Burn Reconstruction in Turkey

The single most important thing on this page, because burn scar is slower than other scar and the temptation to operate early is stronger.

What burn scar does. For the first weeks it is fragile and inflamed. Over the following months it becomes thick, red, raised and intensely itchy, and it contracts — hard, and in the direction that shortens it most. Somewhere between twelve and twenty-four months it begins to soften, flatten and fade, and contraction slows and stops. In children, and in burns over large areas, this can continue beyond two years.

Why operating early fails. Scar that is still contracting will contract again after you release it. A release at four months may look excellent at six months and be back to where it started at eighteen. Unless there is a functional emergency, the operation should wait for mature scar.

The working rule. At least twelve months after the burn for elective reconstruction, and often eighteen to twenty-four for the neck, axilla and hand where contraction is strongest. Judge by the scar, not the calendar: still red, still firm, still tightening means still changing.

Where waiting is wrong, and these matter. An eyelid that cannot close, because the cornea will ulcerate. A mouth that cannot open enough to eat or receive dental care. Airway compromise from a neck contracture. Exposed bone, tendon, joint or cartilage. An unstable graft breaking down repeatedly. A contracture limiting a joint in a growing child, because the growing limb develops secondary joint and bone changes. Any of these needs urgent local assessment, not a planned trip in six months.

What to do while waiting, which is genuinely treatment. Pressure garments worn as close to all day as tolerable. Silicone sheeting or gel. Massage with emollient several times a day. Splinting across any joint at risk, frequently at night for years. Range-of-motion exercises, daily. Strict sun protection, because new scar pigments permanently. Antihistamines or gabapentinoids for itch, which is often the worst symptom in the first year. And steroid injection for hypertrophic areas.

The pay-off. A burn scar that has been well managed for eighteen months is dramatically better than the same scar at four months, needs less surgery, and gives a better result from the surgery it does need.

What a good surgeon says. Come back in a year, here is what to do in the meantime, and here is what we will do then. A surgeon willing to release a four-month-old neck contracture electively is not doing you a favour.

Ask: is my scar mature, what should I be doing now, and when should I return?

What should be established before anyone discusses appearance.

Movement, measured. Range of movement at every joint crossed by scar, active and passive, in degrees and written down. Neck extension and rotation. Shoulder abduction and flexion. Elbow extension. Wrist and finger movement, including whether the fingers can make a fist and whether the thumb can oppose. Knee extension. This is the baseline against which the operation is judged.

Eyelids. Can the eye close fully, with the lids meeting? Is there exposure of the cornea at night? Is there tearing, redness or a dry sore eye? Ectropion of the lower lid or an upper lid that cannot come down is sight-threatening, not cosmetic.

Mouth. How wide can it open, in millimetres? Can the lips seal? Can the patient reach the back teeth for brushing, and can a dentist? Microstomia has real consequences.

Nose and ears. Nostril narrowing restricting breathing; loss of ear cartilage; a nasal tip with thin unstable cover.

Hands, in detail. Web space contracture, clawing, thumb position, nail bed loss, and whether the deformity is skin-driven or has become a joint problem. Where the joints have stiffened or dislocated, release of skin alone will not restore function.

Graft stability. Are there areas that break down repeatedly, ulcerate, or bleed? Unstable scar needs replacing rather than resurfacing, and a very old unstable burn scar carries a small risk of malignant change that should be biopsied rather than ignored.

Hair-bearing loss. Scalp, eyebrow, beard, eyelash — each with its own solution.

Scar quality by area. Hypertrophic, keloid, atrophic, hyperpigmented or hypopigmented, and how it matches the surrounding skin.

Itch, pain and heat intolerance. Common, underestimated, treatable to a degree, and not improved by scar revision.

Sensation. Grafted skin has altered sensation permanently, which matters for burn and pressure injury risk.

Psychological state. Burns carry a heavy psychological burden, and good units assess it and treat it rather than treating it as separate from the reconstruction.

