What Is Silicone Gel and How Does It Work on Scars?

Silicone gel is a synthetic, transparent polymer applied to the skin’s surface to prevent or reduce raised, discolored scars. It works primarily by creating an occlusive barrier that keeps moisture from escaping through scar tissue, which in turn dials down the overactive wound-healing signals responsible for excess collagen production. Available as spreadable gels and adhesive sheets, silicone-based products have been a standard recommendation in scar management for decades, though the full picture of how they influence healing is more layered than a single mechanism can explain.

What Silicone Gel Is Made Of

At its simplest, silicone gel is a crosslinked polymer built from a backbone of silicon and oxygen atoms with organic side groups attached. The result is a soft, inert, breathable material that sits on the skin without being absorbed into it. This matters because silicone is biologically inactive: it does not react with living tissue, dissolve into the bloodstream, or introduce foreign chemicals into the wound bed. It just sits there, forming a thin, flexible, semi-permeable layer.

You will encounter two main product forms. Silicone gel sheets are flexible, reusable pads that adhere lightly to the skin through static cling and are held in place by clothing or tape. Topical silicone gels are liquid formulations you spread on with a finger; they dry into a thin, nearly invisible film within a few minutes. Some topical gels include additional ingredients like vitamin C or vitamin E, though the silicone itself is the active component. Both forms aim to do the same thing, and head-to-head comparisons have found no meaningful difference in scar outcomes between them.

Why Some Scars Become Raised or Discolored

To understand what silicone gel is doing, it helps to know why some scars overshoot the healing process. When skin is injured, the body patches the gap with collagen, a structural protein that forms the scaffolding of new tissue. Normally, collagen production ramps up to close the wound and then tapers off as the scar matures. In hypertrophic scars and keloids, that tapering never fully happens. Fibroblasts, the cells responsible for making collagen, stay hyperactive. They keep churning out collagen well past the point of wound closure, leaving behind a scar that is thick, raised, stiff, and often discolored.

Research tracking the biology of these cells has shown that the number of fibroblasts and the activity of growth signals like TGF-β1 and VEGF increase steadily during the early and proliferative phases of scar formation, then decline as scars regress on their own.¹ In problematic scars, that decline is sluggish or absent. Keloids, for example, show reduced expression of a receptor (MC1R) that normally helps suppress collagen production when stimulated, effectively removing a brake on fibroblast activity.² The upshot: anything that helps slow down fibroblasts or restore normal signaling has the potential to improve these scars.

How Silicone Gel Actually Works on Scars

The honest answer is that researchers have not pinned down one single mechanism. Instead, the evidence points to a chain of effects that starts with something deceptively simple: keeping moisture in.

Scar tissue is structurally different from normal skin. It lacks the organized lipid barrier that healthy skin uses to regulate water loss. As a result, water escapes from scar tissue at a higher rate, a measurement called transepidermal water loss (TEWL). The body interprets that moisture loss as a sign the skin barrier is still compromised and responds by keeping wound-healing signals elevated, which perpetuates collagen overproduction. Silicone gel creates a semi-occlusive layer that reduces TEWL, essentially tricking the scar into thinking its barrier is more intact than it really is.

This hydration effect is real but nuanced. A study comparing silicone gel sheets with moisturizers found that while sheets provided high hydration levels, they also caused a spike in TEWL after removal because retained moisture evaporated rapidly once the barrier was gone.³ Another comparison found that topical silicone gel’s hydration capacity was actually lower than that of specialized moisturizers.⁴ So the question becomes: if moisturizers hydrate better, why does silicone still outperform them in clinical trials?

The answer seems to lie downstream of hydration. When researchers examined scars treated with silicone gel sheets, they found significantly lower levels of key growth factors in both the outer and inner layers of skin. Specifically, TGF-β1 and PDGF, two signals that drive fibroblast activity and collagen production, were reduced in silicone-treated scars compared to untreated ones.⁵ Whether the silicone achieves this purely through its occlusive effect or through some additional interaction with the skin surface remains an open question, but the downstream effect on scar biology is measurable.

