Can I do anything to improve this 20 year old burn scar? (Photos)

Question

Is this still treatable? Can this still be removed by any procedure? I have already had a consultation with a doctor before and he basically said there nothing to be done about my scar. This has been a real insecurity for me ever since I had this which is about 20 years ago. I guess I’m asking for a second opinion.

Anna Chacon, MD, FAAD · Answer

Yes—it’s still treatable, but expectations need to be realistic.

After 20 years, scars are:

Fully matured
Structurally integrated into the skin

We can improve:

Texture
Color
Thickness

Options:
Yes—it’s still treatable, but expectations need to be realistic.

After 20 years, scars are:

Fully matured
Structurally integrated into the skin

We can improve:

Texture
Color
Thickness

Options:

Fractional laser (non-ablative or ablative, carefully chosen)
Microneedling + PRP
Steroid injections (if thick)
Surgical revision (in select cases)

We usually aim for improvement, not complete removal—but meaningful improvement is absolutely possible.
Fractional laser (non-ablative or ablative, carefully chosen)
Microneedling + PRP
Steroid injections (if thick)
Surgical revision (in select cases)

We usually aim for improvement, not complete removal—but meaningful improvement is absolutely possible.

Kally Papantoniou, MD, FAAD · Answer

Even older scars like this can still be improved, but the goal is improvement, not complete removal.

At 20 years out, the scar is already fully matured, so you’re working on blending texture and color rather than “erasing” it. Treatments like Fraxel, Micro RF, or Q-Switch can help soften the appearance over time, but they usually require multiple sessions and gradual progress.

This is also a situation where layering treatments often works best by combining approaches to address both texture and pigment rather than relying on just one device.

I wouldn’t write it off based on one opinion. An in-person evaluation can help determine what type of scar you have and what kind of improvement is realistic.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Can I do anything to improve this 20 year old burn scar? (Photos)

Answers (3)

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