Growth, in children. What will change as the child grows, and what will need repeating.

What a good assessment produces. A written problem list ordered by function, a staged plan with each operation's objective, an expected gain in degrees where a joint is involved, and an honest statement of what will not be restored.

Ask: what are my functional problems, in order, and which ones does this plan change?

Organised by what is wrong rather than by technique.

A contracture limiting a joint. Release the band — typically with a Z-plasty, a series of them, or a straight release with resurfacing — then cover the defect with tissue that resists contracting. Options in ascending order of durability: a split-thickness graft, which is simplest and contracts most; a full-thickness graft, which contracts less and matches better; a local flap, which resists contraction well; and a free flap, for large or hostile areas. Then splint and mobilise for months. The choice of cover largely determines the recurrence rate, which is why it is worth asking about.

Neck contracture. Often the highest priority after eyes and mouth, because it affects airway, anaesthesia, appearance and posture. Usually needs a large release with generous cover — full-thickness graft, expanded local flap or free flap — and rigorous splinting afterwards.

Axillary contracture. Release with local flaps where possible, because grafts across the axilla recontract; then abduction splinting.

Hand and web spaces. Release with full-thickness grafts or local flaps, sometimes with joint releases or pin fixation; then hand therapy, which is the whole point.

Eyelid. Release and full-thickness graft, usually taken from behind the ear or the upper eyelid, sometimes with a canthal repositioning. Protecting the cornea takes priority over symmetry.

Mouth. Commissure release and grafting, sometimes staged, with stretching devices afterwards.

Nostril and ear. Local flaps, cartilage grafts, sometimes prosthetics for a lost ear where flap reconstruction is not realistic.

Hypertrophic scar and keloid. Steroid injection, pressure, silicone; laser for redness; excision only with adjunctive treatment, because excising a keloid alone often produces a bigger one.

Colour and texture mismatch. Hard to fix. Fractional laser improves texture, dermabrasion and thin grafting help in places, and medical tattooing is genuinely useful for stable mismatched areas. Honest counselling matters more than promises.

Contour loss and thin unstable cover. Fat grafting, which restores volume and improves the quality of the scar tissue itself and is one of the more useful advances in burn care; dermal substitutes; flaps for larger defects.

Large areas needing matched skin. Tissue expansion, which grows adjacent normal, matched, hair-bearing skin over weeks — well suited to the scalp and useful on the neck and trunk — with its own risks of infection and extrusion.

Hair-bearing loss. Tissue expansion and hair-bearing flaps for the scalp; follicular grafting into scar for eyebrow and beard, with reduced take.

Unstable chronic ulceration in old burn scar. Excision and stable cover, with biopsy, because of the small risk of malignancy in long-standing scar.

Sequence. Function first — eyes, airway, mouth, hands, major joints — then contour, then colour and scar appearance. Each stage waits for the previous one to settle.

If you read only one section before booking anything, read this one.

Why it matters. Burn scar contracts. Surgery removes a contracture at a moment in time; splinting, positioning and movement are what stop it returning. A release performed brilliantly and then left unsplinted recurs, sometimes within months, and the operation is wasted. Conversely, sustained therapy can avoid some operations entirely.

Pressure garments. Custom-fitted, worn as near to twenty-three hours a day as tolerable, replaced as they lose compression and as a child grows, typically for a year to two years. They reduce hypertrophic scarring and itch.

Silicone. Sheets or gel, worn over scars for months, with reasonable evidence behind it.

Splinting. Static splints hold a released joint in the corrected position; night splints continue for months to years, particularly in children. Non-negotiable after a release.

Range-of-motion and stretching. Daily, guided by a physiotherapist or occupational therapist, resumed within days of most releases.

Massage and emollient. Several times a day. Grafted and scarred skin does not produce oil normally and dries, cracks and itches.

Sun protection. Strict, for at least a year and ideally longer. Pigment change acquired in healing scar is permanent.

