen the problem.

Pressure Therapy

This method of treating burn scars has been in use for decades and it is usually the first treatment option resorted to for hypertrophic (raised scars) in burn centers. It involves you wearing pressure garments—elastic garments that apply pressure to your scar areas. If the burn scars are on your face, the pressure will be applied using transparent face masks. Pressure therapy should be used for 6 to 12 months in order for it to be effective, and it is advised that you wear the garments for 23 hours every day.

While it’s a very effective method of treating (and even preventing) hypertrophic burn scars, there are a couple problems associated with pressure therapy. For one, wearing pressure garments can be very uncomfortable and can even cause blistering, particularly if you live in a hot and humid climate. Secondly, the garments can also cause overheating, itchiness, and wound breakdown. Pressure therapy is to be implemented by your doctor while you’re at the hospital, after which you’ll continue with it at home.

It’s important to note that despite its pervasiveness in hospitals and clinics, there isn't a lot of medical literature backing up the efficacy of pressure therapy.

Steroid Injections

Steroid injections are mainly used to treat keloid burn scars (raised, smooth, thick, and rounded scars that sometimes go outside the boundaries of the original burn injury). Steroids, usually corticosteroids, are injected into the scars to soften and shrink them. The injected steroids can also help reduce the pain and itching that’s generally associated with burn scars. Although it's not usually the first line of therapy for hypertrophic (raised) burn scars, it’s effective and can be used if you’ve tried other treatments and they haven’t worked.

If you receive this line of treatment, you may experience side effects such as skin discoloration and skin thinning. And while allergic reactions to steroid injections are very uncommon, they’re still a possibility.

Steroid injections are done at the hospital or clinic and you shouldn't try to do them for yourself at home.

The Pros and Cons of Cortisone Injections

Laser Therapy

Laser treatments are used to relieve tightness, discomfort, and pain from burn scars, as well as smooth them out and diminish their redness. There are different kinds of laser therapies used to treat burn scars. The main ones are pulse-dyed laser, fractional laser (ablative and non-ablative), CO2 laser, and switched laser. If you’re considering whether or not to have laser treatments, it’s crucial to consult with your doctor and a laser surgeon.

Before and after having laser therapy, you should be very diligent about sun protection. Following your surgeon’s or dermatologist’s post-laser instructions in taking care of the site is also a must.

With laser treatment, it’s possible that you may need more than one treatment and it may also take several weeks before you start to see positive results. Common side effects of laser treatments include redness, swelling, hyperpigmentation, itching, and the formation of new scars. However, the consensus drawn from many studies and clinical trials is that using laser therapy to treat burn scars is safe enough that the benefits outweigh the potential risks.

Surgical Treatments

Some burn scars are serious enough that surgery may be needed to treat them. Typically, with these types of severe scarring, large areas of skin have been damaged and lost. As a result, contractures form. In other words, the skin there is tight, making your range of movement limited.

Most surgeries performed on burn scars are done primarily to deal with contractures and improve range of motion, and this may sometimes necessitate the removal of scar tissue that has formed underneath the skin. The types of surgeries used to treat burn scars include the following.

Skin Graft

In this procedure, a thin piece of skin is taken from a normal part of the body (usually the buttocks or inner thigh) and used to replace the scarred skin. With this kind of surgery, it is likely that the skin used to replace the scarred skin may not match in color or texture. Additionally, while your original burn scars will be less visible after the skin graft, new scars (albeit more aesthetically pleasing) will form.

What to Expect During a Skin Graft

Skin Flap

This procedure is very similar to a skin graft, with the major difference being that the skin taken from the healthy body part has its own blood supply. This means that blood vessels, fat, and muscles are taken along with the piece of skin. This procedure is usually adopted when the blood supply to the scarred skin is damaged.

Z Plasty

This surgical procedure involves making a Z-shaped incision into your burn scars. It reduces the number of contractures, thereby improving flexibility and decreasing tightness. It also minimizes the appearance of the scars and can be used to reposition your scars in order to make them less noticeable and blend in better with natural creases in the surrounding skin areas.

Tissue Expansion

This procedure is used when the burn scars are to be removed either partially or in their entirety. A balloon-like object called a tissue expander is placed under a normal part of your skin near the scarred area. This tissue expander will be continuously filled with saline solution and over time the normal skin it was placed under will stretch out.

Once the surgeon deems the skin to be adequately stretched, the scar is then removed while the stretched skin is pulled over and used to cover the opening.

Dermabrasion

This involves surgically sanding and scraping the top layer of your burn scars in order to make them smoother and improve their appearance.

Fat Graft

This surgical procedure can be used if your burn scars are uneven and depressed in some places. It involves transplanting fat from a healthy part of your body to the scarred and depressed areas to raise them and make their appearance smoother.

What to Expect Post-Surgery

While results and effects vary from person to person, there are a couple of things you should expect after undergoing surgery for your burn scars:

  • You should expect your doctor or surgeon to give you detailed instructions for taking care of the site when you get home. To avoid post surgery complications, it’s crucial that you adhere to these instructions to the letter.
  • You should know that some of these surgical procedures can involve pain, especially in the aftermath after the anaesthetic you may have been given has worn off. Swelling and redness of and around the scar area is also a common occurrence.
  • The different surgeries come with their own unique risks and side effects, all of which you should discuss with your surgeon or doctor prior to undergoing them.

Many doctors like to wait months or even years before performing burn scar surgeries in order to allow your body to heal fully and properly. In any case, it should be up to your doctor to determine when the right time for you is.

A Word From Verywell

With burn scar treatments it’s imperative that you discuss your options with your doctor or surgeon before undergoing any of them. This is because each burn scar is unique and certain treatments suitable for one person may not be suitable for you. Some of these treatments can also be used in combination with each other, or one after the other, depending on what your doctor sees fit.

It’s also important for you to have realistic expectations as it is highly unlikely that your burn scars will go away completely (except when they are really minor). More so, surviving serious burns and being left with scars can be devastating and can affect your confidence. As you come to accept the changes to your appearance, if you are struggling, consider seeing a psychologist or therapist to help you heal emotionally and psychologically.

Was this page helpful?
Article Sources