For burn survivors, healing happens one step at a time. Burn injuries can require a lifetime commitment from inpatient critical and acute care to outpatient rehabilitation and reconstruction. Burn and Reconstructive Centers of America (BRCA) and our nationwide care teams are there with our patients through our extensive burn and reconstructive program. As part of our long-term care and reconstructive services, BRCA provides burn scar treatment options for hypertrophic scars, atrophic scars, hyperpigmented scars and keloids. Our surgeons tailor treatment plans based on the type and appearance of the scar and the severity of the patient’s injury. Every burn scar treatment plan aims to assist with the softening of scars to improve range of motion, decrease itching and pain from scars and offer an improved appearance of the scarred area.
What are the different types of burn scars?
Scars are the product of traumatic skin and soft tissue injuries. The formation of scars can depend on the severity of the wound, the mechanism of injury and the body’s natural healing process.
Hypertrophic: These are textured, raised scars that are usually less severe than keloids and appear within the area of injury or incision. These scars are common among burn patients and those suffering from known contributing factors such as infection, repeated graft harvesting and pre-existing conditions like chronic inflammatory processes or immune deficiencies.
Atrophic: Opposite of hypertrophic scars, atrophic scars are divots or depressions in the skin. These scars are common in those who suffer from inflammatory skin conditions such as acne or chickenpox.
Dyschromia, or unnatural skin color, is a consequence of burn injuries and can show up as:
- Hyperpigmented: Hyperpigmented scars occur due to an overproduction of melanin. This can occur if the cells have been damaged or mutated, such as radiation or sunburn.
- Hypopigmented: Hypopigmented scars occur due to an underproduction of melanin or a loss of melanocytes. This can occur is the cells have been damaged or mutated, such as radiation or sunburn.
Keloid: Keloids are fibrous and thick raised scars that have the potential to appear spontaneously and extend beyond the area of injury or incision. They can be challenging to treat and have the possibility to reoccur.
How do burn scars affect different skin types?
The appearance and the probability of developing certain scars can change based on skin color and ethnicity. For instance, keloid scars are much more likely to develop in people with darker skin tones than those with fair skin. Those with fair skin may experience pink and red scars. In contrast, those with darker skin may experience tan to dark scars (hyperpigmentation) or loss of pigment resulting in pale scars (hypopigmentation). Over time, the color may eventually return to normal but for most, some form of scar revision is necessary to help correct the pigmentation.
How does age affect burn scars?
The formation and development of scars can differ for everyone, but pediatric populations have more sensitive skin and are at a higher risk of scar complications. Due to the skin’s sensitivity, their injuries are likely to be deeper and more severe than the average adult and cause distressing complications over time.
Pediatric populations may experience severe scarring, contractures, disfigurement and mental and social struggles associated with the scars. Due to the age of pediatric patients and the body’s need to grow, multiple rounds of surgery and reconstruction are most likely necessary to help the skin’s pliability and allow for growth without the development of contractions. If reconstruction or treatment is not revisited every so often as the pediatric patient grows, contractions can develop, or the skin may begin to pull, causing further disfigurement and pain.
For older adults or the geriatric population, burns can be detrimental to their health, and scars can be difficult to heal due to pre-existing conditions like cardiovascular problems or diabetes. Pre-existing conditions can cause complications with the healing process, including chronic or non-healing wounds and infections.
What complications can be associated with burn scars?
Depending on the body’s health, the mechanism of injury, the severity of the injury, age, pre-existing conditions and several other factors, complications from burn scars can be a reality for many who suffer from them. These complications can include:
- Chronic or non-healing wounds can be a source of skin cancer (Marjolin’s Ulcer)
- Burn scar alopecia
- Reduced function
- Sensitivity to sunlight
- Sensitivity to hot and cold
How to fade burn scars with invasive and minimally invasive burn scar treatment
Do burn scars go away? The short answer is no. While it is possible for scars to fade over time, burn scars are a skin condition that can be improved with treatment by fading hyperpigmentation, correcting the color of the skin, improving flexibility and reducing the appearance of the scar. Invasive, minimally invasive and non-invasive burn scar treatment options are available to burn, wound and trauma survivors for consideration, especially at BRCA facilities. Here at Burn and Reconstructive Centers of America, we offer various reconstructive services tailored to each patient’s individual needs. These services include:
Contracture Release: This is typically a more invasive procedure that involves a surgical release of the scar tissue and contracture. Contracture release can be done by placing tissue expanders, flap reconstruction and skin grafting. The type of procedure can depend on the pliability of the skin, the location of the contracture and other factors, including pre-existing conditions.
