Silicone gel sheets are a common OTC product used in scar prevention. Whether from trauma, from surgery, or due to other causes, most people don’t like scars and for this reason seek a way to prevent their formation and to improve their look in the hope of making them disappear. It is also common for patients to seek a consult with a specialist because they are unhappy with an old scar.
When googling about this topic, silicone gel and silicone sheets often come up in search results as a way to minimize scarring, but do they really work?
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What type of scars can be treated with silicone gel sheets?
People with a history of abnormal scarring or undergoing procedures which are known to have a high incidence of poor scarring are most likely to benefit from silicone sheeting to prevent hypertrophic scar formation.
Any type of fresh scars can benefit from the use of silicone products, starting with their use from when the skin has fully healed.
Old hypertrophic or keloid scars may benefit from silicon sheeting as well.
Silicone sheets are the best option, but when the location of the scar makes it difficult to apply and wear during the day and night, you may try the silicone gel products: although probably less effective, they may still be better than nothing.
Ask your trusted physician for advice to see if these may be options suitable to your needs.
What is the effect of silicone gel sheets on scars? Do they really work?
The effects produced by silicon sheets on scars are: flattening, increased malleability, softening, increased elasticity, and improved color of the scar.
There is mixed evidence on their efficacy, and some argue that studies showing positive results are biased. Nevertheless, silicone sheeting is a therapy used since 1982 and recommended not only by a great number of doctors worldwide but also by medical societies such as the American Academy of Dermatology.
What is the mechanism of action?
The mechanism why silicone gel sheets are capable of improving the look and feel of scars is not yet completely understood. It could be simply because of the greater moisture retention in the skin covered by the silicone, because they decrease the tension on the scar, because they provide an additional layer of protection from bacteria, or because of other factors capable of influencing collagen breakdown and fibroblast activation. More studies are needed to understand exactly how and why they work.
How to use the silicone gel sheets to improve scars?
To provide positive effects on scars, silicone sheets have to be used for at least 12 hours every day, and they are advised to be used for 24 hours for better results washing them every 12 hours before reapplying. They can be fixed on the scar with some medical tape to increase adhesion to the skin and avoid the risk of falling off. They should be uses for 2 to 3 months, sometimes up to 6 months or as advised by your doctor.
The silicone sheet should be applied as soon as possible, but only on epithelialized skin (ie. not on scabs or open wounds).
Due to the long hours of this treatment and overall long duration, it is common to see poor patient compliance with the sheeting schedule which results in no or little benefits from silicone sheeting.
What are the contraindications and side effects of silicon sheeting?
Silicone sheeting is contraindicated in patients with certain dermatological conditions and patients with known hypersensitivity to silicone. Silicon sheets are not to be used on open wounds.
Side effects, which are more likely to be experienced in hot and humid climates, include persistent itching, skin rash, skin maceration and breakdown.
What else can you do to minimize scars?
There are many lifestyle factors that influence scarring: not smoking and avoiding alcohol consumption help with healing. Not exposing the scar to sun light and covering it or using sunscreen (SPF 50) especially while the scar is still red, is very important to avoid hyperpigmentation. Being well hydrated and following a balanced diet covering all essential micro- and macro-nutrients is also important.
You should also avoid wound and scar tension, keep the incision or wound clean to avoid infections and in general follow precisely post-surgery instructions and doctor’s advice!
Massages may help to decrease sensitivity of the scar and to prevent and treat adhesions with the deeper tissues as well as to increase skin elasticity.
Scars also depend upon personal factors related to the organism capacity to heal and to your own physiology and genetics; age, health status and skin type also affect scarring and all of these factors make it not fully predictable or controllable. For this reason, every person is different and may heal or scar differently as well.
What other products are effective for minimizing and treating scars?
Many products are marketed for their alleged effect in improving the look of scars. Among them there are:
- Topical vitamin C
- Topical vitamin E
- Topical Aloe extract or gel, allantoin, centella asiatica and extracts from many other plants
- Glycosaminoglycan gel, phospholipids and glucosamine creams
While many products may be beneficial for the treatment of scar hyperpigmentation, when it comes to the scar tissue itself most of them have unproven benefits. Moreover, the small benefits provided by few products may actually be due to the massage motion during the application or due to their moisture retention properties.
For this reason, SPF50 to prevent hyperpigmentation and any moisturizer may do just fine. A skin lightening agent, such as a vitamin C serum, may be helpful in treating the hyperpigmentation. Ask your dermatologist for some advice.
What other treatments are best for scars?
The following minimally invasive treatments have been proven effective in treating scars and improving their look and feel. Depending on the specific type of scar and on your personal characteristics, one treatment may be more advisable than another. A combination therapy may also be more beneficial than a single type of treatment, thus it is important to have a consultation with a plastic surgeon or a dermatologist.
- Intralesional injection of triamcinolone acetonide (TAC) and 5-fluorouracil (5-FU) for hypertrophic scars and keloids.
- Different type of lasers: CO2 Laser, fractional laser, Er:YAG laser, pulsed dye laser.
- Scar excision (surgical removal of the scar tissue).
- Chemical peels.
- Dermabrasion.
- Fat grafts and dermal fillers (when there is loss of volume in the area of the scar).
Sources
- Evidence-Based Scar Management: How to Improve Results with Technique and Technology.
I Khansa, B Harrison, JE Janis – Plastic and Reconstructive Surgery, Sep 2016
DOI: https://doi.org/10.1097/prs.0000000000002647 - Topical Scar Treatment Products for Wounds: A Systematic Review.
B Tran, JJ Wu, D Ratner – Dermatologic Surgery, Dec 2020
DOI: https://doi.org/10.1097/dss.0000000000002712 - Essentials of Aesthetic Surery.
JE Janis – Thieme, 2018 - The Unfavorable Results in Plastic Surgery – Avoidance and Treatment. 4th Edition
MN Cohen, SR Thaller – Thieme, 2018 - Cosmetic Dermatology – Principles and Practice. 2nd Edition
L Baumann – McGraw Hill Medical, 2009 - American Academy of Dermatologists (AAD)
