Laser Burn Scar Revision

Laser Burn Scar Revision

C. Scott Hultman

Yuen-Jong Liu


  • Burn scars may affect any part of the body.

  • Hypertrophic scars across joints may cause contracture.

  • Contractures on the face may interfere with competence of the eyelids or the mouth.

  • Burn scars are especially disfiguring on the face due to its high aesthetic importance.

  • Neuropathic pain may be observed in burned areas, grafted regions, and even donor sites.


  • The incidence of hypertrophic scarring after burn injury ranges from 5% to 40%, depending on anatomic location, depth of burn, method of closure, and genomic response to healing.

  • Hypertrophic scarring and contractures can develop in burn scars that heal by secondary intention or re-epithelialization, in split-thickness skin grafts over excised burns, along the seams of full-thickness grafts, and in donor sites that had delayed healing, due to infection of excessive depth of harvest.

  • Hypertrophic scars may be associated with an imbalance of collagen types 1 and 3, as well as TGF beta 1 and TGF beta 3.

  • Hypertrophic scarring can be viewed as an abnormal physiologic response after wound closure, in which collagen deposition and angiogenesis continue beyond their desired end points.


  • Neuropathic symptoms, such as pruritus, searing pain, hyperesthesias, and paresthesias, are a source of frustration for the patient, can limit quality of life, and may prevent return to school, work, and social functions.

  • Hypertrophic scarring may cause disability ranging from minor discomfort to joint contracture.

  • Hyper- or hypopigmentation, erythema, and abnormal texture may cause the burn scars to be aesthetically unacceptable.


  • Complete patient history should be elicited, focusing on the type of energy delivered: scald, electrical, flame, contact, chemical, cold, friction, abrasion, or other.

  • Previous treatments and their effects should be noted, including skin grafting, laser treatments, topical scar treatments, moisturizing agents, sunblock, systemic medications, occupational therapy, physical therapy, compression garments, and massage.

  • The patient should have had no significant improvement in symptoms for at least 3 months on maximal medical therapy.

  • Relative contraindications to laser therapy include connective tissue disorders, utilization of systemic steroids or immunosuppressive medications, and chemotherapy or radiation therapy. Patients with moderate to severe lymphedema should also be treated with caution, as healing from ablative lasers may be delayed.

  • Complete physical exam should be performed, focusing on the burned area, noting whether it is a native burn scar or burn scar after skin grafting.

  • The burned areas should be well healed without open wounds or evidence of cellulitis.

  • Total body surface area of the burn injury should be noted, as extremely large areas should be staged, in terms of laser treatment.

  • Functional deficits should be recorded, such as loss of range of motion or loss of sensation.

  • Aesthetic concerns should also be considered, especially in burns of the face and the hands.

  • The patient’s Fitzpatrick skin type should be documented, and this will advise the initial energy settings for the laser.

  • Photographs are useful for insurance submission and to track progression of the scar between laser treatments.


  • Imaging is not required. However, medical photography is often needed for preauthorization from insurance companies.

  • For patients enrolled in a clinical trial, other imaging modalities might be helpful to measure extent of hypertrophic scarring and quantify changes:

    • Ultrasound to measure thickness of scar

    • Chroma meter to measure light-dark axis and degree of redness from erythema

    • Cutometer to measure elasticity of scar


Feb 27, 2020 | Posted by in Pediatric plastic surgery | Comments Off on Laser Burn Scar Revision

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