Do Silicone Scar Sheets Work?

What the research actually shows

The best summary of the silicone trials is a Cochrane review published in 2013. It pooled 20 trials with 873 people, aged 1.5 to 81, that compared adhesive silicone gel sheets with no treatment or with other treatments. In people prone to scarring, those who wore a sheet after a new wound had healed developed raised (hypertrophic) scars less often: a risk ratio of 0.46, with a 95% confidence interval of 0.21 to 0.98. In trials that treated an existing raised or keloid scar, sheets reduced scar thickness and improved scar color.

The authors attached the same warning to every one of those results: the studies were poor quality and highly susceptible to bias. Their plain-language summary goes further and says it is unclear whether silicone gel sheeting helps prevent abnormal scars or treat existing ones. The upper end of the prevention estimate, 0.98, sits just under 1.0, the point of no difference.

That is the whole picture in one place. A 2014 international scar guideline, written by a group of 24 experts, calls silicone sheeting or gel the first-line option for both preventing and treating hypertrophic scars and keloids. Both things are true at once: silicone is the most-recommended first step in that guideline, and the trials behind it are small and weak. A guideline is a group of experts weighing what is available; a Cochrane review grades how good that evidence is.

How silicone is thought to work

A 2008 review of silicone therapy says the way it works has not been completely determined. The likely explanation is occlusion and hydration: the sheet seals the outer layer of the scar and keeps it moist, and that changes the chemical signals passing from the surface skin cells to the deeper cells that build scar tissue. In plain terms, the benefit is thought to come from covering and hydrating the scar.

The same review describes a newer form, silicone gel from a tube, which dries to a thin flexible film over a newly healed wound or an older scar. It reports that trials and clinical experience suggest the gel is about as effective as a sheet and easier to use. The Cochrane plain-language summary describes the sheet itself as a soft, self-adhesive sheet applied to intact skin. The word intact matters, and we return to it below.

Raised scars and keloids are not the same thing

A hypertrophic scar is raised and often red, but it stays within the edges of the original wound, and it often settles on its own with time. A keloid keeps growing and can spread into the skin around the injury. Keloids are more common in darker skin. The two look alike at first, and the 2013 Cochrane review pooled them, so its results above do not separate one from the other.

For keloids on their own, the evidence is thinner still. A 2023 Cochrane review set out to find randomized trials of silicone sheets for treating keloids and found two, with 16 and 20 participants, followed for three and four and a half months. It rated all the evidence very low certainty and concluded there is not enough to show whether sheets make any difference compared with no treatment, a similar sheet without silicone, or steroid injections. That is not the same as saying silicone fails on keloids. It means no one has tested it properly. A keloid that itches, hurts, or keeps growing usually needs a doctor's treatment plan; the surgical side is described on our keloid and scar revision page.

Old scars, flat scars, and acne scars

Every treatment trial in this research was done on a raised scar, and the prevention trials were done on fresh wounds at risk of becoming raised. A 2021 Cochrane review looked only at sheets for treating existing hypertrophic scars and found 13 randomized trials, each with 10 to 60 participants. Comparing a sheet with no sheet, it found it uncertain whether scar severity differed between the two groups (a mean difference of −1.83, 95% confidence interval −3.77 to 0.12, a range that includes zero, rated very low certainty) and a possible slight reduction in pain, rated low certainty. Its conclusion: limited rigorous evidence.

What is missing matters as much. Nothing in this body of research tested a flat, pale scar that is years old, and nothing tested pitted acne scars. A pitted acne scar is a dent where tissue was lost, the opposite of the raised scar that silicone was designed for. On those two questions the research is not weak; it is absent. If a flat, old scar bothers you, the options are different ones, and a surgeon can tell you which apply.

If you usually heal with a flat scar

Most people who have skin surgery are not prone to raised scars, and the trials in that group point in different directions. In a randomized trial run in an office skin-surgery practice, patients with no history of abnormal scarring showed no statistical difference whether or not they used silicone sheets. The authors concluded that sheets appear useful for patients having a scar revision, which means people whose previous scar had already gone wrong.

