Silicone-based products are the most well-supported topical treatment for scars, recommended as a first-line option in international clinical guidelines. But the best approach depends on the type of scar you’re dealing with, how old it is, and whether it’s raised, sunken, or discolored. Here’s what actually works, what’s overhyped, and when you need professional treatment.
Silicone: The Best-Studied Topical Option
Silicone gel sheets and silicone-based gels have the strongest evidence behind them for preventing and improving raised scars. They work through several mechanisms at once: they trap moisture against the skin, which signals the body to slow down collagen production, and they create gentle compression that helps keep the scar flat and prevents it from widening. The slight change in temperature and oxygen levels under the silicone also appears to discourage excess scar tissue from forming.
You can find silicone in two main forms. Adhesive sheets are placed directly over the scar and worn for hours at a time, typically 12 or more hours per day. Silicone gels dry into a thin film and work better on areas where sheets won’t stay put, like the face or joints. Both are available over the counter. For the best results, start using silicone once the wound has fully closed, usually about four weeks after surgery or injury, and continue daily for at least two to three months.
Sunscreen Matters More Than You Think
New scars are highly vulnerable to UV damage, which can cause permanent darkening that’s much harder to treat later. Apply a broad-spectrum sunscreen with SPF 30 or higher over any healing scar, and reapply every two hours when you’re outdoors. This is one of the simplest, cheapest steps you can take, and skipping it can undo the benefits of everything else you’re using. Combining daily silicone treatment with consistent sunscreen is the foundation of good scar care.
Onion Extract and Vitamin E: Worth It?
Onion extract (the active ingredient in products like Mederma) is one of the most popular over-the-counter scar treatments, but the clinical evidence is less convincing than its marketing. Some small studies suggest modest improvements in scar texture, but head-to-head comparisons with silicone generally favor silicone. If you want to try it, it’s unlikely to cause harm, but it shouldn’t replace silicone as your primary approach.
Vitamin E is the classic home remedy for scars, and it’s one of the most overhyped. A systematic review of six clinical studies found that three showed no significant improvement when vitamin E was used alone, and the three that did show benefit either studied a narrow population or combined it with other treatments. More concerning, up to 33% of patients in one study developed contact dermatitis from topical vitamin E, with others reporting itching and rash. There isn’t sufficient evidence to recommend it, and it carries real risk of irritating healing skin.
Aloe Vera and Honey
Aloe vera gel has shown promise in lab and early clinical studies for wound healing. Its biocompatible properties appear to support faster healing with less visible scarring when applied during the wound-healing phase. Honey has demonstrated antibacterial properties that help prevent infection, which is one of the biggest risk factors for worse scarring. Neither has the depth of clinical evidence that silicone does for established scars, but both are reasonable options during the early healing window, particularly for minor wounds.
When Topicals Aren’t Enough
Over-the-counter products work best on flat or mildly raised scars. If you’re dealing with a keloid (a scar that grows beyond the original wound boundaries), a thick hypertrophic scar, or depressed acne scars, you’ll likely need professional treatment.
Raised and Keloid Scars
Steroid injections are the preferred first-line treatment for keloids. A dermatologist injects a corticosteroid directly into the scar tissue, which breaks down excess collagen and flattens the scar over a series of sessions. In one clinical study, 50% of treated keloids showed excellent flattening (76% to 100% reduction), and another 33% showed good flattening. Laser therapy is another strong option. Pulsed dye lasers target the redness and blood vessels in raised scars, while fractional CO2 lasers improve texture and pigmentation. Combining both laser types has shown a 100% response rate for surgical scar improvement in clinical testing.
Acne Scars
Depressed acne scars are a different challenge because the problem is missing tissue rather than excess tissue. The treatment depends on the shape of the scar. Rolling scars, which create a wavy texture, respond well to subcision (a procedure that releases tethered scar tissue beneath the skin) and hyaluronic acid fillers that restore lost volume. Icepick scars, which are narrow and deep, are treated with a technique called CROSS, where a strong chemical solution is applied precisely into each scar to stimulate collagen rebuilding from the bottom up. Boxcar scars, with their sharp edges and flat bases, improve with fractional lasers. The 1550nm erbium-doped fractional laser has shown clinical improvement across all three acne scar types, making it a versatile option when you have a mix.
Timing Your Treatment
When you start matters almost as much as what you use. Most topical scar treatments should begin about four weeks after surgery or once the wound is fully closed with no scabbing or open areas. Starting too early can irritate the wound and slow healing. Starting too late means missing the window when the scar is most responsive to treatment.
Scars continue to remodel for 12 to 18 months, so consistency during that period gives you the best outcome. If you’re unhappy with a scar after it has fully matured, professional treatments like lasers and injections can still make meaningful improvements, but they typically require more sessions than if you’d started earlier.