Thick red scar
Scar raised above the skin, firm, pink, red, or darker than the surrounding skin.
CONDITION / SKIN AND SCARS
Scars after facial burns.
Scars after facial burns remain where the flame, boiling water, steam, acid, or alkali deeply damaged the skin. They can be thick and red, itchy, pull the skin, and change the appearance of the face, which cannot be hidden.
CONCEPTUAL VISUALIZATION- What it is
- Scars at the site of a deep facial burn — from flames, boiling water, steam, acid, or alkali.
- How they interfere
- Noticeable, itchy, pull on the skin, can tighten the eyelids and mouth, affect mood.
- How long they change
- Most scars lighten over time, but this can take up to 2 years or even longer.
- Who treats it
- Plastic surgeon together with a rehabilitation specialist; if necessary — ophthalmologist and psychologist.
01 / WHAT IS ITWhy a facial burn
Why a facial burn
leaves a scar.
Facial burns can be thermal — from flames, boiling water, steam, or hot objects — and chemical, from acids and alkalis, including household chemicals: bleach, pipe and oven cleaners, battery acid. A superficial burn is attempted to be healed in 2–3 weeks. A deep burn is treated with a skin transplant, and doctors try to make the scar as inconspicuous as possible.
A chemical burn is dangerous because the acid or alkali causes significant tissue damage. The sooner the substance is washed off and treatment begins, the less harm it will cause, so first aid for a chemical burn is plenty of running water.
After a burn, a hypertrophic scar often forms: thick, firm, raised above the skin, but within the boundaries of the previous wound. In a systematic review of 48 articles, the frequency of such scars after burns in different studies ranged from 32 to 72%. If the scar pulls the skin so that the eyelid or lip shifts, and the mouth or neck moves worse, this is already a contracture — there is a separate page about it.
It is impossible to completely get rid of a scar, but it can be made thinner, softer, and less noticeable, and where it pulls — restore movement. Most scars lighten over time without treatment, although this may take up to 2 years or even longer.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow do they look?
How do they look?
scars after burns.
A burn scar can be red, thick and itchy. A hypertrophic scar usually lightens and becomes flatter over time.
Itching and dryness
Healed skin itches, dries, and cracks; the scar may hurt or be uncomfortable.
Tightness
The scar pulls the eyelid, corner of the mouth, wing of the nose, or neck, making them harder to move.
Facial and neck contracturesUneven color
Areas of the scar and transplanted skin are lighter or darker than the surrounding skin, the surface is uneven.
Sore on an old scar
The scar cracks, bleeds, oozes, or forms a crust for more than 4 weeks — it needs to be shown to a doctor.
Unstable scarmood
In a meta-analysis of 21 studies (2394 adults with facial scars), anxiety was 26.1%, depression — 21.4%.
03 / REASONSWhat it depends on,
What it depends on,
what the scar will be like.
The depth of the burn and how it healed determines whether a scar will remain and what it will be like.
Severity of the burn
In a systematic review of 48 articles, the risk of hypertrophic scar was associated with burn severity, prolonged healing, multiple surgeries, and mesh skin grafting.
Chemical substance
Acids and alkalis severely damage tissues; the faster they are rinsed off with plenty of water and treatment is started, the less harm there is.
Human characteristics
In the same review, dark skin, female sex, and young age were also associated with risk.
Burn in a child
Scars on the face can affect the growth of a child's face: due to the pull of scars, the nose and teeth may become deformed.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Old scars do not require emergency care. A fresh facial burn is another matter: cool it with cool running water for 20 minutes, remove jewelry and clothing nearby if they are not stuck, cover with plastic wrap. Brush off dry chemical first, then rinse with plenty of running water for about an hour, carefully removing contaminated clothing. Do not apply creams, oil, or butter, do not pierce blisters.
103 immediately if:
- fresh facial burn;
- acid, alkali, or another chemical substance got on the skin or in the eyes;
- electric burn;
- large or deep burn: skin is white, gray, or charred;
- cough, hoarse voice, or difficulty breathing;
- soot around the nose or mouth.
Do not delay a visit to the doctor:
On the same day: scar or healed area is swollen, painful, hot to the touch, or discharging pus. In the coming days: scar pulls the eyelid, and the eye cannot close completely, or the mouth opens less and less. In the coming weeks: wound on an old scar bleeds, oozes, or forms a scab for more than 4 weeks; area on the scar grows or changes color. Planned: scar is stable but it itches, pulls, or bothers you in appearance — even if the burn happened years ago.
