Burn scars can be significantly improved with the right combination of treatments, though completely erasing one depends on the scar’s size, depth, and type. Burns that heal within 14 days generally leave little to no scarring, while burns that take longer carry a much higher risk of raised, discolored, or tight scars that benefit from active treatment. The good news is that options range from simple at-home care to professional procedures, and starting early makes a real difference.
Why Burn Scars Form
When your skin heals from a burn, it goes through three phases: inflammation, proliferation, and remodeling. During remodeling, your body lays down collagen to close and strengthen the wound. In normal healing, this process is balanced. In burn scars, the repair response overproduces collagen while reducing elastin (the protein that keeps skin flexible), resulting in thick, raised, stiff tissue.
Scarring typically develops within the first few months after a burn, peaks around six months, and may continue to mature over 12 to 18 months. That maturation window is your best opportunity to influence the final result.
Types of Burn Scars
Knowing which type of scar you have helps determine which treatments will work best.
Hypertrophic scars are thick, raised, and pink to red. They stay within the boundaries of the original wound and usually appear one to two months after injury. They’re more common on the chest, shoulders, upper arms, and over joints. These scars are the most responsive to treatment and may become less noticeable on their own over time.
Keloid scars grow beyond the edges of the original wound and can become quite large. They tend to be red to purple, develop months to years after the injury, and never improve without treatment. Keloids are harder to treat and have a high recurrence rate.
Contracture scars form when scar tissue tightens over a joint or across a large area, restricting movement. These are common after deep or extensive burns and often require more aggressive intervention, sometimes including surgery.
Silicone Products: The First-Line Treatment
Silicone gel sheets and silicone-based gels are considered the standard first-line treatment for burn scars by international clinical guidelines. They work by creating a sealed, hydrated environment over the scar. This helps the immature outer skin layer retain moisture, which signals the body to slow down collagen production in that area. Silicone also raises the temperature of the covered skin, which limits blood flow and reduces the excessive healing activity that drives scarring.
You apply silicone sheets directly over the scar for 12 or more hours per day, typically for several months. Silicone gels are an alternative for areas where sheets are hard to keep in place, like the face or hands. Both forms are available over the counter. For best results, start as soon as the wound has fully closed.
Onion Extract Gels
Products containing onion extract (like Mederma) are widely marketed for scars, but the evidence is lukewarm. Multiple comparative studies have found that onion extract gel performs about the same as silicone gel in making scars less visible, with no clear advantage. One review noted that onion extract gel not only showed no superiority to other topical treatments but may slightly increase the chance of skin irritation. A combination product containing both onion extract and silicone may be the better option if you prefer this route, though more evidence is needed to confirm that.
Pressure Therapy
Pressure garments have been a standard treatment for burn scars for decades. They work by applying constant, even pressure to the scar, which helps flatten raised tissue and reduce redness over time. Burn units commonly prescribe custom-fitted garments that you wear for up to 23 hours a day, often for a year or longer. The evidence behind pressure therapy is largely based on long clinical experience rather than large controlled trials, but it remains a core part of burn scar management, especially for large or widespread scars.
Steroid Injections
When silicone and pressure therapy aren’t enough, steroid injections into the scar tissue are the recommended second-line treatment. A doctor injects a corticosteroid directly into the scar, which reduces inflammation and breaks down excess collagen. Treatments are typically given once a month for two to three sessions, though therapy can continue for six months or longer depending on how the scar responds.
For keloid scars specifically, this approach flattens the scar in 50 to 100 percent of cases, though recurrence rates range from 9 to 50 percent. Another injectable option uses a chemotherapy-based compound given two to three times per week, which has shown an 88 percent response rate with no recurrence in studied cases. Your dermatologist or burn specialist can determine which approach fits your scar type.
Laser Treatments
Fractional CO2 laser therapy is one of the more effective options for improving the texture, thickness, and pliability of mature burn scars. The laser creates tiny columns of controlled damage in the scar tissue, triggering the body to replace rigid scar collagen with more normal, flexible tissue. A typical course involves four sessions spaced four to six weeks apart. Studies on hypertrophic burn scars have shown significant improvements in scar pliability and overall appearance after completing treatment.
Pulsed dye lasers target a different problem: redness. They work by shrinking the blood vessels that give scars their pink or red color. For many people, a combination of laser types produces the best cosmetic result. Laser therapy works on mature scars (older than a year) as well as newer ones, making it a viable option even if your burn happened years ago.
Scar Massage
Massage is commonly recommended by occupational and physical therapists after burn injuries. The idea is that manually applying pressure to the scar helps realign collagen fibers and reduce swelling, making the tissue softer and more flexible. A typical regimen involves sessions three times per week for about 12 weeks.
The research, however, is mixed. One controlled trial found that while massage felt beneficial in the short term, there was no lasting improvement in scar elasticity, redness, pigmentation, or thickness once the 12-week program ended. Massage may still help with comfort and stiffness on a day-to-day basis, but it’s best used alongside other proven treatments rather than as a standalone approach.
Surgery for Severe Scars
Surgery is typically reserved for contracture scars that limit your range of motion, or for large, disfiguring scars that haven’t responded to other treatments. The two most common techniques are quite different in approach.
Z-plasty is a technique where the surgeon makes Z-shaped incisions to rearrange the scar tissue, effectively lengthening tight skin without needing to add new tissue. It’s one of the most widely used methods for releasing burn contractures and generally produces better long-term results than grafting because it uses your own surrounding skin.
Skin grafting involves transplanting skin from another part of your body to cover the scarred area. It’s used when the scar is too large or the surrounding skin too damaged for local flap techniques to work. Grafts carry a higher risk of the contracture returning compared to flap-based approaches. For serious contractures, surgeons often combine multiple techniques to restore both function and appearance.
Sun Protection During Healing
Healing burn skin is extremely vulnerable to sun damage, which can cause permanent pigmentation changes, making the scar noticeably darker or lighter than surrounding skin. Use a broad-spectrum sunscreen with SPF 30 or higher on any exposed scar tissue, and reapply frequently. This level of sun protection is recommended for at least one full year after the burn injury. Covering the scar with clothing or silicone sheets also provides protection. Skipping this step can undo the cosmetic progress you’ve made with other treatments.
Timing Matters
The earlier you start treatment, the better your outcome. Since scarring peaks around six months after a burn and continues maturing for 12 to 18 months, beginning silicone therapy and moisturizing as soon as the wound closes gives you the best chance of minimizing the scar before it fully sets. Moisturizers can be applied to healed areas frequently throughout the day to keep the skin hydrated and supple during this critical window.
That said, older scars still respond to treatment. Laser therapy, steroid injections, and surgery can all improve scars that are years or even decades old. The results may be more modest than with early intervention, but meaningful improvement is still possible.