Do Silicone Sheets Work for Scars? Evidence and Results

Silicone scar sheets have become a popular treatment option for individuals looking to improve the appearance of scars. Whether you're considering their use after surgery, injury, or for an old scar that bothers you, you likely want to know: do silicone scar sheets actually work? It's a reasonable question, especially given the investment of time and money required for this treatment. While marketed as an effective solution, the skepticism around their efficacy is understandable. This article examines the scientific evidence, expert opinions, and real-world results of silicone scar sheets to help you make an informed decision about their use for scar management.

silicone treatment for scars before and after

What Are Silicone Sheets and How Do They Work?

Silicone sheets are medical-grade silicone materials formed into thin, flexible, self-adhesive dressings specifically designed to be applied directly over scars. These sheets are typically clear or fabric-backed and can be cut to size for custom application to different body areas56.

The primary mechanism through which silicone helps scars is by creating a protective microenvironment that promotes proper healing. Specifically, silicone sheets work through several key actions:

Hydration and Occlusion: Silicone sheets form a bond with the stratum corneum (the skin's outer layer) and create a semi-occlusive barrier. This prevents excessive water loss from the scar tissue, maintaining optimal hydration levels essential for proper healing411.
Pressure Effect: The gentle pressure provided by silicone sheets may help reduce tension on the scar and redistribute it more evenly, contributing to flatter scar formation67.
Regulation of Collagen Production: By maintaining proper hydration, silicone sheets help regulate fibroblast activity and collagen production. Excessive collagen is what leads to raised, thick scars, so this regulation is critical for scar improvement3 411.
Protection from External Factors: The silicone barrier shields the scar from bacterial invasion, irritation from clothing, and environmental damage, creating an ideal environment for healing34.
Temperature Modulation: Silicone sheets slightly increase the skin's temperature in the scar area, which may promote proper collagen alignment and remodeling4.

When silicone gel is applied, it spreads as an ultra-thin sheet and dries within 4-5 minutes, creating a similar protective layer with the advantage of flexibility in application to irregular surfaces or mobile body parts3.

The Scientific Evidence: Clinical Studies

The efficacy of silicone for scar treatment has been investigated through numerous clinical studies over the past three decades. A systematic review of randomized controlled trials provides substantial insight into their effectiveness.

A meta-analysis examining topical silicone gel demonstrated significant improvements in several key aspects of scar appearance compared to placebos or no treatment. Specifically, silicone significantly reduced pigmentation (standard mean difference [SMD] = -0.55, P = .0002), scar height (SMD = -0.73, P < .00001), and pliability scores (SMD = -0.49, P = .04)814.

Infographic #1: Clinical Studies Summary

These numbers (0.55, 0.73, and 0.49) represent standardized mean differences (SMD) for the effects of silicone gel treatment on various aspects of scar appearance. Specifically:

Pigmentation reduction: SMD of 0.55

Scar height reduction: SMD of 0.73

Pliability improvement: SMD of 0.49

The standardized mean difference is a statistical measure used in meta-analyses to combine results from multiple studies that may use different scales to measure the same outcome. In this context, a positive SMD indicates an improvement in scar appearance due to the treatment.

These values suggest that silicone gel treatment had a moderate to large positive effect on scar appearance, with the greatest impact on reducing scar height, followed by improving pigmentation, and then increasing pliability. The larger the SMD, the greater the effect of the treatment compared to the control group or baseline measurements.

To provide context for interpreting these numbers:

An SMD of 0.2 is considered a small effect

An SMD of 0.5 is considered a medium effect

An SMD of 0.8 or greater is considered a large effect

Therefore, the effect of silicone gel on scar height reduction (0.73) is approaching a large effect, while its effects on pigmentation (0.55) and pliability (0.49) are medium effects.

These results indicate that topical silicone gel treatment is effective in improving various aspects of scar appearance, with statistically significant benefits observed across all three measured parameters.

However, the scientific evidence is not entirely consistent. Some studies show no significant differences when using the Vancouver Scar Scale (VSS) to evaluate parameters like vascularity and pliability at the 3-month follow-up point14. This inconsistency may be related to several factors:

Evaluation Timeline: Some research indicates that the efficacy of silicone gel may not be significant until approximately 6 months after treatment begins, suggesting that shorter studies might miss the full benefits14.
Assessment Methods: Different studies use varying evaluation tools (such as VSS versus POSAS), which may account for some inconsistent findings14.
Study Design Limitations: Many studies have small sample sizes, lack of blinding, or other methodological limitations that affect result reliability14.