05 / DIAGNOSTICSHow to evaluate
How to evaluate
scars.
- Conversation
When and from what the burn was, how it was treated, what surgeries have already been done, and what bothers the most: itching, tightness, or appearance.
- Scar examination
Thickness, color, softness, and scar boundaries; whether the scar is still changing or has already matured.
- Functions
Whether the eyes close completely, how wide the mouth opens, whether the neck moves freely.
- Healthy skin
Which areas of skin nearby and on the body can be used to replace the scar.
06 / TREATMENTHow we treat
How we treat
scars after burns.
The goal is to make the scar thinner, softer, and less noticeable, and where it pulls — restore movement. Methods are combined, and treatment lasts a long time: the full effect of any scar treatment can appear in about 18 months.
01
Without surgery
While the scar matures.
- Silicone
- International practical guidelines from a group of 24 experts consider silicone sheets or gel as the first line of prevention and treatment of hypertrophic scars. The gel is applied so that it extends beyond the edges of the scar.
- Face mask
- A custom transparent mask applies pressure to facial scars. According to international recommendations — pressure of 20–32 mmHg and wearing it 20–23 hours a day for at least 2 months. However, a systematic review found only 11 publications on such masks (a total of 21 patients), and the Cochrane review (15 studies, 1179 participants) did not find sufficient evidence to recommend compression garments or other therapy for the prevention of hypertrophic scars, so the decision is made together with the patient.
- Daily care
- Massage the scar with a water-based cream several times a day — only when the wound has completely healed; avoid strong massage while the scar is inflamed or cracking. Protect the scar from the sun with clothing and a cream with SPF 30 or higher for at least a year.
02
Laser
Surface, color, and firmness of the scar.
- Fractional CO2 laser
- The 2020 international consensus (26 dermatologists and plastic surgeons from 13 countries) named lasers as the first-line therapy for traumatic scars and contractures. In a meta-analysis on burn scars, the laser significantly improved scars; very few side effects were reported, and treatment is mostly outpatient.
- Along with surgery
- The laser is a valuable addition to tissue redistribution and skin grafting. But if the scar tightens the skin, the laser does not replace surgery: a contracture requires additional skin.
03
Surgery
When the scar pulls or does not change.
- When to operate
- Most reconstructions are postponed until the scar matures. They are not postponed if the scar threatens the eye or narrows the mouth: in children, these complications are addressed urgently to avoid irreversible consequences.
- Scar or contracture
- A scar needs rehabilitation, while a contracture requires additional skin. Most facial burns affect only the skin, so complex flaps are not always necessary. Large excisions are avoided whenever possible: new deformities after them are even harder to correct.
- Local tissues
- Z-plasty and local flaps redistribute the skin, can relieve tension, and over time soften the scar.
- Skin replacement
- The most favorable results are achieved when the facial skin is replaced with entire aesthetic units: cheek, nose, chin. For this, skin grafts, flaps, or expanders are used: in a series of 12 patients, an expander was placed under the neck skin, and the stretched skin was then used to cover scars on the middle and lower parts of the face.
04
support
Children, mood, daily life.
- Children
- Children with facial scars are monitored for a long time by a team of doctors and rehabilitation specialists because scars can affect facial growth.
- mood
- If a scar is distressing, it is worth consulting a psychologist. Special camouflage makeup, selected to match the skin tone, helps to hide the scar.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Scars after facial burns at the Valikhnovskyi Institute of Surgery are treated under the direction of "Post-burn Reconstruction": first, what interferes with movement and threatens the eye, then appearance. A fresh facial burn is a reason to call 103; it is treated in the burn department; a plastic surgeon can already be involved at this stage to plan reconstruction in advance.
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
- Scar excision — narrow scars that can be sutured without tension.
- Z-plasty and local flaps — scar bands, displaced eyelids and lips.
- Skin grafting — For the face, a full-thickness graft is more often taken because it contracts less; the skin is replaced with entire aesthetic areas so that the seams lie along natural boundaries.
- Expander — Stretched adjacent skin of the same color and thickness replaces the scar.
- Lipofilling — Retracted scars and lack of soft tissue volume.
- Fractional CO2 laser — The surface, color, and firmness of the scar, itching; often together with surgery.
- Compression, silicone, and rehabilitation — While the scar is maturing, to reduce the extent of future surgeries.
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 straight on and from the side, with eyes closed and mouth open.
- ConsultationExamination of scars, assessment of the functions of eyelids, mouth, and neck, and of healthy skin nearby.
