Scar type

Burn scars

Most burn scars keep changing for 12 to 18 months. Silicone, pressure and massage during that window improve the final result.

Last reviewed 17 Aug 2026 4 articles How we rate evidence

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Overview Treatments Causes Stages Skin tone Self-care FAQ

What burn scars are

In brief

A burn scar forms when heat destroys the dermis and the body rebuilds it with disorganized collagen instead of the normal basket weave. Hypertrophic scars stay inside the original wound, keloids grow past it, and contractures tighten across a joint until movement is limited. Up to 70% of burn patients develop hypertrophic scarring or contracture. Treatment is a routine of pressure, silicone, massage and lasers layered over months. No single procedure resolves it.

Also called: Post-burn scarring, hypertrophic burn scars, burn contracture
Typical timeline: Scarring peaks around 6 months. Maturation takes 12 to 18 months, and some scars remodel for up to 2 years.
Strongest evidence: Silicone and pressure therapy for raised scars, fractional CO2 laser for thickness and stiffness, pulsed dye laser for redness.
See a doctor if: The scar tightens across a joint, or you are losing range of motion.

When to see a doctor

The scar is tightening across a joint or you cannot fully move a limb.
A wound from the burn is still open past two to three weeks.
The scar is growing past the edges of the original burn, which suggests a keloid.
Itch or pain is severe enough to break your sleep or stop you using the limb.

Treatments for burn scars

Treatment	Evidence	Best for	Cost
Silicone gel / sheets 12 to 24 hours a day for at least 2 to 3 months. Sheets are slightly more effective; gels are easier to keep on the face and joints. Consistency matters more than format.	Strong	Raised, immature hypertrophic scars	$	Full page →
Pressure garments 15 to 30 mmHg, worn about 23 hours a day until the scar matures, which can be 8 to 24 months. Garments lose elasticity and need replacing roughly every 3 months.	Limited	Large areas, limbs and torso, active raised scars	$$
Fractional CO2 laser Usually 3 to 6 sessions. A 2021 meta-analysis found improved Vancouver Scar Scale and POSAS scores, with reduced thickness and better pliability. Ablative laser runs roughly $1,000 to $2,509 per session.	Moderate	Thick, stiff, movement-limiting scars	$$$	Full page →
Pulsed dye laser Targets blood vessels at 585 to 595 nm to cut redness and itch. A 2023 systematic review found the largest combined VSS and POSAS reduction of any laser category, though protocols varied widely.	Moderate	Red, immature, itchy, highly vascular scars	$$	Full page →
Massage and moisturizing A 2025 network meta-analysis of 17 randomized trials ranked massage highest for overall scar quality. Firm circular friction plus a neutral water-based moisturizer at least three times daily.	Moderate	Pliability and adhesions, once the wound is closed	$	Full page →
Surgical release (Z-plasty, grafts, flaps) Surgery exchanges a problem scar for a thinner, more flexible one. It does not remove it. Surgeon fees for scar revision run about $1,500 to $5,000 and up.	Strongfor function	Contractures that restrict a joint	$$$$	Full page →

What causes them

Burn depth is the main determinant. First-degree burns heal in about a week without scarring. Partial-thickness burns that close within 14 days usually scar minimally, and the risk climbs sharply once healing passes 14 to 21 days. Full-thickness burns destroy the whole dermis and scar permanently. At the cellular level, TGF-beta 1 and interleukin-6 push fibroblasts to become myofibroblasts, which contract the wound and overproduce collagen. About 11 million people worldwide need medical treatment for burns each year. Between 30% and 90% of survivors develop some pathological scarring.

How they change over time

Stage 1

Wound closure (weeks 0 to 3)

Closure speed predicts the scar. Wounds still open past 14 to 21 days scar substantially more. Keeping the wound moist and free of infection is the priority at this stage.

Stage 2

Active scarring (from 2 to 6 weeks, peaking near 6 months)

The scar rises, reddens, itches and feels tight. Hypertrophic scars appear 2 to 6 weeks after closure and keep growing for 6 to 12 months. Pressure and silicone do most of their work in this window.

Stage 3

Maturation (12 to 18 months, sometimes 2 years)

Color drains from red or purple toward pale and the tissue softens. Major surgical revision usually waits for maturity, unless function is being lost before then.

How this differs across skin tones

Healed burn skin discolors easily, and darker skin is more likely to hyperpigment after both the injury and the treatment. Keloid overgrowth is also more common in darker skin tones. Lasers remain effective at higher pigment risk. Standard practice is conservative settings, test patches and cooling, with non-ablative and vascular devices as the starting point. New burn scar tissue stains permanently with UV exposure, so sun protection is part of the treatment.

What you can do yourself

Worth doing

Moisturize with a neutral, water-based product at least three times a day. Burned skin has lost its own oil glands.
Massage the scar with firm circular pressure once it is fully closed, several minutes at a time, most days.
Wear pressure garments and silicone as prescribed, even when the scar looks calm. The scar is still remodeling.
Use broad-spectrum SPF 30 or higher plus covering clothing for at least a year.

Not worth doing

Fragranced or high-alcohol moisturizers. Burned skin is unusually reactive to both.
Letting a healing wound scab and dry out. Petroleum jelly under a dressing produces better outcomes than air-drying.
Stopping garments or silicone early because the scar looks better. Relapse is common.
Direct sun on a new scar, which drives permanent darkening.

Common questions

How long until a burn scar stops changing?

Maturation typically takes 12 to 18 months, and some scars remodel for up to two years. Over that time redness fades toward a paler tone and the tissue softens. Major revision surgery usually waits for that, unless function is at stake.

Will laser get rid of my burn scar?

No. Laser reduces thickness, redness, itch and stiffness, and can improve range of motion. In selected cases it softens tissue enough to reduce or delay release surgery, which clinicians sometimes call prehabilitation. It does not erase the scar.

Are silicone sheets better than gel?

Sheets appear slightly more effective, because they add occlusion and light pressure. Gels are preferred on the face and over joints, where sheets do not stay in place. Consistent use of either beats picking the theoretically better format and using it intermittently.

Does insurance cover burn scar treatment?

Often, when the goal is function and not appearance. Chronic pain, intense itch and restricted joint movement are the strongest grounds. Documentation from a burn specialist is usually required.