Why Skin Graft Surgery for Burns May Not Meet Expectations | [Yonsei Star Dermatology Sinchon]

After experiencing severe burns, if the skin doesn't regenerate properly or if the scar pulls, causing discomfort in movement, skin graft surgery naturally comes to mind. At this point, patients' first question is clear: "Since it's my own skin being transplanted, won't it heal cleanly without a scar?" To put it simply, skin grafting is a surgery focused on functional recovery, so aesthetic satisfaction often doesn't meet expectations.

This article, based on conversations with patients during burn scar treatment at Yonsei Star Dermatology Sinchon, summarizes the principles and limitations of skin graft surgery, and the direction of subsequent scar management.

Skin grafting is a surgical procedure where a patient's own skin is taken from a less exposed area, such as the thigh or buttocks, and transplanted to the area damaged by a burn scar. It is considered when skin regeneration is difficult due to deep burns of third degree or higher, or when there is a high risk of joint movement impairment due to contracture.

Nowadays, difficult surgeries like heart, liver, and lung transplants have advanced and become more common, leading many to view skin grafting as a simple procedure. It is true that skin grafting is relatively simpler compared to organ transplants. However, there is one crucial difference.

Organs like the heart or lungs only need to function normally. Whether they are aesthetically transplanted or not is not important. However, skin is a visible organ. Aesthetic aspects are as important as, and sometimes even more important than, function.

Even within your own skin, different areas have distinct colors, textures, and characteristics. Transplanted skin retains the color and texture of its original location, leading to differences from the surrounding healthy skin at the graft site.

You can easily check this at home. If you bring your arm and leg close together and compare their color and texture, you'll find that the difference is surprisingly significant, even though it's skin from the same body.

There is another important reason. The grafting process involves taking skin from a healthy area and attaching it to the burn-damaged site. During this process, a scar forms under the transplanted skin.

No matter how healthy the skin is that's attached, the process of attachment itself causes damage to that skin. Furthermore, because the tissue in the burn area is extensively damaged, a large scar remains beneath the grafted skin. As a result, the color, texture, and shape of the transplanted skin differ from the surrounding healthy skin.

In the clinic, we often see patients who are initially relieved because the scar isn't visible on the surface, only to later notice changes in texture and shape over time.

Since the early 2000s, laser-based treatments have emerged, and it is reported that most burn scars can be improved to a level similar to normal skin. Therefore, unless the burn is so severe that it impairs skin function or movement, it is generally advisable to decide on skin graft surgery with caution.

Before considering surgery, please review the following:

• Whether the scar actually restricts joint movement or daily activities
• Whether the goal is functional recovery or aesthetic improvement
• Whether there is room to try non-surgical treatments like lasers first
• Whether you understand that scars may remain on both the graft site and the donor site
• Whether you have consulted sufficiently with a dermatologist specializing in burn scar treatment

If you are considering a skin graft, you can check your current condition by inquiring about burn scar treatment consultation.

When skin is grafted onto a burn area, both the donor site and the recipient site are left with large wounds. Although the scar may not be visible on the surface because damaged skin is covered with healthy skin from another area, a scar remains underneath, affecting texture and shape over time.

Typical manifestations include the grafted skin becoming hard like leather, or changing to a shiny color and texture like plastic. This foreign sensation is the most common complaint from patients.

Even if you have already undergone skin graft surgery and are concerned about a foreign sensation, improvement is possible through laser treatment, so there's no need to worry too much. The approach varies depending on the stage of the scar.

In cases where red and thick scars appear in the early stage, Vbeam Prima Laser and steroid injection treatment to reduce scar height are reported to be helpful. For fully established scars, depending on the severity, laser treatments reported to have skin regeneration effects, such as Ultrapulse Encore and StarLux, can be considered.

If both scar shape and pulling are problematic, Surgical Scar Revision may also be considered. Similar principles apply to surgical scars as well as burn scars, with treatment tailored to the stage.

Of course, treating burn scars to see significant changes requires long-term treatment. However, if you endure the battle with time, you often experience objective improvement, and if the scar is not too severe, it can be refined to be barely visible.

It's fortunate if you're not under much stress due to scars, but if you're secretly experiencing a lot of stress, we recommend considering treatment rather than enduring it. If you're curious about which treatment is right for you, consult us directly below.

Consult about your burn scar condition now

Skin graft surgery is an important option for restoring function in deep burns. However, the aesthetic results may fall short of expectations, and there is a structural limitation that scars remain under the grafted skin. Therefore, the decision to undergo surgery should be carefully made based on the degree of functional impairment. If you have already received a graft and are concerned about a foreign sensation, you can try to improve it with laser and injection treatments tailored to the scar stage, so we recommend consulting with a dermatologist experienced in burn scar treatment.

Thank you for reading.

Dr. Sang-Joo Lee · Dermatologist As the chief director of Yonsei Star Dermatology Sinchon, Dr. Lee has long specialized in pigment and scar treatments. He will serve as the president of the Korean Dermatological Association in 2026 and is an adjunct professor at the Department of Dermatology, Yonsei University College of Medicine. View Dr. Sang-Joo Lee's Profile First published 2024-05-13 · Last reviewed 2026년 7월 23일

This article provides general medical information, and treatment methods and results may vary depending on individual skin conditions. Please consult a dermatologist for an accurate diagnosis.