Sheets Versus Topical Gels

This is one of the most common practical questions, and the answer is straightforward: both work about equally well. A randomized trial in deep hand burn patients who received skin grafts found that scar stiffness improved at comparable rates in both the silicone gel group and the silicone gel sheet group, with no significant difference between them.⁶ A separate study comparing the two for postsurgical scars reached the same conclusion and noted that topical gels were more convenient to use.⁷

That said, the choice between them often comes down to the scar’s location and the person’s lifestyle. Sheets work well on flat, covered areas like the chest, abdomen, or limbs where clothing can hold them in place. Topical gels are easier for the face, hands, joints, and any area where a visible sheet would be impractical or would not stay put. For newly healed skin that is still fragile, pediatric guidelines recommend starting with topical gel first and transitioning to sheets once the skin can tolerate adhesion.⁸

What the Clinical Evidence Shows

The evidence base for silicone gel in scar management is substantial, though it comes with the caveat that scar research is inherently messy. Scars vary enormously depending on wound type, location, genetics, and skin type, making it hard to run the kind of tightly controlled trials you might see in drug research.

With that caveat in mind, a systematic review and meta-analysis of randomized controlled trials found that topical silicone gel significantly reduced scar pigmentation, height, and pliability compared to placebo or no treatment.⁹ A separate systematic review confirmed that liquid silicone gels are associated with both preventive and therapeutic effects on hypertrophic scars.¹⁰

The effects tend to be most noticeable for scar height and stiffness, with pigmentation and color changes improving somewhat less dramatically. Silicone is not a miracle cure. A raised, angry-looking scar will not disappear entirely. But the evidence consistently points to meaningful improvements in the physical characteristics that bother people most: the thickness, the tightness, and the texture difference from surrounding skin.

How Silicone Compares to Other Scar Treatments

Silicone gel occupies an interesting middle ground in the scar treatment landscape. It is the first-line recommendation for most guidelines, largely because it is non-invasive and has few side effects. But how does it stack up against alternatives?

When compared to onion extract-based products (the most common being Contractubex, which combines onion extract, heparin, and allantoin), silicone has consistently come out ahead. A study comparing silicone gel, silicone sheets, and Contractubex for postburn hypertrophic scars found that both silicone products outperformed the onion extract formulation.¹¹ A separate randomized trial looking at postsurgical scars found that silicone gel and Contractubex produced roughly similar results for vascularity, pliability, pigmentation, and height, though that study was smaller.¹² The balance of evidence favors silicone, though onion extract products are not worthless. They are just a weaker option.

More aggressive treatments like steroid injections (triamcinolone acetonide) remain the standard for established keloids and severe hypertrophic scars. Silicone gel is typically positioned as a preventive measure or a first step, with injections reserved for scars that do not respond to topical management.

Combining Silicone With Other Approaches

Silicone gel does not have to work alone. Combining it with pressure garments, a mainstay for burn scars, appears to add benefit. A study examining the combined approach found that while silicone gel alone was effective across widespread burn scars, pressure garments provided a synergistic effect, with the combination producing the most significant improvements in scar thickness and pliability.¹³

Laser therapy is another combination partner gaining evidence. A comparative study found that pairing silicone gel with a 577-nm diode laser produced significantly better outcomes than silicone gel alone, with particularly strong results for scars on the lip and breast areas.¹⁴ The laser addresses vascular redness that silicone alone does not tackle as effectively, making the combination particularly useful for scars with prominent color changes.

Timing, Duration, and Compliance

When you start matters, and how consistently you keep going matters even more. For sutured wounds, most guidelines recommend beginning silicone application after suture removal. For open wounds like burns, you can typically start about a week after the skin has fully closed over. The goal is to begin treatment early enough to influence the scar during its most active remodeling phase.

For children, a 2025 clinical practice guideline recommends using silicone-based products after wound re-epithelialization for at least 12 hours per day until the scar matures, which can take many months.⁸ That 12-hour daily target applies broadly, not just to pediatric patients.

