Purpose Hypertrophic scarring remains an area of burns care that lacks consensus management guidelines informed by robust evidence. This complication has potentially severe functional, aesthetic and psychological consequences for patients of all ages, despite a range of available treatment modalities with variable efficacy and rates of clinical application. This presentation provides an evidence-based overview of factors contributing to scar formation in burns, preventative therapies and available treatment modalities. Methodology A literature review was conducted to summarise the clinical predictors of hypertrophic burns scars and analyse the effectiveness of different scar management techniques for both prevention and treatment. Results Increased burn depth, delayed wound healing, infection, genetic predisposition and certain anatomical locations are all factors associated with increased risk of hypertrophic scarring. Non-invasive silicone therapy and compression garments remain the cornerstone of scar prevention. For established scars, there is a paucity of evidence to support specific interventions. Silicone gel or gel sheets and compression treatments are widely used, although evidence is modest. Other techniques including laser therapy, topical or intralesional corticosteroid, microneedling and systemic pharmacotherapy lack strong evidence despite rising use in clinical practice. Conclusions In the management of hypertrophic burns scarring, there is a clear need for well-designed clinical trials to elucidate the relative efficacy of different modalities. This presentation highlights the available evidence to better equip burns clinicians to employ a multimodal and patient-centred treatment algorithm.