Patients with post-burn scarring frequently request help in improving the aesthetic appearance of their residual cicatricial deformity. This quest has led to the application of many different topical therapies, which have included carbon dioxide (CO2) laser resurfacing, dermabrasion, and deep chemical peels. All these modalities share a similar mechanism of action, topically ablating the skin to yield a more homogenous surface. However, these therapeutic modalities ablate the epidermis and the basement membrane with subsequent protracted reepithelialization, possibly causing additional dermal fibrosis. In contrast, medical needling will preserve the epidermis and restructure the dermis, leading to an improved appearance and high patient satisfaction.