Itch management. Often the worst symptom in the first year: emollients, cooling, antihistamines, gabapentinoids, and pressure.

Scar-directed treatments. Steroid injection for hypertrophic areas; vascular laser for redness; fractional laser for texture and pliability.

Nutrition and general health. Healing large areas is metabolically demanding, and smoking materially worsens graft and flap survival.

Psychological support. Appearance-related distress, post-traumatic symptoms and social avoidance are common and treatable, and addressing them changes how satisfied patients are with surgery.

The practical consequence for anyone considering travelling. The operation is one or two weeks; the programme is a year or more, delivered where you live, frequently, by a therapist. Arrange the therapist before you book the surgeon, and ask for the splinting and therapy programme in writing. A quote for a contracture release that does not mention splinting and physiotherapy is describing half the treatment — and the half that determines whether it holds.

Worth its own section, because most burn contractures in children are mismanaged by being treated as one-off operations.

Growth changes everything. A released contracture in a five-year-old is not finished. Scar does not grow at the rate the child does, so tightness returns as the limb lengthens, and repeat releases through childhood are the norm rather than evidence of failure. Families should be told this at the start.

Secondary changes. A contracture left across a growing joint causes joint contracture, bone deformity, muscle shortening and, in the hand, permanent loss of function. This is why waiting is not always right in children: a contracture actively limiting a growing joint should be released rather than observed.

Facial growth. Scar across a growing face distorts development of the jaw, nose and eyelids, so facial burn scar in children may need earlier intervention and repeated revision through growth.

Splinting for years. Night splints and pressure garments continue for years, with garments remade as the child grows, and adherence is the family's work as much as the therapist's.

School and function. Getting a hand to open and a neck to extend has consequences for writing, eating, sport and social life that outweigh appearance.

Why this argues for local care. Repeat releases, garment refitting, growth monitoring, a paediatric therapy service and a family that can attend — all argue strongly for a local paediatric burns unit rather than an episode of surgery abroad. Most countries fund it.

Where travelling may still be reasonable. Where no paediatric burns service is available locally, or where a specific procedure is unavailable, with a therapy plan arranged at home and a realistic expectation of returning.

Consent and the child. Older children and adolescents should be part of the decision, particularly for appearance-driven stages, and a good unit involves them.

Psychology and school support. Bullying, avoidance of swimming and PE, and appearance concerns need addressing alongside surgery.

Anaesthesia. Repeated general anaesthetics over childhood need a unit with paediatric anaesthetic capability and paediatric intensive care available.

Ask: what will need repeating as my child grows, who will refit the garments, and who provides the therapy?

The range in the cost section above is wide because a small scar revision and a neck release with free flap cover are not comparable operations.

A proper proposal includes review of your acute burn records, operation notes, graft and donor site history and photographs; a consultation that measures range of movement in degrees, assesses eyelid closure and mouth opening, and produces a problem list ordered by function; confirmation that the scar is mature enough; a written staged plan naming each operation, its objective, its order and the interval; an expected functional gain stated in degrees; the type of cover proposed for each release and why; a written splinting and physiotherapy programme with a named requirement for who delivers it at home; blood tests and anaesthetic assessment; surgery in a licensed hospital with burns or reconstructive capability and the appropriate level of post-operative care; hospital nights appropriate to the operation; accommodation with transfers; graft and donor site care; fitness-to-fly confirmation; and an operation note and discharge summary your own doctors and therapists can read.

Not included: physiotherapy, occupational therapy and splinting at home, which is the largest single element of the treatment; pressure garments and their refitting; silicone products; flights for each stage; travel insurance covering surgery abroad; extra nights if grafts are slow; later stages such as fat grafting, laser, further releases and refinement; revision; dental treatment where mouth opening is restricted; ophthalmology where the eye is affected; prosthetics; and psychological support, which burns frequently warrant.

