Using Silicone Sheets for Old Scars: Does It Work?

Scars are often considered permanent reminders of past injuries or surgeries, with conventional wisdom suggesting that once a scar has matured, little can be done to improve its appearance. However, silicone sheets for old scars have emerged as a potential solution even for long-established scars that were previously thought untreatable. This comprehensive review examines the scientific evidence behind silicone sheet therapy for mature scars and provides realistic expectations for those seeking to improve the appearance of scars that have been present for years.

Understanding Scar Maturation and Old vs. New Scars

Skin healing is a dynamic process that can take up to two years to complete12. During this period, scars undergo significant changes in appearance and structure. While new scars are metabolically active with ongoing collagen production and remodeling, old scars have largely stabilized their collagen structure and have decreased blood flow and metabolic activity.

Old vs. New Scars Structural Differences

Mature scars (typically those older than 1-2 years) are characterized by:

Stabilized collagen arrangement
Reduced metabolic processes
Decreased vascularity
More defined boundaries
Less inflammation

These biological differences explain why mature scars have traditionally been considered more challenging to treat. The active remodeling processes that can be easily influenced in fresh scars have largely concluded in old scars, making them appear less responsive to treatment. However, research indicates that even mature scar tissue can undergo further remodeling with appropriate interventions914.

The Ongoing Nature of Scar Tissue

It's important to understand that even "mature" scars maintain some degree of metabolic activity. While the most dramatic changes occur within the first 6-12 months, scars continue to undergo subtle remodeling for years. This ongoing, albeit slower, activity is what makes treatment of old scars possible, though typically with more modest results compared to newer scars12.

Scientific Mechanisms: How Silicone Affects Mature Scar Tissue

Silicone's effectiveness for scar treatment has been recognized since the 1980s1, with multiple mechanisms contributing to its ability to improve even long-established scars:

Hydration and Occlusion

Silicone sheets create a semi-occlusive barrier over the scar that increases hydration of the stratum corneum (the outermost layer of skin)13. This increased hydration softens the scar tissue and creates an environment conducive to collagen remodeling. For old scars, this hydrating effect can gradually soften rigid collagen structures that have been established for years15.

Regulation of Collagen Balance

The hydration provided by silicone sheets helps normalize the production and breakdown of collagen through various signaling pathways3. In mature scars, silicone modulates the expression of growth factors, including fibroblast growth factor β (FGF β) and tumor growth factor β (TGF β)13. This helps restore balance between collagen production and breakdown, potentially improving even long-established scar tissue.

Mechanical Effects

Silicone sheets apply gentle pressure to the scar area, which may help reorganize collagen fibers over time15. This pressure effect, combined with the occlusive environment, can gradually improve the texture and pliability of mature scars.

Protective Barrier

Silicone creates a protective microenvironment that shields the scar from environmental factors and mechanical stress, allowing the natural remodeling processes to continue without disruption713. This protection is valuable even for old scars, as it prevents additional damage and irritation that might otherwise hinder improvement.

Clinical Evidence for Old Scar Treatment

Multiple clinical studies have evaluated silicone's effectiveness specifically for mature scars, with encouraging results:

A notable clinical evaluation found that dermatologists rated the efficacy of silicone treatment as "good to very good" for 75% of mature scars, compared to 88.9% for immature scars9. While this confirms that newer scars respond more readily, it also demonstrates significant potential for improvement in older scars with consistent treatment.

Clinical Evidence for Silicone Sheet Treatment

Studies examining the results after six months of silicone treatment have shown impressive improvements: 86% reduction in scar texture, 84% reduction in scar color, and 68% reduction in scar height14. While these studies included both new and old scars, they indicate substantial improvements are possible with consistent silicone therapy.

Research also shows efficacy across different scar types, with good to very good results for 80% of hypertrophic scars, 82.3% of minor keloids, and 70% of major keloids9. This suggests that silicone sheets can be effective for various scar types, even when mature.

It's worth noting that improvements in mature scars typically take longer to manifest. While changes in newer scars might be visible within weeks, old scars generally require 3-6 months of consistent treatment before significant improvements are observed58.

Realistic Expectations: What Improvements Are Possible?

When treating old scars with silicone sheets, it's essential to maintain realistic expectations. Complete elimination of mature scars is unlikely, but meaningful improvements are possible in several aspects:

Aspects More Likely to Improve

Texture: Studies show up to 86% improvement in scar texture, with scars becoming softer and smoother over time14.
Color: Redness and hyperpigmentation can reduce significantly, with potential improvements of up to 84%14.
Comfort: Itching, tenderness, and discomfort often decrease substantially with silicone treatment313.
Pliability: Stiff, restrictive scars typically become more flexible and less constraining with consistent treatment2.
Height: Slightly raised scars may flatten, with studies showing height reduction of up to 68% in responsive scars14.

Aspects Less Likely to Improve

Overall size/area: The footprint of the scar is unlikely to diminish significantly.
Deep structural changes: Significant indentations or deep textural issues may show less improvement.
Very old scars: Scars older than 4-5 years may show more modest improvements, though some benefit is still possible14.

The degree of improvement varies based on individual factors, but evidence suggests that even scars up to four years old can respond well to silicone treatment14. Improvements tend to be gradual rather than dramatic, with continued enhancement over months of consistent application.

