The eyelid turns outward
The lower eyelid pulls away from the eye, and the eye does not close completely.
Ectropion
CONDITION / SKIN AND SCARS
Scarring contractures of the face and neck.
Facial and neck scar contractures are a condition where the scar after a burn tightens the skin: it turns the eyelid outward, narrows the mouth, pulls the lip or chin toward the chest. Because of this, it is difficult to close the eye, eat, speak, lift, and turn the head.
CONCEPTUAL VISUALIZATION- What it is
- A burn scar tightens the skin of the face or neck and displaces the eyelid, lip, corner of the mouth, or chin.
- What prevents
- Closing the eye, eating, speaking, lifting, and turning the head; the neck may hurt.
- How common
- Contractures after burns occur in almost a third of people with burns; on the neck, they occur more often.
- How we treat
- Splints and rehabilitation, and when there is not enough skin — surgery: flap or skin graft.
01 / WHAT IS ITWhat is
What is
Contracture after a burn.
Contracture is a scar that tightens and limits movement. The face is especially prone to contractures: there are many concave areas — around the eyes, mouth, nose — and the scar can pull the skin so that the face becomes deformed. On the neck, the scar pulls the chin to the chest and does not allow the head to be lifted.
Scar and contracture are different problems. A normal scar requires care and rehabilitation: silicone, massage, laser. A contracture needs extra skin because there is not enough of its own, and skin can only be added through surgery.
Neck contracture affects not only appearance: it can impair chewing, speech, and breathing and cause neck pain. Eyelid contracture threatens the eye, and a narrowed mouth makes it difficult to eat and brush teeth.
In a systematic review (9 articles and 1 thesis), the frequency of contractures at discharge from the burn unit was 38–54%, and later it was lower. Study data vary greatly.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
contracture presents.
A contracture is usually noticeable when something stops moving as it did before: eyelid, lip, neck.
The mouth narrows
The scar pulls the corners of the mouth, the mouth opens less, making it difficult to eat and brush teeth.
MicrostomeThe lip or nose is displaced
The scar pulls the lower lip down or the nasal wing up; in children, scar traction can deform the nose and teeth.
The head does not lift
The scar pulls the chin to the chest: it is difficult to look up, turn the head, or tilt it back.
Band or tightened area
A scar forms a narrow tight band or a wide contracted area — the choice of surgery depends on this.
Pain and discomfort
A contracted area is difficult or painful to move; the neck may hurt.
03 / REASONSWhy is it formed?
Why is it formed?
contracture
Contracture is the result of excessive scarring and the fact that the scar continues to contract after healing.
Severe burn
In a systematic review, contractures more often occurred after more severe burns and flame burns.
Scars after facial burnsNeck
In the same review, contractures more often occurred on the neck and arms; the neck is also mentioned among areas at risk of hypertrophic scars.
Children's age
In children, contractures occur more frequently, and scars on the face may affect facial growth.
Other factors
The risk of contractures was also associated with female sex; the risk of hypertrophic scars — with delayed healing and multiple surgeries.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Ancient contracture usually does not require emergency care. Immediate help is needed for a fresh burn (cool it with cool running water for 20 minutes), for breathing problems and eye issues, as well as for concerning signs after eyelid surgery.
103 immediately if:
- fresh facial burn;
- acid, other chemical or electric burn;
- very difficult to breathe: the person is choking, cannot speak;
- lips or skin have become very pale, blue or gray;
- sudden worsening of vision: wavy lines, flashes, loss of vision;
- the eye hurts when looking at light;
- after eyelid surgery — severe or increasing pain in or around the eye;
- after eyelid surgery — the eye bulges, the eyelids do not open, double vision appears;
Do not delay a visit to the doctor:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after neck or facial surgery (not on the eyelids) increasing pain or swelling. If it is also difficult to breathe — call 103. On the same day: the eye is red and very painful; scar or wound after surgery is swollen, hot to the touch, with pus discharge. In the coming days: The scar pulls the eyelid, and the eye does not close completely; in a child, the scar pulls the eyelid or narrows the mouth. Planned: It is difficult to lift or turn the neck, the mouth does not open wide, the scar pulls the lip, but the condition has not changed for a long time.
05 / DIAGNOSTICSHow to evaluate
How to evaluate
contracture
- Conversation
When the burn occurred, how it was treated, which surgeries have already been done, what interferes the most: eye, mouth, neck movement, or appearance.
