Hypertrophic scars can be flattened at home using a combination of silicone therapy, consistent massage, and pressure. The good news is that unlike keloids, hypertrophic scars naturally tend to regress over time, often beginning to improve around six months after they first appear. The right home treatments can speed that process and produce meaningful results, with silicone products alone shown to reduce scar height by up to 68%.
First, Make Sure It’s a Hypertrophic Scar
Before investing weeks in a home treatment plan, it helps to confirm what you’re dealing with. Hypertrophic scars stay within the boundaries of the original wound. They’re raised, firm, and often pink or red, but they don’t creep outward beyond where the injury was. Keloids, by contrast, grow past the edges of the original wound, tend to appear on the earlobes, shoulders, chest, and upper back, and do not regress on their own.
This distinction matters because home treatments work well for hypertrophic scars but are far less effective for keloids, which typically need clinical intervention. If your raised scar is spreading beyond the original wound line, that’s a sign you’re dealing with a keloid rather than a hypertrophic scar.
Silicone Sheets and Gels: The Strongest Option
Silicone is the most evidence-backed home treatment for hypertrophic scars. It’s one of only two therapies (the other being steroid injections, which require a clinic visit) with strong enough evidence to be recommended as a standard treatment. Clinical studies have reported an 86% improvement in texture, 84% in color, and 68% reduction in scar height with silicone use.
The exact mechanism isn’t fully understood, but silicone works primarily by trapping moisture against the skin’s surface. This hydration signals the outer skin cells to communicate with the deeper scar tissue, slowing the overproduction of collagen that makes hypertrophic scars raised and firm in the first place.
You have two main options: silicone sheets (thin, reusable strips you place directly over the scar) and silicone gel (which you apply like a cream and let dry into a thin film). Both are available over the counter. Sheets work best on flat body areas where they can stay in place, like the forearm, chest, or abdomen. Gel is more practical for joints, the face, or other areas where a sheet won’t stick reliably. To see results, you need to wear sheets or apply gel for many hours each day, ideally 12 or more, over several weeks to months. Consistency is what makes silicone work; occasional use won’t produce noticeable changes.
Potential Side Effects
Silicone is generally safe, but long-term wear can cause issues, especially in hot or humid climates. In one study conducted in Saudi Arabia, 80% of patients experienced itching under the sheet, 28% developed a skin rash, and 16% had skin maceration (where the skin becomes soft and starts to break down from excess moisture). If you notice persistent irritation, try reducing wear time by a few hours, cleaning both the scar and the sheet daily, and letting the skin breathe overnight. Poor compliance was reported in 12% of patients, often because of these comfort issues, so finding a wearing schedule you can actually maintain matters more than hitting a perfect number of hours.
Scar Massage Technique
Massage is a simple, cost-free way to help flatten a hypertrophic scar, and it works well alongside silicone therapy. The key is timing: don’t start until at least two to three weeks after the wound has fully closed. Before that point, the scar tissue hasn’t built enough strength, and you risk reopening the wound or causing irritation.
Once you’re past that window, apply petroleum jelly or a plain moisturizer to the scar and use gentle pressure in a circular motion. You’re not trying to break anything down with force. Gentle, steady pressure is what helps remodel the collagen fibers that make the scar raised and stiff. Aim for 10-minute sessions, twice a day, for at least six weeks. Massage also relieves the itching that often accompanies hypertrophic scars, which is a practical benefit you’ll notice quickly even before the scar visibly flattens.
Pressure Therapy at Home
Sustained pressure on a hypertrophic scar reduces blood flow to the area, which slows collagen production and helps the scar flatten. This is the principle behind compression garments commonly used after burns, and you can apply the same concept at home.
The target pressure range is 20 to 30 mmHg, which is above the pressure inside your small blood vessels but low enough to avoid cutting off circulation. Custom pressure garments, typically ordered through a medical supply provider, deliver around 25 mmHg. For smaller scars, compression bandages or even well-fitted adhesive tapes designed for scar therapy can provide similar pressure. Pressures above 40 mmHg can cause numbness and skin breakdown, so tighter is not better.
The catch with pressure therapy is the time commitment. For best results, pressure garments should be worn 23 hours a day for 6 to 12 months. Starting early, as soon as two weeks after the wound closes, produces better outcomes than starting later. This level of commitment is realistic for burn scars under clothing but less practical for visible areas like the face or hands. If you can stick with it, the evidence supports combining pressure with silicone for a stronger effect than either alone.
What About Onion Extract Gels?
Products containing onion extract (the most well-known being Mederma) are widely marketed for scars, but the evidence is mixed. A meta-analysis of randomized controlled trials found that onion extract gel alone performed similarly to silicone gel in some studies but was found inferior to silicone gel and silicone sheets in others. The results weren’t consistent enough to call onion extract a reliable standalone treatment.
There is, however, an interesting finding: onion extract combined with silicone gel outperformed both plain silicone gel sheets and placebo gels across multiple trials. So if you want to use an onion extract product, look for one that combines it with silicone rather than using onion extract as your only treatment.
Skip the Vitamin E
Vitamin E oil is one of the most common home remedies people reach for, but clinical evidence doesn’t support it. In a study of patients who had skin surgery, topical vitamin E either had no effect or actually worsened the appearance of scars in 90% of cases. On top of that, 33% of patients developed contact dermatitis, an allergic skin reaction that adds redness and irritation to the scar area. There are better options for every dollar and minute you’d spend on vitamin E.
Realistic Timeline for Results
Hypertrophic scars typically appear within a month of injury and may begin to naturally regress around six months. Home treatments can accelerate that timeline and push the final result further than your body would manage on its own, but you won’t see changes overnight.
With consistent silicone use, most people notice the scar becoming softer and slightly flatter within four to eight weeks. Significant height reduction takes longer, often three to six months of daily treatment. Massage results are subtler and build gradually over the initial six-week protocol. Pressure therapy, when worn consistently, typically shows meaningful results over 6 to 12 months.
The most effective approach combines all three: silicone for hydration and collagen regulation, massage for tissue remodeling and itch relief, and pressure for reducing blood flow to the scar. Add sun protection to the scar whenever it’s exposed, since UV exposure can darken scar tissue and make it more noticeable even as it flattens. A combined routine started early in the scar’s life gives you the best chance of a flat, pale result without needing clinical procedures.