Silicone Gel and Sheets: Use in Scar Treatment 2026

The Scientific Basis of Silicone Gel Treatment: The Occlusion Mechanism

Silicone gel and silicone sheets have been used in scar treatment since the 1980s and are supported by dozens of randomized controlled trials. A brief look at the wound healing process is necessary to fully understand the mechanism of action.

Normal wound healing proceeds sequentially through four stages: hemostasis, inflammation, proliferation, and remodeling. In hypertrophic scar and keloid formation, the proliferation phase continues uncontrolled; fibroblasts produce excessive amounts of collagen type I and III. Silicone formulations are thought to intervene at this stage through the following mechanisms:

• Hydration (Occlusive Effect): Silicone forms an airtight film on the epidermal surface, increasing stratum corneum hydration levels. In a hydrated environment, keratinocyte activation normalizes and the production of pro-inflammatory cytokines (TGF-β1, IL-6) decreases, which in turn slows fibroblast proliferation.
• Reduction of Static Charge: Silicone reduces the static electric charge normally generated by the epidermis. It has been proposed that this reduction in electrical stimulation suppresses fibroblast hyperactivity.
• Mechanical Pressure: Silicone sheets apply low pressure to the skin surface, limiting the irregular cross-linking of collagen fibers.
• MMP-9 Activation: Recent studies show that silicone application increases matrix metalloproteinase-9 levels and accelerates the breakdown of excess collagen.

Differences Between Silicone Gel and Silicone Sheets

Both forms are effective; however, there are important differences in terms of ease of use, anatomical location, and patient preference:

Feature	Silicone Gel	Silicone Sheet
Ease of Application	Very easy; thin transparent film	May require adhesive; difficult on irregular surfaces
Suitability for the Face	Ideal; invisible	Limited; strip appearance may be an issue
Daily Duration of Use	12–24 hours (depending on formulation)	12–24 hours (can be washed and reused)
Cost	Moderate; consumable	Higher upfront; reusable
Suitability for Large Areas	Yes; can be spread over wide areas	Limited; cut to specific sizes
Evidence Level	IA (multiple RCTs)	IA (multiple RCTs)

Clinical Evidence: How Effective Is Silicone Gel?

The 2023 guidelines of the International Scar Management Society (ISDS) and the European Society of Plastic Surgery recommend silicone-based treatment for hypertrophic scar and keloid prophylaxis and treatment with the highest level of evidence (IA).

Study / Year	Patient Group	Treatment Duration	Outcome
Mustoe et al., 2002	Hypertrophic scar (n=120)	3 months, 12+ hours/day	68% reduction in redness, 61% reduction in elevation
Signorini et al., 2007	Surgical scar (n=60)	6 months	55% better cosmetic outcome compared to control group
Gold et al., 2014 (meta-analysis)	14 RCTs, 577 patients	Variable	69% reduction in keloid recurrence (surgery + silicone)
Bleasdale et al., 2023 (Cochrane)	Burn scar	3–6 months	Significant improvement in scar height and discoloration

Silicone in Hypertrophic Scar Treatment: Step-by-Step Protocol

The clinical efficacy of silicone gel treatment is directly related to patient compliance. The standard protocol we apply at Virtuana Clinic for hypertrophic scar patients is as follows:

1. Waiting period after wound closure: Wait 2–4 weeks after complete wound closure (generally after suture removal); silicone is not initiated on open or infected wounds.
2. Cleansing: The area is washed with a mild moisturizing cleanser and dried.
3. Gel application: Applied in a thin layer to the scar and 0.5 cm of the surrounding area; left to dry for 3–5 minutes. Twice daily or as directed by the product instructions.
4. Duration: Minimum 2–3 months; can be extended to 6 months for hypertrophic scars and up to 12 months for keloid-prone cases.
5. Sun protection: SPF 50+ sunscreen must be added; UV permanently darkens scar color.
6. Follow-up: Assessment at week 4 and month 3; laser or corticosteroid injection combination is planned if necessary.

Silicone in Keloid Prevention: Prophylactic Use

For individuals at risk of keloid formation — darker skin tones (Fitzpatrick IV–VI), family history of keloids, shoulder/chest surgeries — prophylactic silicone use should be initiated immediately after surgical intervention.

International evidence demonstrates: In patients at risk of keloid, postoperative silicone combined with radiotherapy provides a 70–80% lower keloid recurrence rate compared to surgery alone. Silicone alone reduces the risk by approximately 40–50%.

Treatments That Can Be Combined with Silicone Gel

Silicone is also effective as monotherapy; however, combination protocols demonstrate superior performance in terms of both speed and final outcome:

Combination	Indication	Added Benefit
Silicone + Triamcinolone injection	Raised, itchy hypertrophic scar / keloid	Rapid flattening; reduces corticosteroid dosage
Silicone + Fractional Laser	Texture and color irregularities	Resurfacing; collagen renewal
Silicone + PDL (Pulsed Dye Laser)	Erythematous, red hypertrophic scar	Targets vascular component; color correction
Silicone + Pressure Garment	Burn scar, large area	Synergy of mechanical pressure + silicone occlusion

Choosing the Right Product: How to Evaluate Silicone Products on the Market

There are many silicone gel and sheet brands on the market. The characteristics of an effective product are:

• 100% polydimethylsiloxane (PDMS) content: This is the active component; not every product labeled "silicone" is of the same quality.
• Clinically tested formulation: Look for CE or FDA certification; inexpensive gels that have not been the subject of clinical trials carry no guarantee of efficacy.
• Appropriate viscosity: For the facial area, lightly fluid (non-sticky) forms; for the body, denser gel or sheets may be preferred.
• Products containing UV filters: Formulations with added SPF for daytime use provide an advantage in preventing scar pigmentation.

Common Mistakes and Unrealistic Expectations

The most common errors associated with silicone treatment are:

• Starting too early: Initiating silicone before the wound has fully closed increases the risk of infection and delayed healing.
• Insufficient duration of use: Abandoning treatment when no visible change occurs within the first 2–4 weeks is very common; the effect emerges no earlier than weeks 6–8.
• Reducing daily application time: Application of less than 12 hours per day falls far short of the efficacy figures seen in clinical studies.
• Neglecting sunscreen: In patients who use silicone but go out in the sun without SPF, discoloration may become permanent.

Side Effects and Contraindications

Silicone gel and sheets have one of the lowest side effect profiles of all topical treatments. Rarely observed issues include:

• Itching or rash: May appear when the product accumulates without being washed off; the cleansing routine should be reviewed.
• Heat and moisture discomfort: Particularly in humid climates or during physical activity; shorter application periods may be adopted.
• Adhesive sheet marks: Skin irritation from adhesive sheets; switching to gel form resolves this.

Open wounds, active infections, and known silicone allergy are absolute contraindications.

Virtuana Clinic Approach to Scar Treatment: Izmit/Kocaeli

At Virtuana Clinic, we evaluate each scar case individually. Based on scar type, age, location, and the patient's risk profile, we combine silicone gel treatment with:

1. Fractional laser (CO2 or Er:YAG) for tissue renewal,
2. Intralesional triamcinolone acetonide injection,
3. PDL targeting of the vascular component,
4. Microneedling for dermal collagen remodeling

to prepare personalized scar rehabilitation programs. At our clinic in Izmit and Kocaeli, a detailed dermoscopic and clinical evaluation of your scar is performed at the initial consultation to determine the treatment schedule.

This article is for informational purposes only. Please consult a qualified physician for treatment decisions.