- Movement Measurement
How much the head lifts and turns, the mouth opens, whether the eyes close completely.
- Scar map
A cord or a wide tight area; which areas of the neck are involved — front, sides, one or several.
- Healthy tissues
Which adjacent skin can be used for a flap: chest, area above the collarbone, back.
- Preparation for anesthesia
In cases of pronounced neck contracture, the anesthesiologist plans in advance how to ensure breathing during the surgery.
06 / TREATMENTHow we treat
How we treat
Contractures.
The goal is to restore movement to the eyelids, mouth, and neck, and then improve appearance. The method is chosen individually: depending on the size and location of the contracture, and on how much healthy tissue is nearby.
01
Without surgery
Prevention and mild contractures.
- Splints
- Due to a lack of high-quality research, the practical guideline could provide only one recommendation: in adults after a burn, splints should be considered to increase range of motion or reduce contracture.
- Laser
- The 2020 international consensus (26 specialists from 13 countries) named lasers as first-line therapy for traumatic scars and contractures. Laser is a valuable addition to surgery, but it does not add missing skin.
- Prevention
- According to a review of 327 publications, most methods for preventing contractures are still in the early stages of development. Do not skip follow-up checkups and show the scar to a doctor if it starts to pull.
02
Surgery
When there is not enough skin.
- A cord or a wide area
- A narrow cord is usually corrected with Z-plasty or a transposed flap. A wide tight area is incised and covered with a skin graft or its substitute.
- Flaps for the neck
- In a systematic review of 54 studies (1346 patients), the scapular and supraclavicular flaps were most often described. In studies that assessed movement, over 90% of patients achieved almost normal neck mobility; major complications—5.7%, minor—7.2%, recurrence of contracture—less than 1%.
- Results and risks
- In a meta-analysis of 46 studies (1,636 adults), movement improved in 92% of cases, and appearance was satisfactory in 90%. Complications occurred in 15%, more often after free flaps; recurrent contracture and disfiguring scars—about 6%. Skin grafts and substitutes provided less stable results and more frequent relapse.
- From size—to method
- In one of the centers, the neck was divided into an anterior and two lateral areas: if the contracture involved less than one area—local flaps; one area or more but less than two—pedicled flaps from the chest, areas above the clavicle, or back; two areas or more—usually more complex flaps with two pedicles.
- Eyelids
- Ectropion after burns is corrected earlier than other scars: according to the review, early interventions improve the outcome. But there are few studies—14 works in the review were all observational.
03
Children and anesthesia
What is worth knowing in advance.
- Children
- Most reconstructions are postponed until the scar matures, but when the scar threatens the eye or narrows the mouth, in children it is addressed urgently to avoid irreversible consequences.
- Anesthesia
- It is more difficult to insert a breathing tube with a tight neck. Therefore, the plan is prepared in advance; sometimes the airways are secured while the patient is still awake, or the scar is first incised under local anesthesia. In children, detailed planning and preparation are the basis of safe anesthesia.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Facial and neck contractures at the Institute of Surgery of Dr. Valikhnovskyi are treated in the direction of "Post-burn Reconstruction": first restoring movement and function, then working on appearance. A scar that prevents the eye from closing or the mouth from opening is operated on earlier, without waiting for other scars to mature.
CLINIC SERVICE
Reconstruction after burns
Scars, contractures, and lost tissue after burns — first movement and function, then appearance.
View service
What we do for this condition
- Tendon release, Z-plasty, and local flaps — scar bands, displaced eyelids and lips.
- Neck contracture — scar tissue is excised, skin deficit is covered with a graft or flap; after surgery, the neck is fixed in the correct position for some time.
- Skin grafting — for the face, a full-thickness graft is more often used because it contracts less; the skin is replaced in whole aesthetic areas.
- Eyelid operations — for ectropion — canthopexy, grafts, or spacers for the lower eyelid.
- Expander — stretched neighboring skin replaces the scar on the face or neck.
- Perforator flaps and microsurgery — when deeper tissues are damaged and local tissues are insufficient.
- Splints, laser, and rehabilitation — after surgery — splints, compression, and exercises with a physiotherapist so that contracture does not return.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos of the face and neck from the front and side, with eyes closed, mouth open, and head tilted back.
- ConsultationMeasurement of movements of the neck, mouth, and eyelids, assessment of scars and healthy tissue nearby.