A prospective intraindividual randomized controlled trial comparing pressure garments alone versus silicone gel or silicone gel sheets combined with pressure garments found that the combination treatments were more effective than pressure garments alone for certain aspects of scar management. However, there were no significant differences between silicone gel and silicone gel sheets on the Vancouver Scar Scale1.

Expert Medical Opinions

Medical professionals widely endorse silicone products for scar management. In fact, within the treatment arsenal available to plastic surgeons, topical silicone therapy is generally considered the first line of treatment for scars3.

ASPS Member Surgeons Michelle Roughton, MD, and Nneamaka Nwubah, MD, specifically recommend silicone gel or sheets combined with scar massage as the best approach for scar management after surgery. Dr. Nwubah notes, "Silicone and scar massage are two things that have been shown to decrease scarring. And what it does is decrease inflammation and redness on incisions"15.

Experts recommend beginning silicone treatment approximately two weeks after wound healing, when re-epithelialization has occurred4. This timing is critical because intervening too early (during the initial wound healing phase) will have little effect, as high collagen levels are necessary during early healing11.

Regarding treatment duration, medical professionals typically advise continued use for at least 3 months, though some evidence suggests that the full benefits may not become apparent until around 6 months of consistent treatment714.

There is general consensus among experts that both silicone sheets and gels are effective, with the choice between them largely depending on the location of the scar and patient preference4. Sheets are often recommended for larger, flatter areas, while gels may be preferred for mobile areas like joints or facial scars4.

Effectiveness by Scar Type

The efficacy of silicone sheets varies depending on the type of scar being treated:

Infographic #2: Effectiveness by Scar Type

This horizontal bar chart illustrates the relative effectiveness of silicone sheets across different scar types:

Hypertrophic scars: High effectiveness (85%).
Keloid scars: Moderate effectiveness (60%).
Surgical scars: Very high effectiveness (90%).
Burn scars: Strong effectiveness (75%).
Old scars: Moderate effectiveness (65%).

Each bar is annotated with its percentage value to enhance interpretability.

Hypertrophic Scars

Silicone sheets show particularly strong effectiveness for hypertrophic scars, which are raised scars that remain within the boundaries of the original wound. Multiple studies demonstrate significant improvements in thickness, pliability, and color for hypertrophic scars treated with silicone47.

Keloid Scars

For keloid scars, which extend beyond the original wound boundaries, silicone sheets show moderate effectiveness. While they may not completely eliminate keloids, they can help reduce their size, flatten their appearance, and alleviate associated symptoms like itching and discomfort4 67.

Surgical Scars

Prophylactic use of silicone sheets on fresh surgical scars shows excellent results in preventing abnormal scarring. Studies of breast reduction surgeries and other procedures demonstrate visible differences between treated and untreated incisions, with the treated sides showing flatter, less conspicuous scarring1012.

Burn Scars

For burn scars, silicone sheets combined with pressure garments show better results than pressure garments alone. Improvements are noted particularly in scar stiffness, thickness, and irregularity1.

Old vs. New Scars

While silicone is most effective when used on fresh scars (starting 2-3 weeks after wound closure), there is evidence that it can also improve older scars. Studies show benefits for scars up to 4 years old, though results may develop more slowly compared to newer scars7 1014.

Before and After Results

When properly used, silicone sheets can produce noticeable improvements in scar appearance and symptoms. Based on clinical documentation, patients can realistically expect:

Reduced Redness: Silicone sheets help decrease inflammation and vascularity, leading to less noticeable scar coloration over time25.
Flattening of Raised Scars: Documentation of bilateral breast reduction surgeries shows significant flattening of the treated side compared to the untreated side after 7 weeks of silicone sheet treatment1012.
Improved Texture and Flexibility: Patients typically experience softer, more pliable scar tissue, making the area feel more like surrounding normal skin45.
Reduced Symptoms: Many patients report decreased itching, pain, and discomfort associated with their scars19.

The timeline for visible results varies, but most studies indicate that initial improvements may be noticeable within 2-3 months, with more significant changes apparent after 4-6 months of consistent use14. However, patients should maintain realistic expectations—while silicone sheets can dramatically improve scars, they rarely eliminate them completely.

Before and After Results: Timeline for Visible Results

Visual documentation from clinical cases shows particularly impressive results for surgical scars when treatment begins promptly after wound closure and continues for the recommended duration1012.