Why quotes differ. First, which problem is addressed and how many stages. Second, the cover proposed — a split-thickness graft is cheaper and recontracts more than a full-thickness graft or a flap, so a low quote may be buying a higher recurrence rate. Third, whether tissue expansion or microsurgery is involved. Fourth, whether the therapy requirement appears at all. Fifth, whether the unit has burns capability or is a cosmetic clinic taking on a burns case. Sixth, documentation.

The honest value point. Cheaper cover that recontracts is not cheaper. And in most countries this is funded reconstruction, so check what your own system offers before comparing prices at all.

The unit matters more here than in almost any other procedure on this site, because burn reconstruction needs a burns service, not a cosmetic clinic.

Ankara's university and state hospitals are the first place to look. Burn reconstruction draws on a burns unit, plastic and reconstructive surgery with microsurgical capability, hand surgery, physiotherapy and occupational therapy with burns experience, orthotics for splints and garments, ophthalmology where eyelids are involved, oral and maxillofacial or dental services where mouth opening is restricted, paediatric services for children, and psychology. University units can also stage a plan across years, which is what this work needs.

Istanbul has university hospitals and large private hospitals with burns and reconstructive units, microsurgical capability and the surgeons with the highest volumes in contracture release and flap reconstruction. It is also the centre of the cosmetic market, and the specific risk is a burns problem being treated cosmetically: a laser course sold for a scar whose problem is a contracture, or a resurfacing procedure where a release was needed. Ask whether the range of movement will be measured. Hospitals cluster in Şişli, Levent, Ataşehir and on the Anatolian side, and the two airports give the most direct flights.

Izmir has university-affiliated hospitals with plastic surgery, burns capability and physiotherapy, and is reasonable for a defined single-stage reconstruction in a unit you have checked.

Antalya is the least suitable. A small mature scar revision could reasonably be done in a private clinic; a neck or axillary release, a hand contracture, an eyelid at risk, tissue expansion or a flap should not be. Post-operative splinting and burns therapy are also hard to organise in a resort setting.

Three questions in any city. Do you have a burns unit and burns-experienced therapists? Will you measure and document my range of movement and state the expected gain? And who delivers the splinting and therapy at home?

Wherever you go, the clinic must hold the Ministry of Health international health tourism authorisation, surgery must be in a licensed hospital appropriate to the complexity, and the surgeon must be registered with the Turkish Medical Association in plastic, reconstructive and aesthetic surgery.

A programme, with surgery as episodes inside it.

Before anything: wait, and treat the scar. At least twelve months after the burn for elective work, and eighteen to twenty-four for neck, axilla and hand. Meanwhile: pressure garments as near to all day as tolerable, silicone, massage several times daily, splinting, daily range-of-motion work, strict sun protection, itch treatment, and steroid injection for hypertrophic areas. This is treatment, not waiting.

Exceptions needing assessment now. An eyelid that cannot close, restricted mouth opening, airway compromise, exposed bone, tendon or cartilage, an unstable graft breaking down, chronic ulceration in old scar, and a contracture limiting a growing child's joint.

Check funding and continuity. Burns care is funded in most countries and the unit that treated the burn holds your records and can deliver therapy.

Arrange the therapist first. For any release this is not optional. Get the splinting and therapy programme in writing before you commit to surgery.

Gather records. Acute burn notes with the percentage of body surface and depth, all operation notes, graft and donor site history, infection and organism details, photographs across time, current garment and splint details, and physiotherapy notes with range of movement in degrees.

Remote assessment. Records, photographs and movement measurements reviewed, with a statement of maturity, what is achievable, how many stages, and the therapy required.

Trip one, assessment, one to two days. Movement measured, eyelid and mouth assessed, problem list ordered by function, cover type chosen and explained, written staged plan, consent covering recurrence, graft failure and the therapy requirement.