- PlanWhat to do first, and what afterwards, which steps are needed and how much time between them.
- SurgeryScar incision, flap, graft, or eyelid surgery — depending on contracture.
- RecoveryNeck splint or fixation, compression, exercises with a rehabilitation specialist, follow-up examinations.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it possible to do without surgery?
Splints, laser, and exercises help, especially in the early stage. But if the scar is already lacking skin, it can only be added surgically.
Will the contracture return after surgery?
It might, but not often: in a meta-analysis, recurrent contractures and disfiguring scars occurred in about 6% of cases. To prevent the contracture from returning, splints and exercises are prescribed after surgery.
When is it better to operate?
If the scar prevents closing the eye or opening the mouth — sooner, without waiting. In other cases, usually they wait until the scar matures.
Where do they take the skin for the neck?
In studies, the most commonly described flaps are from the back (scapular) and from the area above the clavicle; the skin of the chest is also used. Sometimes skin is transplanted from other parts of the body.
Is anesthesia safe if the neck is tight?
The anesthesiologist plans in advance how to ensure breathing and, if necessary, does it while the patient is still awake. Tell them about the contracture and previous anesthesia.
Do they operate on contractures in children?
Yes. Scars can interfere with facial growth, so children are examined regularly, and the eyes and mouth are treated as early as possible.
How is this different from a regular scar?
A regular scar is treated with care, silicone, and laser. A contracture limits movement, and additional skin is needed for it.
Sources
19 sources · guideline, reviews, meta-analyses, and NHSshowCollapse
- Prevalence of scar contractures after burn: A systematic reviewBurns, 2017doi:10.1016/j.burns.2016.08.002 ↗
- Prevention and Treatment of Burn Scar Contracture: A Practical ReviewPlastic and Reconstructive Surgery Global Open, 2024doi:10.1097/GOX.0000000000005333 ↗
- Flap reconstruction of post-burn neck contractures: A systematic reviewBurns, 2025doi:10.1016/j.burns.2025.107745 ↗
- Reconstruction of Post-Burn Neck Contractures: A Systematic Review and Meta-Analysis Comparing Surgical Techniques and OutcomesJournal of Clinical Medicine, 2026doi:10.3390/jcm15145583 ↗
- Postburn Neck Contracture: Principles of Reconstruction and a Treatment AlgorithmJournal of Reconstructive Microsurgery, 2018doi:10.1055/s-0038-1641724 ↗
- Common postburn deformities and their managementSurgical Clinics of North America, 2014doi:10.1016/j.suc.2014.05.006 ↗
- The neck burn scar contracture: a concept of effective treatmentBurns & Trauma, 2017doi:10.1186/s41038-017-0086-8 ↗
- Airway management in patients with burn contractures of the neckBurns, 2015doi:10.1016/j.burns.2015.03.011 ↗
- Airway Management in Pediatric Patients With Burn Contractures of the Face and NeckJournal of Burn Care & Research, 2022doi:10.1093/jbcr/irac016 ↗
- Interventions for Functional and Cosmetic Outcomes Post Burn for Eyelid Ectropion — A Scoping ReviewEuropean Burn Journal, 2025doi:10.3390/ebj6030046 ↗
- Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice GuidelinesJournal of Burn Care & Research, 2020doi:10.1093/jbcr/irz150 ↗
- Pediatric facial burnsJournal of Craniofacial Surgery, 2008doi:10.1097/SCS.0b013e318175f42f ↗
- Pediatric Facial Burn ReconstructionSeminars in Plastic Surgery, 2024doi:10.1055/s-0044-1786009 ↗
- Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus RecommendationsLasers in Surgery and Medicine, 2020doi:10.1002/lsm.23201 ↗
- Epidemiology and impact of scarring after burn injury: a systematic review of the literatureJournal of Burn Care & Research, 2012doi:10.1097/BCR.0b013e3182374452 ↗
- Burns and scaldsNHS, 2026nhs.uk/conditions/burns-and-scalds ↗
- ScarsNHS, 2023nhs.uk/conditions/scars ↗
- Red eyeNHS, 2025nhs.uk/symptoms/red-eye ↗
- Shortness of breathNHS, 2024nhs.uk/symptoms/shortness-of-breath ↗
The figures on the page are from these sources.
The scar pulls the eyelid,
mouth or neck?
Send photos of the face and neck directly, from the side and with the head tilted back. The doctor will say what can be done and where to start.