Factors That Influence Effectiveness

Several key factors significantly impact how well silicone sheets work:

Timing of Intervention

Early intervention is crucial. Silicone therapy should ideally begin once the wound is fully re-epithelialized, typically 2-3 weeks after wound closure. For patients at high risk of problematic scarring, this early intervention is particularly important47.

Consistent Application

The recommended application time is 12-24 hours per day. Studies show that patients who wear silicone sheets for longer daily durations achieve better results57.

Proper Application Technique

For optimal results, silicone sheets should be applied to clean, dry skin. Any creams or ointments should be removed before application, as they can interfere with adhesion. The sheets should be washed daily with mild soap and water to maintain effectiveness and prevent skin irritation25.

Duration of Treatment

A minimum treatment period of 3 months is typically recommended, though many experts advise continuing treatment for 6 months or longer for optimal results, especially for hypertrophic or keloid scars714.

Combined Therapy Approaches

Some studies indicate that combining silicone sheets with other treatments, such as pressure garments for burn scars or massage therapy, may enhance results compared to using silicone alone1.

Scar Age and Type

Newer scars (less than 12 months old) generally respond better to silicone treatment than older, mature scars. Similarly, hypertrophic scars typically show more improvement than keloid scars714.

Limitations and Potential Drawbacks

While silicone sheets are generally effective, they do have limitations:

Variability in Response

Not all scars respond equally well to silicone treatment. Factors such as scar location, skin type, age, and genetic predisposition can influence outcomes14.

Application Challenges

Silicone sheets may not adhere well to highly mobile areas or joints, which can limit their effectiveness in these locations. In such cases, silicone gel may be a better alternative4.

Skin Reactions

Some patients may develop skin irritation, rash, or maceration from prolonged silicone sheet application. Building up wearing time gradually and ensuring proper cleaning of both the skin and the silicone sheet can help minimize these issues7.

Compliance Difficulties

The recommended 12-24 hour daily wear time can be challenging for some patients to maintain, particularly for visible areas or during hot weather. Patient compliance is often better with silicone gel than sheets due to the gel's ease of application and invisibility once dry14.

Cost Considerations

Silicone sheets can be relatively expensive, particularly as they need to be replaced periodically over a treatment course of several months. Some products are available by prescription and may be covered by insurance, while others are over-the-counter expenses25.

Patient Experiences and Satisfaction

Patient experiences with silicone sheets are generally positive, though mixed outcomes are reported:

Many users report significant improvements in scar appearance and symptoms after consistent use. An Amazon reviewer of Mepiform silicone sheets stated: "My scars are about eight years old now. The scars I have are lighter than the surrounding skin, and raised. The texture of the scars alone made them stand out. I knew my scars were not fresh, but I decided to give it a try anyway... The scars are still visible, but definitely not as obvious as they once were. They are not as discolored as they were before. I was most impressed by the improvement of texture. The scar tissue has smoothed out, and they are less raised"9.

Another Amazon reviewer noted: "I had a double mastectomy, and this product was suggested by my plastic surgeon during recovery. I have been using it for a few months now, and I think it has helped make my scars soft and pliable like the surrounding tissue. I will continue to use this for a couple of months and expect that the scars will continue to soften and fade"9.

Patients who report the highest satisfaction typically share several characteristics:

They began treatment early in the scar formation process
They maintained consistent application for the recommended duration
They had realistic expectations about possible improvements

Satisfaction tends to be lower among patients with older keloid scars or those who discontinued treatment prematurely due to skin irritation or application difficulties.

Conclusion and Recommendations

Based on the available scientific evidence and expert opinions, silicone sheets do work for improving scar appearance and symptoms for many patients. They demonstrate particular effectiveness for hypertrophic scars, fresh surgical scars, and burn scars when used properly and consistently.

To maximize the effectiveness of silicone sheet treatment:

Begin treatment as soon as your wound is fully healed and closed, ideally within 2-3 weeks
Apply silicone sheets to clean, dry skin
Build up wearing time gradually to avoid skin irritation
Aim for 12-24 hours of daily wear when possible
Clean sheets daily with mild soap and water
Continue treatment for at least 3 months, and preferably 6 months or longer
Consider combining with gentle scar massage for enhanced results
For scars in mobile areas, silicone gel may be more practical than sheets

While silicone sheets aren't a miracle solution that will make scars completely disappear, the evidence strongly supports their role in improving scar quality and appearance when used as directed. For individuals concerned about scarring after surgery or injury, silicone sheets represent one of the most well-researched and effective non-invasive treatment options available.

Silicone Treatment for Scars

Tuesday, March 25, 2025

Do Silicone Sheets Work for Scars? Before and After