The operation. Scar revision or a small release with graft: one to two hours, day case or one night, seven to ten days in the country because graft care and splinting start immediately. A neck or axillary release with generous cover: two to four hours, two to four nights, two to three weeks. Tissue expansion: two operations weeks apart with expansion between them, needing either a long stay or two trips. A free flap: longer, several nights of monitoring, and three to four weeks before flying.

Weeks one to twelve. Splint exactly as prescribed, often continuously at first then at night. Therapy starting within days. Graft and donor site care. Garments resumed once healed.

Months three to twenty-four. The new scars mature in turn. Further stages — fat grafting, laser, a second release, refinement — at six to twelve month intervals.

Judging it. A year after the final stage, by movement and function as well as appearance.

The clinic must hold the Ministry of Health International Health Tourism Authorisation Certificate, with its number and the licensed hospital's address, and the surgeon must be registered with the Turkish Medical Association in plastic, reconstructive and aesthetic surgery.

Then the questions that separate a burns unit from a cosmetic clinic.

Do you have a burns unit, and do your physiotherapists and occupational therapists have burns experience?

Is my scar mature enough to operate on? If not, when should I come back, and what should I be doing?

Will you measure my range of movement in degrees and document it, and what gain do you expect?

Is my problem a scar or a contracture? Those need different operations.

What cover will you use for the release — split graft, full-thickness graft, local flap, free flap — and why? What is the recurrence rate with each?

Can my eye close fully, and does that need addressing first?

How wide does my mouth open, and does that need addressing?

Are my joints themselves stiff or dislocated, in which case will releasing the skin achieve anything?

What splinting and physiotherapy will I need, for how long, and who provides it at home? Will you write the programme down?

How many stages, in what order, with what intervals, and over how long?

If tissue expansion is proposed: how often does the expander need filling, where will that happen, and what is your infection and extrusion rate?

What can you not fix — colour match, texture, sensation, itch? I want that stated plainly.

How many burn reconstructions do you personally do a year, and may I see your own photographs at a year, with movement documented?

How long before I can fly, and will you confirm fitness in writing?

Will you give me an operation note and discharge summary my doctors and therapist can read?

What happens if a graft fails or the contracture recurs after I fly home?

Should I have this at home instead?

A unit that answers the therapy questions as fully as the surgical ones is the one to take seriously.

High, because this is surgery on damaged, scarred, poorly vascularised tissue, often across joints.

Recurrence of contracture. The commonest problem, driven by inadequate splinting and therapy, by choosing a split-thickness graft where a flap was needed, and by growth in children — where repeat releases are expected rather than a failure.

Graft failure, partial or complete, requiring further dressings and re-grafting. More likely on scarred beds.

Flap failure. In free flaps this follows clotting of the joined vessels and needs urgent return to theatre, which is the central argument for having microsurgery where the microsurgeon is.

Donor site problems: pain, slow healing, hypertrophic scarring and its own pigment change. Donor sites in burns patients are often limited and previously used.

Wound breakdown and delayed healing, sometimes over months.

Infection, including cellulitis, graft loss and rarely deeper infection.

Worse scarring. Every operation makes a new scar that goes through the same cycle, and in keloid-prone patients excision can produce a larger keloid.

Hypertrophic scarring at the release site and at graft margins.

Pigment change: darker or lighter, usually permanent, and worsened by sun exposure while healing.

Colour and texture mismatch that cannot be fully corrected. This is the commonest source of disappointment and needs honest counselling.

Failure to gain the expected movement, or gaining and then losing it.

Persistent itch, dryness, cracking and heat intolerance in grafted skin.

Altered or absent sensation, permanently, with a resulting risk of further burns and pressure injury.

Tissue expansion complications: infection, exposure, extrusion, pain during expansion and failure to reach the needed size.

Fat graft volume loss, requiring repeat sessions.

Eye complications where eyelids are involved, including corneal exposure.

Stiffness from immobilisation, which is why guided early movement matters.

Venous thromboembolism, particularly after limb surgery with reduced mobility.

