Mechanical pressure used on healed second- and third-degree burns has long been accepted as a successful means of controlling hypertrophic scarring. Custom-fitted elastic pressure garments, when used alone, are not effective on some areas of anatomical contour and require that additional materials be inserted under the garment.A variety of insert materials are available, including Polycushion, Betapile, thermoplastics, and silicone elastomer. The criteria for use, fabrication method, and advantages and disadvantages of the materials are outlined.As soon as a problem area in the palm, side of the nose, breast cleavage, axilla, or sternal notch is identified and pressure can be tolerated, an insert is added under the pressure garment. Inserts also can be used to add pressure on any area where there is a raised scar or a decrease in range of motion due to a scar band. A pressure program is a vital part of a comprehensive rehabilitation protocol, but all selected treatment methods must be used together to obtain the best results. This review describes the characteristics of currently available synthetic insert materials and outlines the most advantageous use of each.