Does Silicone Gel Really Improve Surgical Scars? What a Placebo Trial Found

Quick answer: Silicone gel is the most widely recommended non prescription scar treatment, and guidelines support it for raised or thickened scars. But a placebo controlled trial on eyelid surgery scars found no significant difference at six months. The honest reading is that silicone helps most where scars are prone to thickening, and adds little where the skin heals neatly on its own.

What does a surgical scar normally do?

A closed surgical wound usually seals within a week or two, but the scar itself keeps remodelling for a year or longer. In the early months a normal scar is often pink, slightly firm and a little raised. Over time most scars flatten, soften and fade towards the surrounding skin tone. That natural fading is the single most important thing to understand before spending money on scar products, because a lot of improvement happens whether or not anything is applied.

Some scars do not follow that path. Hypertrophic scars stay thick, red and itchy within the original wound border. Keloids grow beyond the border and behave more like an overgrowth. These are far more common on the chest, shoulders, upper back and earlobes, where skin is under tension, and in people with a personal or family history of them.

How is silicone supposed to work?

Silicone sheets and gels are thought to work mainly by occlusion, meaning they hold moisture in the outer layer of the scar and reduce water loss through it. The prevailing explanation is that a better hydrated scar signals the underlying fibroblasts to lay down less collagen, which over months means a flatter, softer, less red scar. Silicone is not absorbed into the skin and is not a drug, which is also why it has such a low side effect profile. The main complaints are irritation under sheets and the nuisance of applying gel twice a day for months.

What did the trial actually find?

A useful test of silicone gel is registered as NCT03601247, sponsored by Montefiore Medical Center. It enrolled 132 participants having eyelid surgery and used a within patient design: silicone gel on the scar of one eye, a placebo on the other, so each person acted as their own control. A blinded third party physician graded the scars at one week, one month, three months and six months for redness, elevation and pigmentation. The registry lists the study as completed, with results posted.

The posted results do not show a benefit. Redness scores at six months were 1.00 for the silicone gel side and 1.09 for the placebo side. Elevation scores at six months were 1.00 on both sides. None of the comparisons at any timepoint reached statistical significance, with reported p values ranging from 0.11 to 1.00. In plain terms, the gel did not beat the placebo on this type of scar.

Being fair to silicone, this is one site and one operation. Eyelid skin is thin, under almost no tension, and heals unusually well. Both groups in this study ended up with near invisible scars, which leaves very little room for any treatment to show an effect. A study on a thick, high tension scar across the chest would be a much harder test and might read differently. What this trial does establish is that silicone is not a universal improvement on every surgical scar.

So should you use silicone at all?

International scar management guidance has long placed silicone as a reasonable first line option for preventing and treating hypertrophic scars, and it remains the most studied topical approach. A sensible way to hold both facts at once:

• If your scar is on a high tension area, is already looking thick or red at six to eight weeks, or you have a history of keloids, silicone is worth trying and worth discussing with your surgeon.
• If your scar is small, flat, on thin skin such as the eyelid, and is already settling, silicone is unlikely to change your outcome much.
• Either way, start only once the wound is fully closed with no scabs or open areas, typically two to three weeks after surgery.
• Consistency matters more than brand. Most protocols involve 12 or more hours a day for at least two to three months, and scars respond slowly.

What else genuinely affects how a scar turns out?

Two things carry more weight than any gel. The first is sun protection. A new scar pigments readily, and sun exposure in the first year can leave it permanently darker than the skin around it. Cover it or use a high factor sunscreen once it is closed. The second is tension. Scars stretched by movement or by pulling across a joint tend to widen. Supportive taping, sensible activity limits in the early weeks, and following your surgeon's instructions about lifting all reduce that.

Massage is often recommended once the wound is closed, usually firm circular pressure for a few minutes a day. The evidence for it is modest and inconsistent, but it is low risk and many people find it helps with the tightness.

When to get the scar looked at

• The scar is growing beyond the original wound edges, which suggests a keloid rather than a normal scar.
• It becomes increasingly itchy, painful or thickened after the second month rather than settling.
• It restricts movement across a joint, or pulls on the eyelid, lip or another structure.
• There is new redness, warmth, swelling or discharge, which points to infection rather than scarring.

Thickened and keloid scars have treatment options beyond topical care, including pressure therapy, steroid injections and laser. These are much more effective when started early rather than after a year of waiting to see.

An important note

This article is general information, not medical advice. Scarring depends on your skin type, the site and tension of the wound, and your own healing history. Please consult your doctor or surgeon about your own scar, particularly before starting anything on a wound that is not fully closed.

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