Factors That Influence Success with Old Scars

Several key factors can significantly impact the effectiveness of silicone sheet treatment for mature scars:

Scar Age and Type

While silicone can help scars of various ages, those between 1-4 years old typically respond better than very old scars14. Different scar types also show varying responsiveness, with hypertrophic scars generally responding better (80% good to very good results) than major keloids (70% good results)9.

Anatomical Location

Scars in areas with good blood supply and less tension (such as the face) often show better improvement than those in high-tension areas like joints or the chest. The anatomical location affects both the original scar formation and its response to treatment.

Treatment Consistency and Duration

Perhaps the most critical factor is adherence to the treatment protocol. Consistent, long-term application (12-24 hours daily for 3-6 months) yields significantly better results than intermittent use78. For mature scars especially, patience and persistence are essential.

Individual Factors

Personal factors such as age, skin type, genetics, and overall health can influence treatment outcomes. Younger individuals with good skin elasticity typically see better results, though improvements are possible for all age groups.

Previous Treatments

How the scar has been previously managed can impact its response to silicone therapy. Scars that have undergone multiple treatments may respond differently than those that have never been treated.

Treatment Protocol for Old Scars

Treating mature scars effectively with silicone sheets requires a specific approach:

Duration and Application Time

For old scars, treatment typically needs to continue for at least 3-6 months to see significant improvement8. Silicone sheets should be worn for 12-24 hours daily, with many protocols recommending a gradual increase to 23 hours of daily wear to allow the skin to adjust78.

Application Method

Ensure the scar area is completely clean and dry
Apply the silicone sheet directly to the scar, ensuring complete coverage
For curved or difficult areas, consider cutting the sheet to fit precisely
Remove daily to clean both the scar and the sheet with mild soap and water
Reapply to clean, dry skin

Signs of Progress

For mature scars, improvements may be subtle initially. Early signs of progress typically include decreased itching and discomfort, followed by gradual softening of the scar texture. Visual improvements in color and height often take longer to become apparent13.

When to Reassess

If no improvements are noted after 2-3 months of consistent use, it may be worth reassessing your approach or consulting a dermatologist. Sometimes adjustments to the protocol or complementary treatments may enhance results.

It's important to note that old scars require more patience than fresh ones. While newer scars might show visible improvement within weeks, mature scars typically require months of consistent treatment before noticeable changes occur5.

Combining Approaches for Better Results

For enhanced efficacy on mature scars, combining silicone sheets with complementary treatments can yield superior results:

Scar Massage

Gentle massage of the scar area when not wearing silicone sheets can improve circulation and help break down rigid collagen structures. This creates synergistic effects with silicone therapy by enhancing collagen remodeling11.

Sun Protection

Mature scars remain vulnerable to UV damage, which can worsen their appearance. Diligent sun protection helps prevent additional discoloration while the silicone treatment improves existing issues7.

Professional Treatments

For more significant improvements, professional treatments like laser therapy, microneedling, or corticosteroid injections can work synergistically with silicone sheets. For example, the combination of intralesional corticosteroid injection and silicone gel sheeting was recommended by the International Advisory Panel for management of hypertrophic scars and keloids4.

Topical Alternatives

For areas where sheets may be difficult to apply, silicone gel can offer similar benefits with greater convenience. Studies show comparable efficacy between silicone gel sheets and topical silicone gel, with the choice depending primarily on patient preference and treatment location10.

By integrating these approaches, you create a comprehensive scar management strategy that addresses multiple aspects of scar remodeling, potentially yielding better results than silicone alone—especially for stubborn mature scars.

When to Consider Professional Options

While silicone sheets can be effective for many old scars, certain situations may warrant professional intervention:

Signs Professional Help May Be Needed

Your scar shows no improvement after 3-6 months of consistent silicone treatment
The scar causes functional limitations (restricting movement)
The scar causes significant psychological distress
The scar is very large, extremely raised, or deeply depressed

Professional Treatment Options

Laser Therapy: Various laser treatments can target pigmentation, vascularity, and texture of mature scars
Corticosteroid Injections: Particularly effective for flattening raised scars and keloids4
Surgical Revision: In some cases, excising and reclosing an old scar may yield better cosmetic results, especially when combined with proper post-surgical care including silicone sheets

When consulting a dermatologist about old scar treatment, discuss your treatment history, expectations, and the potential for combination approaches. Professional interventions often provide more dramatic improvements for particularly challenging mature scars but typically involve higher costs and potentially greater risks.

Combination Treatments for Better Results

Conclusion: Do Silicone Sheets Work for Old Scars?

The scientific evidence supports that silicone sheets can indeed improve old scars, though typically with more modest and gradual results compared to their effectiveness on fresh scars. Studies demonstrate good to very good improvement in 75% of mature scars9, with potential reductions of up to 86% in texture, 84% in color, and 68% in height after six months of consistent treatment14.

For individuals with mature scars seeking improvement, silicone sheets represent a non-invasive, relatively affordable option worth trying before considering more invasive alternatives. The key to success lies in consistency—wearing the sheets for 12-24 hours daily for at least 3-6 months—and maintaining realistic expectations about the degree of improvement possible.

While silicone sheets may not completely eliminate old scars, they offer a scientifically-backed method for improving their appearance and potentially reducing related discomfort. For best results, consider a comprehensive approach that may include complementary treatments, and remember that patience is essential when treating mature scars. With consistent application and reasonable expectations, many individuals can achieve meaningful improvements in even long-established scars.

Silicone Treatment for Scars

Saturday, March 29, 2025

Do Silicone Sheets Work on Old Scars?