A woman holding her head in her hands

A burn injury, regardless of size, can change how the body looks and works. Burn injuries can also lead to experiencing body image distress for people with scars even if they are not readily visible. Body image refers to how happy, comfortable, and confident a person is with how they look. About one-third of burn survivors have severe distress about changes in the way their body looks, feels, and works when they are first hospitalized. Almost everyone has ups and downs as they heal but most children and adults get used to the change in their appearance over time.

What Causes Body Image Distress?

Many factors may cause body image distress after a burn injury. These include how a person feels about their burns; unhelpful coping strategies; and a person’s gender, mental health history, pre-injury body image, and support network. Body image distress may involve:

  • Grief or sadness about changes in appearance and physical abilities,
  • Anxiety about social or intimate scenarios where scars may be seen,
  • Anxiety about actual and expected questions and stares from people in the community,
  • Worry about how people will react when they see the scars, and
  • A desire to be with a trusted person when in public places.

These feelings are a common part of adjusting after a burn injury. The following sections describe ways you can ease this distress and feel more positive about your body.

Phases of Healing

After a burn injury, your skin goes through several phases of healing. During each phase, it’s important to follow the advice of your burn team to improve how your skin heals. Doing things to help with healing can also improve confidence and feeling in control.

Wound Healing Phase

What you see: Lighter colored skin replaces open wounds. For people with darker skin, pink colored skin may replace the burn wound at first and then return to closer to uninjured skin color with time. Generally, the faster a wound heals, the less scarring will occur.

What you can do: Get involved with your wound care as much as possible, such as helping with the dressing changes. A cleaner wound heals faster. The more aware and involved you are with your wound care, the more likely you are to take good care of your burn.

Scar Formation Phase

What you see: After the wound heals, the skin changes over the next 3–4 months. It becomes darker, stiffer, and raised.

What you can do: Get involved with your wound care as much as possible, such as helping with the dressing changes. A cleaner wound heals faster. The more aware and involved you are with your wound care, the more likely you are to take good care of your burn.

Scar Formation Phase

What you see: After the wound heals, the skin changes over the next 3–4 months. It becomes darker, stiffer, and raised.

What you can do: Scars can cause distress because they look and feel different than uninjured skin. Scarring can also make skin stiff and painful.

  • Work with your medical team to prevent and lessen scarring. Your team may tell you to wear pressure garments or splints, massage the scar, or do stretching exercises.
  • Protect your healing skin from the sun by wearing protective clothing, like a hat or long sleeves, and applying sunscreen with SPF 30 or greater.

Scar Maturation Phase

What you see: Scar maturation can take up to 1–2 years. During this process, the scarred skin gradually returns to a more normal skin tone. It also becomes softer and flatter.

What you can do:

  • The rehab team may tell you to keep wearing pressure garments or splints. The team may also tell you to keep massaging the scar and doing stretching exercises.
  • Continue to protect your skin from the sun. For more information, visit: https://msktc.org/burn/burn-topics/sun-protection-after-burn-injury.
  • You may want to meet with a surgeon who is trained in burn reconstruction. They may have tips for how to improve the appearance of scars and restore function. Some of their techniques may include lasers and cosmetic tattoos.

Burn injuries change how your skin looks. They can also change your appearance in other ways:

  • Severe burns can damage structures under the skin. For example, when cartilage in the ears or nose is burned, there can be visible changes in these structures.
  • Some burn survivors have many skin grafts and other reconstructive surgeries. These procedures can change the way a person looks.
  • Healed skin or grafted skin may be permanently discolored. It may become lighter or darker than your uninjured skin.
  • The appearance of burn scars may be difficult to change. If interested, ask trained make-up artists to assist with altering the appearance of your burn scars. For more information, visit: https://resources.phoenix-society.org/makeup-application-for-burn-survivors.
  • Skin grafts can cause hair loss because hair follicles don’t regrow.
  • Sometimes burn injuries can result in the amputation or loss of fingers, toes, or limbs.

Wanting to look your best is normal and an important part of recovery. Even with the best care, rehabilitation, and reconstruction, burns can cause some permanent changes in how your body looks, feels, and works. Makeup, clothing, or reconstructive surgery can help you feel more confident but part of the emotional healing process is learning to adjust to changes in your appearance. It may be helpful to focus less on your physical appearance and more on internal strengths and interests that make up your self-image. For example, focus on your accomplishments or roles that make you proud. These may include your education, career, or being a good friend or parent. Accepting your scars does not mean you have to like them. While some survivors report being completely comfortable in their changed bodies, others get their self-worth from internal qualities such as kindness and humor.