Other trials found a benefit in unselected patients. In a trial of foot surgery done on both feet at once, with a silicone sheet applied to only one scar for 12 weeks from the day the stitches came out, the sheeted scar scored better at 4 and 12 weeks on every scar measure except length. In the largest of these trials, 129 women after breast reduction, a high-tension site where 64.3 percent of patients developed a hypertrophic scar by three months, neither a silicone sheet nor a silicone gel prevented hypertrophic scars, and when the two silicone groups were pooled, the silicone-treated scars developed significantly more hypertrophy than scars supported with a microporous paper tape. That is one trial, at one site, against tape rather than nothing. Three trials, three different answers. For a routine surgical scar in someone who usually heals flat, the benefit is unproven either way.

No randomized trial of silicone after Mohs surgery, or on facial surgical closures specifically, turned up in our search of the medical literature. The surgeon who closed your wound knows how it was closed, where it sits, and how you have scarred before, which is why that conversation beats any general rule.

When the trials started silicone, and for how long

Published trials disagree on the schedule, so there is no single rule to quote. Several began when the stitches came out. The foot-surgery trial above applied the sheet for 12 weeks from stitch removal. A trial that treated established raised scars on the chest after heart surgery had patients wear the sheet continuously for 12 hours a day for 12 weeks. A cesarean-scar trial applied sheets or paper tape for three months. The Cochrane review describes a silicone sheet as something applied to intact skin, and the trials that gave a start point began on healed, closed skin.

Nothing on this page is a start date for your wound. A sheet or gel placed over an open wound, a scab, or stitches is not what these trials did, and it is not something to try on your own. If your wound still has sutures or adhesive strips, our article Steri-Strips: When Do They Come Off? explains the difference between the strips placed at surgery and taping a healed scar later. When your skin is ready for anything on top of it, and whether silicone suits your scar, are questions for the surgeon who treated you. Your surgeon will tell you when your wound is ready.

Sheet or gel? That is not settled either. The 2008 review says trials and experience suggest the gel is about as effective as the sheet and easier to use. The 2021 Cochrane review found one trial of 32 people comparing the two and could not tell whether they differ. The choice between them is usually about where the scar is and what will stay in place, and your surgeon may have a preference.

Other scar treatments with evidence

Silicone is not the only measure with trials behind it. The alternatives that come up most often, with what the trials found:

• Paper tape. In a randomized trial of 70 women after cesarean section, 41 percent of the untaped group had a hypertrophic scar at 12 weeks compared with none of the taped group (p = 0.003). Only 39 of the 70 completed the study, one taped patient developed a hypertrophic scar and four developed stretched scars after the tape came off, and four had a brief rash under the tape. Our Steri-Strips article charts this trial.
• Pressure garments. The 2014 guideline lists them for more widespread scarring, especially after burns.
• Steroid injection. Injecting a steroid into a raised scar has long been a standard treatment. In a small randomized trial of 14 heart-surgery patients with symptomatic raised chest scars, one half of each scar was injected and the other half wore a silicone sheet: 11 preferred the sheet, 1 had no preference, and 2 preferred the injection, and symptoms eased sooner on the sheeted half (3.9 versus 6.8 days on average). The 2023 keloid review could not tell whether sheets or injections do better for keloids.
• Laser. A 2022 Cochrane review of laser treatment for hypertrophic and keloid scars pooled 15 randomized trials with 604 participants. Low-certainty evidence suggested more improvement with a pulsed-dye laser than with no treatment (risk ratio 1.96, 95% confidence interval 1.11 to 3.45, from two studies and 60 scar segments). The authors concluded there is insufficient evidence to support or refute laser treatment for these scars.
• Vitamin E. In a double-blind trial of 15 patients after skin-cancer surgery, with vitamin E applied to one half of each scar, it either had no effect on or worsened the scar's appearance in 90 percent of cases, and 33 percent of the patients developed a contact dermatitis to it.
• Onion extract. In a double-blind trial of 24 patients with new surgical scars, an onion-extract gel did not improve the scar's appearance or symptoms compared with a plain petrolatum ointment. Surgeons differ on both of these products; ask yours before using either on a scar.

What the guideline lists for any new scar

The 2014 international guideline begins with measures it says apply to all scars, before, during, and right after surgery: careful surgical technique, reducing tension on the skin, taping, hydration, and protecting the early scar from ultraviolet light. Those measures are the background against which silicone is judged. How they apply to your wound, and in what order, is part of the instructions from the surgeon who treated you.

If something about a healing scar worries you, such as a rash, blistering, or broken skin under an adhesive sheet, or a scar that is getting thicker, more painful, or itchier, that surgeon is the person to call. Follow the instructions from the surgeon who treated you before anything you read here.