Flap Reconstruction: Flap reconstruction is an surgical procedure that takes healthy tissue from skin, fat or muscle from one part of your body to another. With flap reconstruction, full-thickness tissue is being used instead of a skin graft. Local tissue can be moved into the wound to optimize function and appearance.
Tissue Expansion: A tissue expansion procedure consists of a balloon inserted under the skin and tissue of the affected area to gently release contractures, increase skin flexibility, help alleviate burn scar alopecia or improve overall form. These balloons are slowly expanded over time to create more skin or more space.
Scar Excision: Excision or removal of undesirable scars can be performed and needs to be combined with a technique for wound closure for minimal appearance and disfigurement.
Dermal Substitutes: Dermal substitutes may involve the placement of skin grafts after scar excision procedures or to aid contracture release if tissue expansion isn’t an option. Dermal substitutes also aid in resurfacing the scarred areas to improve overall appearance and function.
Laser Scar Revision: Laser scar revision is a minimally invasive procedure that uses medical lasers to correct pigmentation, reduce the appearance of hypertrophic scars, reduce scar-associated pain and itching and improve skin pliability. BRCA uses two types of lasers. The type of laser used in the patient treatment plan depends on the injury the treatment is for and the desired results.
- Fractional CO2
- The Fractional CO2 Laser treatment used at BRCA uses ablative fractional resurfacing, which makes pinpoint holes in the scarred skin and then remodels the skin through the creation or stimulation of collagen. This technique is used for exaggerated hypertrophic scars, but it can also benefit patients with wrinkles, acne scars or sagging facial tissue.
- Pulsed Dye Laser
- Pulsed Dye Laser (PDL) therapy is a non-ablative treatment that uses 585 or 595 nm wavelengths to target small blood vessels and destroy them by converting light into heat. PDL therapy can help improve erythema (skin rash caused by inflamed blood vessels), texture and flexibility and reduce itch.
- Intense Pulsed Light
- Intense Pulsed Light (IPL) therapy is a non-ablative treatment that uses a spectrum of light to target specific colors in your skin. IPL uses energy to heat the skin and remove unwanted cells, sending out multiple wavelengths simultaneously to treat skin conditions. IPL therapy is non-invasive, and treatments typically take a few minutes.
- While some scars need multiple treatments, IPL is recommended for patients with:
- Facial redness
- Dark spots or liver spots
- Facial vines and broken capillaries
When should you consult a doctor?
Burns can affect more than a person’s appearance or functionality. They can be highly detrimental to mental health and social well-being. They can affect how a child sees themself in others, how an adult interacts with the outside world and how older adults recover and go back to living an active life. Though some burn scars may fade over time or improve in flexibility, they typically do not improve or go away independently. They have the potential to get worse over time with increased sun exposure, re-injury or growth spurts, causing further pigmentation, pain and increasing the risk of contracture and other complications. If you suffer from scars to the face, neck, hands, feet and other regions of the body that restrict motion, such as chewing, drinking and hand, neck or leg movements or that severely alter the body’s form or appearance, please consult with a reconstructive or burn surgeon to talk about possible burn scar treatment options. If you experience severe pain, sensitivity to sunlight or persistent itching, laser scar therapy can also help with these symptoms of burn scars. Don’t allow burn scars to get in the way of life. Consult with your doctor about a treatment plan that is right for you.
At BRCA, our team of board-certified plastic and reconstructive surgeons are continuing to develop different avenues to best treat our burn patients, those with congenital and acquired skin anomalies, wounds and people interested in elective plastic surgery procedures. Through our experience of working with thousands of patients, we have developed the skills necessary to create a thorough treatment plan to improve our burn patients’ aesthetics, form and function. We are not only involved in the reconstruction process but also the acute phase of patient care. This helps plan procedures for future reconstruction, enhance rehabilitation and improve patients’ form, function, aesthetic outcome and, ultimately, quality of life.
To speak with a provider or set up an appointment, please call (855) 863-9595. For more information about our reconstructive services, please click here.