- PlanWhat to do now while the scar is maturing, and what afterward, and in what sequence.
- TreatmentLaser, local flaps, skin graft, or expander — step by step.
- RecoveryScar care, silicone or mask, sun protection, follow-up checkups.
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 completely remove a scar after a burn?
No, it is impossible to completely get rid of a scar. The goal of treatment is to make it thinner, softer, less noticeable, and restore movement where it pulls.
When is surgery possible?
Usually after the scar has matured, when it has lightened and softened. Surgery is done earlier if the scar prevents closing the eye or opening the mouth.
Will laser help without surgery?
Laser improves the surface, color, and softness of the scar. However, if the scar pulls on the eyelid or mouth, surgery with additional skin is needed.
Is it mandatory to wear a facial mask?
Masks are often prescribed, but there is little research on them, and evidence in favor of compression is insufficient. Whether you need it is decided together with the doctor.
What to do immediately after a chemical burn of the face?
Call 103, carefully remove contaminated clothing, brush off the dry substance, and rinse the skin or eyes with a large amount of running water for about an hour. Do not apply anything to the burn.
How to care for a scar daily?
After complete healing — massage with a water-based cream, silicone, sun protection for at least a year, and a cream with SPF 30 or higher.
Burns from many years ago — is it too late to seek help?
No, old scars can be treated even after years. And if you have a wound on an old scar that does not heal for more than 4 weeks, be sure to show it to a doctor: occasionally skin cancer develops in old burn scars.
Sources
18 sources · guidelines, reviews, studies, and NHSshowCollapse
- Management of facial burnsBurns & Trauma, 2020doi:10.1093/burnst/tkaa023 ↗
- Pediatric Facial Burn ReconstructionSeminars in Plastic Surgery, 2024doi:10.1055/s-0044-1786009 ↗
- Pediatric facial burnsJournal of Craniofacial Surgery, 2008doi:10.1097/SCS.0b013e318175f42f ↗
- Management of chemical burnsBritish Journal of Hospital Medicine, 2022doi:10.12968/hmed.2020.0056 ↗
- Epidemiology and impact of scarring after burn injury: a systematic review of the literatureJournal of Burn Care & Research, 2012doi:10.1097/BCR.0b013e3182374452 ↗
- The association of affective disorders and facial scarring: Systematic review and meta-analysisJournal of Affective Disorders, 2018doi:10.1016/j.jad.2018.06.013 ↗
- Current Trends in Management of Marjolin’s Ulcer: A Systematic ReviewJournal of Burn Care & Research, 2021doi:10.1093/jbcr/iraa128 ↗
- Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus RecommendationsLasers in Surgery and Medicine, 2020doi:10.1002/lsm.23201 ↗
- Fractional CO2 laser treatment for burn scar improvement: A systematic review and meta-analysisBurns, 2021doi:10.1016/j.burns.2020.10.026 ↗
- Updated scar management practical guidelines: non-invasive and invasive measuresJournal of Plastic, Reconstructive & Aesthetic Surgery, 2014doi:10.1016/j.bjps.2014.04.011 ↗
- Manufacture and use of transparent facial orthotic masks for treating facial burn scars: A systematic reviewBurns, 2024doi:10.1016/j.burns.2023.06.009 ↗
- Evidence Supporting Conservative Scar Management Interventions Following Burn Injury: A Review ArticleJournal of Burn Care & Research, 2025doi:10.1093/jbcr/irae204 ↗
- Pressure-garment therapy for preventing hypertrophic scarring after burn injuryCochrane Database of Systematic Reviews, 2024doi:10.1002/14651858.CD013530.pub2 ↗
- Reconstruction of Skin Defects on the Mid and Lower Face Using Expanded Flap in the NeckJournal of Craniofacial Surgery, 2017doi:10.1097/SCS.0000000000003394 ↗
- Burns and scaldsNHS, 2026nhs.uk/conditions/burns-and-scalds ↗
- Acid and chemical burnsNHS, 2024nhs.uk/conditions/acid-and-chemical-burns ↗
- ScarsNHS, 2023nhs.uk/conditions/scars ↗
- Symptoms of non-melanoma skin cancerNHS, 2026nhs.uk/conditions/non-melanoma-skin-cancer/symptoms ↗
The figures on the page are from these sources.
Burn scar
Does it interfere with life?
Send photos of the face straight on and from the side. The doctor will tell you what can be done now and what can be done after the scar matures.