Burn scars require ongoing treatment that may continue for years after wounds heal. Scarring affects both function and appearance, and comprehensive scar management can significantly improve outcomes. Understanding scar treatment options helps burn victims maximize recovery and ensures legal claims capture the full cost of scar care.
How Burn Scars Form
Burn wounds heal through scar formation when the dermis is damaged and cannot regenerate normally. Collagen production during healing creates scar tissue that differs from normal skin in appearance, texture, and function. Deep burns produce more prominent scars than superficial burns because more dermis is destroyed.
Hypertrophic scars remain within the boundaries of the original wound but are raised, red, and firm. These scars are common after burns and may improve over time with treatment. Hypertrophic scars typically reach maximum thickness three to six months after injury before gradually softening.
Keloid scars grow beyond the original wound boundaries into surrounding skin. Keloids are more common in certain ethnicities and body locations. Unlike hypertrophic scars, keloids do not improve without treatment and may continue enlarging.
Scar contracture occurs when scar tissue shortens, pulling surrounding skin and limiting movement. Contractures are particularly problematic when burns cross joints, potentially restricting range of motion and function.
Pressure Therapy
Pressure garments are the foundation of burn scar treatment. Custom-fitted elastic garments apply constant pressure that helps flatten scars and reduce redness. Pressure therapy should begin as soon as wounds are healed enough to tolerate compression.
Compliance requirements are demanding—garments must be worn 23 hours daily for one to two years for optimal results. Patients need multiple sets of garments as they wear out and as measurements change. Children need frequent garment replacement as they grow.
Effectiveness depends on consistent wear. Patients who cannot tolerate garments or who remove them frequently see diminished results. Starting pressure therapy early and maintaining compliance produce the best scar outcomes.
Silicone Treatment
Silicone sheets and gels help soften and flatten scars through mechanisms not fully understood. Silicone products may work by maintaining hydration and temperature at the scar surface. These treatments are used alone or in combination with pressure therapy.
Silicone application requires consistency similar to pressure garments. Sheets are worn for extended periods daily. Gels are applied regularly to keep scar surfaces covered. Several months of consistent treatment are needed to see improvement.
Injection Treatments
Corticosteroid injections reduce inflammation and can flatten hypertrophic and keloid scars. Multiple injection sessions over months may be needed. Injections can be painful and may cause side effects including skin thinning and depigmentation.
Other injectable treatments including 5-fluorouracil and bleomycin may be used for resistant scars. These chemotherapy agents interfere with collagen production. They are typically reserved for scars not responding to corticosteroids.
Laser Treatment
Pulsed dye lasers target blood vessels in red, hypertrophic scars. Multiple treatments reduce redness and may improve scar texture. Laser therapy can significantly improve scar appearance when combined with other treatments.
Fractional lasers create tiny wounds that stimulate collagen remodeling as they heal. These treatments can improve scar texture and blend scar edges with surrounding skin. Multiple treatment sessions are typically required.
Laser treatment costs vary based on scar size and number of sessions needed. Each session may cost several hundred to several thousand dollars. Comprehensive laser treatment can total tens of thousands of dollars for extensive scarring.
Surgical Scar Revision
Scar excision removes scar tissue and reclosures wounds, potentially producing less prominent scars. This technique works best for narrow linear scars that can be closed with minimal tension.
Z-plasty and other geometric revisions reorient scar lines to reduce tension and improve appearance. These techniques are particularly useful for releasing scar contractures and repositioning scars to less visible locations.
Tissue expansion provides additional skin for scar replacement. Expanders placed under healthy skin near scars gradually stretch tissue that can then cover excised scar areas. This technique provides skin matching the surrounding area.
Ongoing Treatment Needs
Scar treatment continues for years after initial healing. Scars mature over 12 to 24 months, changing throughout this period. Treatment protocols adapt as scars evolve. Ongoing monitoring identifies problems requiring intervention.
Children with burn scars need treatment adjusted as they grow. Scars that are adequate in childhood may become tight or prominent during growth spurts. Regular follow-up and revision procedures address these changes.
Life care planning projects lifetime scar treatment needs and costs. Planners estimate years of pressure garments, laser treatments, and revision surgeries based on injury severity and expected scar behavior. These projections support claims for future scar care costs.
Conclusion
Burn scar treatment requires sustained effort over months to years using multiple treatment modalities. Pressure therapy, silicone, injections, lasers, and surgery each play roles in comprehensive scar management. Understanding treatment options and costs helps burn victims pursue optimal scar outcomes and ensures legal claims capture the full extent of scar treatment expenses.