Managing surgical scars: silicone gel and ointments

How do scars form?

When the skin is cut, the body makes new tissue to fill in the wound, and the mark it leaves behind becomes a scar. Most scars flatten and fade over time, but in some people the healing process does not proceed normally and the scar becomes prominent.

Keloids and hypertrophic scars are scars that are markedly raised and dark in color, with an increased number of blood vessels and cells, and they form when wound healing does not proceed properly in some people with a family history and genetic factors ^[4]. Depending on their location, these scars can greatly reduce quality of life through pain, itching, tightness, and concerns about appearance ^[4].

The evidence for silicone gel and sheets

A 2020 systematic review analyzed 34 clinical trials of topical scar products ^[1]. Of the 16 that looked at silicone gel sheeting, several high-quality randomized controlled trials found that silicone gel sheeting and silicone gel meaningfully improved scar outcomes ^[1]. The researchers concluded that silicone gel products are a noninvasive treatment that prevents abnormal scars from forming and improves scars that have already formed ^[1].

In a 2020 meta-analysis that combined 6 randomized controlled trials with 375 patients, silicone gel meaningfully lowered scores for the pigmentation, height, and pliability of scars after surgery compared with a placebo or no treatment ^[2]. Topical silicone gel and silicone gel sheeting had similar effects ^[2].

However, silicone gel also performed similarly when compared with other topical treatments that do not contain silicone ^[2]. It has also been noted that more high-quality research is needed to establish its long-term effects ^[1].

Other topical products

The number of over-the-counter medicines and cosmetics that claim to prevent or improve scars keeps growing, but there is a lack of solid clinical data to support these claims and guide product choice ^[1]. In the same systematic review, research supporting the effectiveness of onion extract, vitamin E, trolamine, and microporous tape was limited ^[1].

• Silicone gel and silicone gel sheeting: relatively more high-quality studies
• Onion extract: limited evidence
• Vitamin E: limited evidence
• Trolamine: limited evidence
• Microporous tape: limited evidence

Treating hypertrophic scars and keloids

Keloids and hypertrophic scars are treated with oral medications, topical medications, and injections into the scar, which are sometimes combined with surgical removal, cryotherapy (freezing), laser treatment, radiation therapy, or silicone gel or sheets ^[4]. A 2024 literature review summarized that the effects of treatment with a single medication were inconsistent across studies, and that combination drug therapy targeting several mechanisms at once was more effective than treatment with a single medication ^[4].

Literature on neck scars also described many methods, including topical steroids, steroid injections into the scar, interferon, 5-fluorouracil, silicone gel, radiation, laser treatment, and surgery, but there was no consensus on the best treatment ^[3]. Which method to use is judged by your specialist based on the type and location of the scar and your individual constitution.

Pressure therapy and how long care lasts

A 2024 Cochrane systematic review of pressure-garment therapy, which is widely used to prevent hypertrophic scars after burns, examined data from 15 studies with 1,179 people, but concluded that there was not enough evidence to recommend pressure-garment therapy or other alternatives ^[5]. It was also suggested that silicone may cause fewer adverse effects than pressure garments or be easier to keep using, but this too was based on very low-certainty evidence ^[5].

The same review pointed out that the effects of treatment on scar healing may not become fully apparent until around 18 months ^[5]. These data are about burn scars, but they show that scar care may not be finished in a short time.

What to expect and what to check during your consultation

The literature on neck scars stressed that patients need to understand that treatment is likely to improve a scar but may not make it disappear completely ^[3]. How noticeable a scar remains differs from person to person depending on the surgical site, skin characteristics, constitution, and how the scar is cared for. If a scar becomes red and raised, itchy, or painful, it is best to have it checked at a clinic visit.

• When to start using scar care products and for how long
• Any family history of keloids or hypertrophic scars, and your past experience with scars
• The treatments available if a scar becomes raised or itchy
• The follow-up schedule for checking your progress