Scars are weird. They aren't just "tough skin" or a memory of a bad kitchen accident. They’re basically a biological panic response. When your skin gets torn open, your body doesn't care about looking pretty for Instagram; it just wants to close the gap before an infection sets in. This rush job—this frantic layering of collagen—is what leaves us with those raised, red, or itchy marks.
If you've spent any time looking for a fix, you've definitely bumped into silicone based scar gel. It’s everywhere. Dermatologists swear by it, but honestly, most people use it totally wrong. They slap a bit on once a week and wonder why that surgical scar still looks like a bright purple worm.
The reality is that silicone is the "gold standard" for a reason. But it isn't magic. It's chemistry. And it’s a slow-motion game of patience.
Why silicone actually works (and it’s not what you think)
Most people assume these gels "sink in" like a moisturizer to soften the skin. That’s actually not it at all. Silicone is "occlusive." Basically, it creates a microscopic, breathable barrier over the scar. It's like a high-tech rain jacket for your injury.
When a scar is exposed to the air, it loses moisture. This dehydration sends a signal to your body: "Hey, we're losing water! Send more collagen!" The body overcompensates, making the scar thicker and harder. By applying a silicone based scar gel, you're tricking the skin into thinking it's already hydrated.
This shuts down the emergency collagen production.
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According to a massive review published in the Journal of Cutaneous and Aesthetic Surgery, silicone gel has been the clinical recommendation for scar management since the early 1980s. It works by increasing the temperature of the scar surface slightly, which helps the collagen fibers reorganize themselves into a flatter, more natural pattern. It's subtle. You won't see it happen overnight. But over months? The difference is massive.
The hydration factor
Think about a piece of dried leather. If you leave it in the sun, it gets brittle and cracks. If you keep it conditioned, it stays flexible. Your scar is the same. Silicone mimics the natural barrier function of healthy skin, which is something your newly formed scar tissue is really bad at doing on its own.
The big mistake: Timing and consistency
I see this all the time. Someone gets a mole removed or has a C-section, and they start rubbing gel on the wound while it’s still bleeding or scabbed over.
Don't do that.
You have to wait until the "epithelialization" is complete. In plain English? The wound must be closed. No scabs. No oozing. If you put gel on an open wound, you’re just inviting a mess and potentially an infection.
The other issue is the "once-in-a-while" approach. Silicone only works if it's in contact with the skin for almost 24 hours a day. Most experts, including those at the American Academy of Dermatology, suggest that for a silicone based scar gel to be effective, it needs to be on the skin for at least 12 to 22 hours daily.
If you put it on in the morning and it rubs off on your shirt by noon, you've basically done nothing for the rest of the day. You've gotta be religious about it. Apply, let it dry (which takes about 4-5 minutes for a good formula), and then go about your business. If it's still sticky after five minutes, you used too much. You only need a tiny, thin film.
New scars vs. Old scars: Is it too late?
People always ask if that old scar from a 10-year-old bike wreck can be fixed.
The short answer? Maybe a little, but don't expect miracles.
Silicone is most effective on "immature" scars—those that are still red, raised, or itchy. This is usually within the first 6 to 12 months after an injury. Once a scar turns white and flat, it's considered "mature." At that point, the collagen is pretty much set in its ways.
That said, some studies have shown that even older hypertrophic (raised) scars can soften slightly with long-term silicone use. But if you’re looking to get rid of a flat, white line from 1998, a gel probably isn't the answer. You'd likely need lasers or microneedling for that.
Keloids are a different beast
Let’s talk about keloids. These are those aggressive scars that grow way beyond the original injury site. They’re common in darker skin tones and can be really painful. While silicone based scar gel is used to manage them, it usually isn't enough on its own. Doctors often pair it with steroid injections or pressure therapy. If you have a true keloid, don't just buy a tube of gel and hope for the best. Go see a pro.
What to look for on the label
Not all gels are created equal. You’ll see some "scar creams" at the drugstore that are mostly onion extract (allium cepa) or Vitamin E. Honestly? The science on onion extract is a bit hit-or-miss compared to silicone. Vitamin E can actually cause contact dermatitis in some people, making the scar redder.
When you're shopping for a silicone based scar gel, look for these ingredients:
- Polysiloxanes: This is the fancy word for medical-grade silicone.
- Silicon Dioxide: This helps the gel dry quickly and stay matte.
- Dimethicone: A very common, safe silicone that adds a silky feel.
Brands like Kelo-Cote or Strataderm are the heavy hitters in the medical world. They're pricier than the stuff you find in the "First Aid" aisle, but they're formulated to stay on the skin better. Some newer versions include SPF, which is actually a genius move. UV rays turn scars dark brown (hyperpigmentation), and once that happens, it’s incredibly hard to reverse.
If your scar is going to see the sun, you must use a gel with SPF or put sunscreen over your gel. No excuses.
Real talk on the "Natural" alternatives
I get it. Everyone wants to use coconut oil or honey because it feels "cleaner."
And look, keeping a scar moisturized is better than doing nothing. If all you have is Vaseline, use it! It provides some of that occlusive benefit. But silicone based scar gel is the only topical treatment that has decades of peer-reviewed data proving it can actually flatten and fade raised scars.
Honey is great for wound healing (especially medical-grade Manuka honey), but once the wound is closed and you're in the "scar phase," it’s just sticky. It’s not going to remodel collagen.
Managing your expectations
You have to be patient. We’re talking 60 to 90 days of daily use.
It’s like watching grass grow, but more boring. You’ll probably think it’s not working for the first month. Then, one day, you’ll realize the scar isn't quite as "angry" looking. It won't be as itchy. The tight, pulling sensation will start to fade.
Eventually, the color should shift from a dark red or purple to a lighter pink, and finally, something closer to your natural skin tone.
It won't disappear. No gel can give you your original skin back. A scar is a permanent change in the architecture of your dermis. But a good silicone based scar gel can turn a "noticeable" scar into one that people don't even see unless you point it out.
Actionable steps for better healing
- Wait for closure: Do not start until the wound is 100% closed and scabs are gone.
- Clean the area: Wash with mild, fragrance-free soap. Oils or lotions under the silicone will prevent it from "sealing" to the skin.
- Apply a thin layer: If you can see it, it's too thick. It should be an invisible film.
- Wait for it to dry: Give it five minutes before putting clothes over it. If it stays tacky, wipe the excess off.
- Be consistent: Twice a day, every day. Most failures with silicone based scar gel happen because people forget to use it for three days straight.
- Protect from sun: Scars lack the natural protection of regular skin. Use SPF 30 or higher religiously for at least a year.
- Massage the area: If your doctor says it's okay, gently massaging the scar while applying the gel can help break up those tough collagen clumps.
Don't overcomplicate this. Get a high-quality, medical-grade gel. Apply it. Forget about it. Let the chemistry do the heavy lifting while you get on with your life.
Scientific References for Further Reading:
- Mustoe TA. "Evolution of silicone therapy and mechanism of action." Aesthetic Plastic Surgery Journal.
- Gold MH, et al. "Updated international clinical recommendations on scar management." Dermatologic Surgery.
- Berman B, et al. "A review of the pharmacology and clinical efficacy of silicone gel sheeting and topical silicone gel." Journal of Drugs in Dermatology.