Here is an excerpt from a burn survivor talking about the change in their appearance:

“I don’t like my appearance, some things not at all, but I like me. The person I am. The contributions I make. The impact I can have on others. The kindness I can show.”

Social Interactions After Burn Injury

When seeing or meeting someone with burn scars for the first time, some people may stare, avoid contact, or ask pushy questions.

If This Happens, Here Are Some Things You Can Do:

  • To feel confident when you’re talking to someone, make eye contact. You should also use confident body language, smile, and use a friendly tone of voice.
  • Have a quick response ready for when people ask “what happened,” this can help relieve some anxiety when questions arise. Remember, you are in control of how much of your story you share! For example, “I was burned when I was younger, but fortunately I am back to doing all the activities I did before.” Some burn survivors find that talking about their injury helps with emotional healing.
  • If you don’t want to discuss your appearance, you can say you don’t want to talk about it. You also can guide the conversation to take the focus off you. Ask the other person open-ended questions (questions that a person can’t answer with “yes” or “no”). For example, “I heard you went on a vacation. That sounds exciting. Tell me about it.”
  • When people stare or make negative comments, having a catch phrase—like “remember to be gracious”—can help you refocus and use social tools instead of reacting in a negative way.
  • Some burn survivors find it helpful to be with a trusted person when in public places during the early stages of their recovery or return to the community.

Intimacy Following Burn Injury

You may be worried about showing your burn scars during intimate experiences. Here are some ways to help you feel more comfortable and confident:

  • Talk to your partner. Learn about the different stages they may go through as you recover. These include withdrawal, avoidance, or being irritable with you.
  • Encourage your partner to have contact with your skin. Moisturizing or massaging your scars can help both of you to overcome any hesitation or the “fear of rejection.” Perhaps your partner can get familiar with the different feel and texture of your skin before you leave the hospital.
  • Pursue grooming activities like styling your hair, showering, shaving, painting your nails, etc. This helps to improve your well-being and readjustments in body image.
  • Get the support you need to address your concerns about intimacy. This may include talking to your health care team, other burn survivors, and/or organizations supportive of the burn community.

Other Resources That Can Help You With Social Interactions

Young Burn Survivors and Teasing

Parents and teachers need to closely watch how young burn survivors act and interact with other people. Children and teenagers often tease each other about even slight differences in appearance. Young burn survivors who are teased may become depressed or anxious when meeting new people. Children and teenagers often tease because they are curious or don’t understand the situation or why their peers may look different.

Adults can intervene early to help protect kids from teasing and bullying through education. For example, it is helpful if adults explain the differences between curiosity (questions asked based on curiosity) versus teasing (malicious or mean intent). Young survivors may feel like they are being teased when their peers are simply being curious when asking about their scars. Second, adults can give their children and students, teachers, and coaches some basic information about burns and scarring. This might satisfy their curiosity in a less intrusive way. They can also teach others how to treat a burn survivor with respect. This can help create a supportive environment for young burn survivors. Schools often have policies in place to minimize teasing and bullying and create a supportive learning environment. Parents should review and communicate with school administration about these policies to decide how they can help their child.

School Reentry and Burn Camp Programs

Burn centers often have information and/or programs to help burn survivors return to school or may connect you with organizations supportive of the burn community that can help with this. Such programs may include inviting a burn expert to visit the burn survivor’s school before the child returns. The burn expert explains the burn recovery process to the survivor’s teachers and classmates. The burn expert also encourages students to be kind and supportive of the burn survivor. Many families find this process helpful in creating a supportive environment for the burn survivor.

Going Back to School After a Major Burn Injury and the Phoenix Society’s Return to School After a Burn Injury has helpful information about the school reentry process. For more information on these resources, visit https://msktc.org/burn/factsheets/going-back-school-after-major-burn-injury and https://www.phoenix-society.org/what-we-do/school-reentry.

Some burn centers offer burn camps for children. These camps are often free. These camps give children a chance to play and interact with other children with burn injuries in order to build confidence and practice social skills. Ask your burn center if they or other known organizations may offer these opportunities in your area.

Finding help

Recovering from a burn can be tough emotionally. Get help if you feel anxious or depressed, have nightmares, or relive how you were injured. Many burn survivors find it helpful to talk to a mental health provider who has experience with the challenges of recovering from a burn. Your local burn center or health care provider can refer you to a mental health professional in your area.

You may want to talk to your health care provider about the following treatment options:

Cognitive behavioral therapy (CBT): CBT is a treatment approach used in behavioral health. CBT shows people how to understand and improve the connections between their thoughts, emotions, and behaviors. It is effective in treating severe depression and anxiety. CBT also helps people with body image distress.