Anaesthetic risk, rising with length and with repeated anaesthetics in children.

Psychological difficulty: results improve rather than restore, and expectations that surgery will undo a burn are not met.

Specific to travelling. A flap failing when the surgeon is unreachable, therapy and splinting not arranged so the release recurs, garments not refitted, a staged plan abandoned halfway, and records that never reach the therapist who has to deliver the programme.

What you control: waiting for maturity, doing the garment, silicone, massage, splinting and exercise programme, arranging the therapist first, insisting on movement being measured, choosing durable cover over cheap cover, not smoking, and not starting a staged plan you cannot finish.

It can be, but this is the procedure on this site where the decision depends least on the surgeon's price and most on two other things: whether your scar is ready, and who does the therapy.

Start with timing, because it is where most avoidable disappointment comes from. Burn scar contracts, then softens and remodels for two years or more, and longer in children and in large burns. Operate into scar that is still contracting and it will contract again: a release at four months can look excellent at six and be back where it started at eighteen. So the working rule is at least twelve months after the burn for elective reconstruction, and eighteen to twenty-four months for the neck, axilla and hand where contraction is strongest — judged by the scar rather than the calendar. If it is still red, still firm and still tightening, it is still changing.

That waiting is not passive, and this is the part most quotes leave out. Pressure garments worn as close to all day as you can manage, silicone sheeting or gel, emollient and massage several times a day, splinting across any joint at risk, daily range-of-motion work, strict sun protection and treatment for the itch. A burn scar managed properly for eighteen months is dramatically better than the same scar at four months without any surgery at all, needs less surgery, and gives a better result from the surgery it does need.

There are situations where waiting is wrong and you should be assessed locally now rather than planning a trip: an eyelid that cannot close, because the cornea will ulcerate; a mouth that cannot open enough to eat or be treated by a dentist; airway compromise from a neck contracture; exposed bone, tendon, joint or cartilage; a graft that keeps breaking down, or chronic ulceration in an old burn scar, which needs biopsy as well as surgery; and a contracture limiting a joint in a growing child, because a growing limb deformed by scar develops permanent joint and bone changes.

The second question decides whether the operation holds. Releasing a contracture creates a defect that must be covered with tissue that resists contracting, and the joint must then be splinted in the corrected position and moved under guidance for months. Without that, it recurs. So arrange the physiotherapist and the splinting at home before you book the surgeon, and ask for the programme in writing. Ask too what cover is proposed and why: a split-thickness graft is the cheapest and recontracts the most, a full-thickness graft less, a flap least. Cheaper cover that recontracts is not cheaper.

Be honest with yourself about what surgery cannot do. It can give you movement back, let an eye close, let a mouth open, restore contour and stabilise fragile skin. It will not make grafted skin match the skin around it in colour or texture, it will not restore normal sensation, and it does not reliably fix itch. Medical tattooing, laser and fat grafting each help at the margins. A surgeon who promises the scars will go is not describing burn reconstruction.

And accept the shape of the thing: this is a programme over years, several operations in a deliberate order, function before appearance, with long intervals in between. That is manageable across countries only if you can commit to returning, or if the plan is a single defined stage. For children it argues strongly for a local paediatric burns unit, because they need repeat releases as they grow, garments refitted, and a family that can attend.

Where travelling does make sense: a mature, defined reconstruction in a unit with a real burns service and burns-experienced therapists, where your own system does not fund the work or the wait is very long, and where the therapy can be delivered at home. Turkish burns and university reconstructive units do this work with microsurgical and hand surgery capability at a fraction of Western European private cost. Check first what your own health system funds, because burns care is covered reconstruction in most countries and the unit that treated your burn holds your records and can deliver the therapy — which is worth a great deal.

The comparison table above shows what this costs where you live, from published prices and marked where a figure is an estimate. The consultation request below reaches a coordinator who can route this to a hospital burns or reconstructive unit rather than a cosmetic quote.