Compliance is the weak link in silicone therapy. A study tracking patient adherence found that scar pigmentation and height actually worsened in people who applied silicone products fewer than three days per week, while those who applied them at least four days per week saw significant improvements across all scar parameters.¹⁵ In other words, inconsistent use can be worse than no use at all, possibly because repeatedly starting and stopping the occlusive effect disrupts the scar’s adjustment to a more stable hydration state. If you are going to use silicone gel, commit to it daily.

Side Effects and Practical Frustrations

Silicone products are generally well tolerated, which is a major reason they sit at the top of scar treatment recommendations. But “generally well tolerated” is not the same as “problem-free,” especially in certain environments.

A study conducted in Saudi Arabia documented the challenges of using silicone gel sheets in hot climates. The most common complaint was persistent itching, reported by the majority of patients. Skin rash and skin softening to the point of maceration were also frequent. Perhaps most striking, over half of patients reported that the sheets failed to improve the dryness of their scars, and about a quarter saw poor scar response to treatment overall.¹⁶ Heat and humidity make sheets harder to keep in place, promote sweating underneath the occlusive layer, and create an environment ripe for skin irritation.

Topical gels sidestep some of these issues because they form a thinner, breathable film. If you live in a hot or humid climate, or if you find that sheets cause itching or rash, switching to a topical gel formulation is a reasonable first step before giving up on silicone altogether. Other practical tips: wash the scar and surrounding skin before application, let topical gels dry fully before dressing, and clean reusable sheets daily with mild soap.

Cost and Accessibility

Silicone gel also has a cost advantage over more complex interventions. A trial-based economic evaluation comparing three scar management approaches for burn patients found that topical silicone gel was the cheapest option by a wide margin, with a mean cost roughly a third of pressure garment therapy and a quarter of combined silicone-plus-pressure therapy. Quality-of-life outcomes did not differ significantly between the groups, and there was a high probability that topical silicone gel was both cheaper and at least as effective as the alternatives.¹⁷

Most silicone gel products are available over the counter at pharmacies and online, without a prescription. Prices range from modest for generic topical gels to considerably more expensive for branded sheets. Because treatment typically lasts months, cost can add up, but it remains far less burdensome than regular clinic visits for steroid injections or laser sessions. For many people, especially those managing scars from routine surgery, silicone gel represents the most accessible entry point into scar care.

Silicone Gel for Children

Pediatric scar management deserves its own mention because children’s skin heals differently, and compliance challenges are amplified. Kids are less patient with sticky sheets, more active, and more likely to peel products off. A 2025 pediatric clinical practice guideline rated silicone-based agents as strongly recommended for scar prevention after wound healing, noting high-level evidence for their role in suppressing excess collagen, alleviating itching and redness, and improving scar texture. For established hypertrophic scars and keloids in children, the guideline supports topical silicone applied once to twice daily to soften tissue and reduce symptoms. Vitamin C-containing silicone gels were highlighted as particularly effective for severe pediatric scars, with recommendations for continuous use exceeding three months.⁸

The practical advice for parents is to start with topical gel rather than sheets when the new skin is still thin and fragile, and to transition to sheets once the skin can handle them. For facial scars in young children, topical gel is preferred indefinitely because of the risk of accidental ingestion with sheets or tape near the mouth.

What Silicone Gel Cannot Do

Setting realistic expectations saves a lot of frustration. Silicone gel is most effective at prevention and early intervention, meaning scars that are caught during their active remodeling phase respond better than scars that have been stable for years. An old, fully matured keloid is unlikely to flatten meaningfully from silicone alone; that situation usually calls for steroid injections, surgical revision, or a combination approach.

Silicone also works on the scar’s surface characteristics, not on deeper structural issues. It can improve pliability, reduce height, and soften color, but it will not change the fundamental architecture of severely contracted tissue that is limiting joint movement. Burn contractures, for instance, may need physical therapy or surgery in addition to any topical management.

And while silicone products reduce scar redness and pigmentation, they do not act like a skin lightening agent. The color improvements happen because the scar itself is becoming healthier and less inflamed, not because the silicone is bleaching anything. For persistent hyperpigmentation after the scar has otherwise improved, separate dermatological treatments may be needed.