Physical activity: Exercise may improve a person’s body image. Exercise can increase energy and build confidence. It can also lessen feelings of hopelessness and lead to an appreciation of one’s body. Even if you have never been physically active, you can start with 20 minutes of walking every day. Talk to your health care team about a structured exercise program.

Getting the Support You Need

With burn injuries, emotional healing is just as important as physical healing. Consider getting support from family, friends, colleagues, health professionals, and other burn survivors who may share your experience.

The Phoenix Society, a nonprofit organization based in the United States, offers the Phoenix Survivors Offering Assistance in Recovery (SOAR) program. This program connects people with new burn injuries to survivors and family members who have been impacted by a burn injury. Trained burn survivors are available across the United States to offer support. For more information, visit https://www.phoenix-society.org/phoenix-soar.

Additional Resources

The Model System Knowledge Translation Center website has many free research-based resources available, one that may be helpful for parents is “Help Your Child Recover—Build Your Child's Resilience after a Burn Injury.” See: http://www.msktc.org/burn/factsheets/Build-Childs-Resilience-After-Burn-Injury.

The Phoenix Society is “dedicated to empowering anyone affected by a burn injury.” For more information, visit http://www.phoenix-society.org or call 1-800-888-BURN. The Phoenix Society offers the following resources:

Changing Faces is an advocacy organization in England. Its mission is “to create a better and fairer future for everyone who has a disfigurement to their face or body from any cause and their families.” For more information, visit http://www.changingfaces.org.uk/Home.

References

Ajoudani, F., Jasemi, M., & Lotfi, M. (2018). Social participation, social support, and body image in the first year of rehabilitation in burn survivors: A longitudinal, three-wave cross-lagged panel analysis using structural equation modeling. Burns, 44(5), 1141–1150.

Blakeney, P., Partridge, J., & Rumsey, N. (2007). Community integration. A review of the issues related to community integration of burn survivors. Journal of Burn Care & Research, 28(4), 598–601.

Cleary, M., Kornhaber, R., Thapa, D., West, S., Visentin, D. (2020). A quantitative systematic review assessing the impact of burn injuries on body image. Body Image, 33, 47–65.

Corry, N., Pruzinsky, T., & Rumsey, N. (2009). Quality of life and psychological adjustment to burn injury: social functioning, body image, and health policy perspectives. International Review of Psychiatry, 21(6), 539–548.

Huang, Y. K., Su, Y. J. (2021). Burn severity and long-term psychosocial adjustment after burn injury: The mediating role of body image dissatisfaction. Burns, 47(6), 1373–1380.

Kammerer Quayle, B. (2006). Behavioral skills and image enhancement training for burn survivors: essential interventions for improving quality of life and community integration. In R. Sood & B. Achauer (Eds.), Achauer and Sood’s burn surgery: reconstruction and rehabilitation. Elsevier Health Sciences.

King, I. (2018). Body image in paediatric burns: a review. (2018). Burns & Trauma. 6, 12.

Partridge, J. (2006). From burns unit to board-room. British Medical Journal, 332(7547), 956–959.

Thompson, A., & Kent, G. (2001). Adjusting to disfigurement: Processes involved in dealing with being visibly different. Clinical Psychology Review, 21, 663–682.

Willemse, H., Geenen, R., Egberts, M. R., Engelhard, I. M., & Van Loey, N. E. (2023). Perceived stigmatization and fear of negative evaluation: Two distinct pathways to body image dissatisfaction and self-esteem in burn survivors. Psychology & Health, 38(4), 445–458.

Authorship

Understanding & Improving Body Image After Burn Injury was originally developed by John Lawrence, PhD, James Fauerbach, PhD, and Shawn Mason, PhD, in collaboration with Model Systems Knowledge Translation Center (MSKTC). It was reviewed and updated by Karen Kowalske, MD, Kimberly Roaten, PhD, Emma Turner, and Kyra Solis-Beach from the University of Texas Southwestern Medical Center and Parkland Burn Center/NTBRMS in collaboration with the MSKTC.

Source: The content in this factsheet is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Burn Model System (BMS) centers, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The content of the factsheet has also been reviewed by individuals with burn injury and/or their family members.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. The contents of this factsheet were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DP0082) and were updated under an NIDILRR grant (90DPKT0009 and 90DPBU0006). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

Recommended citation: Kowalske, K., Roaten, K., Turner, E., & Solis-Beach, K. (2023). Understanding and improving body image after burn injury. Model Systems Knowledge Translation Center (MSKTC). https://msktc.org/burn/factsheets/understanding-and-improving-body-image-after-burn-injury

Copyright © 2023 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.