Background: Facial burns in patients with a background of keloid scaring can lead to disfiguring hypertrophic or even keloid scars, posing both aesthetic and functional challenges. This case study explores the application of a staged multimodal approach, combining CO2 laser therapy, steroid injection, follicular unit extraction (FUE) techniques, 5-flurouracil injection (5-FU) to address these challenges. Case Description: A 29-year-old man, with previous keloid scarring, suffered a 2% TBSA mid-dermal flame burn to his left cheek in 2022 after falling into a fire whilst intoxicated. He received surgical debridement and autologous keratinocyte cell suspension. Despite scar management, at 2 months post-injury, the patient developed a 15x10cm hypertrophic plaque from left oral commissure to angle of the mandible. Interventional scar treatment began with CO2 laser therapy and intralesional steroid injections, but was abandoned after 4 sessions due to worsening scar caused by intractable folliculitis. There was no improvement despite dermatology consultation and medical management. The cycle of hair follicles being blocked by scar, folliculitis, and inflammation causing further scarring had to be broken. Borrowing techniques from FUE hair transplant surgery, we strategically employed follicle reduction surgery over 3 sessions. With fewer follicles the infection settled, and intralesional steroid and 5-FU injections commenced, leading to a vast reduction in scar hypertrophy and inflammation. Conclusion: This case was unique in its use of FUE techniques to remove hair follicles. It furthermore highlights the efficacy of a multimodal approach in the management of hypertrophic scars following facial burns to improve both aesthetic and functional outcomes.