All posts by beas

Natural and Medical Treatment Options for White Scars

White scars can result from injury or treatments such as surgery, lasers and chemical peels.

Anything that damages the skin and the underlying layers of tissue such as acne or a wound can result in a white scar.

When the skin and underlying tissues are injured, the wound healing process begins with inflammation and then proceeds with tissue formation.

If the healing process is disrupted by too much or too little collagen one will get scar formation. Collagen is a protein in the body that is used for structural purposes.
Scars can be hyperpigmented, an excess of pigmentation, or hypopigmented, a lack of pigmentation.

Pigmentation is developed in the skin by melanin. Depending on the natural skin tone, either type can be significantly different from surrounding skin.

The build-up of collagen within a healing scar can prevent melanin from getting to the top layers of new skin.

The loss of pigment is neither serious nor dangerous but it can make one feel uncomfortable and self-conscious.

White scar treatments

There is a variety of treatment options available ranging from surgical to home remedies when the appearance of a scar causes distress.

The scar’s depth, width, and quality of the underlying tissue will determine which treatments may successfully reduce the unwanted appearance.

In some cases the goal may be to induce pigmentation, bringing the scar to a more natural, less white color.

Medical Procedures to Minimize White Scars

If a scar is very large, a scar revision procedure can be done to reduce its appearance.

A piece of skin from another part of the body is used to cover the wound left from the scar.

Skin grafting is expensive and may require multiple surgeries so it is mainly used in the treatment of burns and other serious injuries.

Laser treatments focus concentrated light at the scar, removing layers of skin. This in turn causes the tissues to regenerate new skin which will have active melanin providing skin pigmentation.

This method can take several treatments depending on the size of the scar. Other lasers may target lower layers of the skin, restoring collagen growth and reducing scars from the inside out.

ReLume is an FDA-approved procedure that uses ultraviolet light to darken the scar until it more closely matches the surrounding skin.

Six to 15 treatments may be needed and then maintenance treatments may be recommended.

Smaller white scars may be reduced in appearance with the application of dermabrasion which eliminates the top layers of skin with an electrical or manual device.

This is often done in a dermatologist’s office.

A home version is called skin micro-needling or derma rolling. Collagen and elastin production are stimulated resulting in a less noticeable scar.

The device injures the top layers of skin allowing new skin to grow again so numerous treatments may be necessary to achieve the desired effect.

Topical Treatments

For many, topical treatments for scarring are more affordable and can provide an acceptable change in the appearance of white scars.

There are several creams available as a prescription from a dermatologist that can stimulate the production of pigment and reduce size of the scar. Drugstores and online stores carry a vast selection of scar treatment creams.

Camouflage and make-up are less expensive methods (compared to medical procedures) for those looking only to hide the scar and not eliminate it.

Camouflage tattoos done by a professional tattoo artist can cover a scar with a skin-matching pigment (or use it as part of the tattooed design) for an indefinite amount of time.

Make-up can be more than adequate to hide a scar depending on its size and location. Medical-grade make-up will contain more pigments and provide a more natural looking tone.

CoverBlend and DuraBlend are two medical-grade products for scar concealment and can be found online.

The downside to this method is the potential daily application, but it may be an acceptable alternative that costs less than dermatological treatments or if the scar is located somewhere on the body that is not always in plain sight.

Home remedies are often used for white scar treatment. Keeping a scar hydrated prevents tightening of the skin and promotes healing.

Aloe Vera gel is said to help the appearance of scars and is known for its hydrating and healing properties. Honey also hydrates and treats scars.

The preferred form is known as medicinal honey which can be found in drugstores or online. The honey is usually applied 30 minutes per day.

Another home remedy is Vitamin E which can be purchased as a liquid or capsule. Applying the oil to the scar three times a day is commonly thought to allow this strong antioxidant to fade scarring. Research however shows side effects that may actually cause scars to become more prominent.

Alpha hydroxy acid is a chemical that can improve the appearance of scars by removing dead skin cells.

Exfoliating creams containing alpha hydroxy acid can be found in stores or online. For a higher concentration there are prescription formulas available as well.

Final thoughts

There are multiple ways to reduce or eliminate white scars. From simple camouflage to invasive skin grafting there is a scar treatment option for everyone.

There is hope when a white scar causes distress and is not aesthetically-pleasing. A dermatologist can provide guidance on appropriate treatment options that will fit any budget.

 

By: Anna Coss, RN, BSN, MSN

Mederma or Silicone Scar Sheets? Here’s What Studies Say About Silicone vs Mederma

which is better, Mederma onion extract cream or silicone scar sheets?

You worry about people staring at your scar. You remember exactly how it got there or you don’t but you’re still anxious to know how to remove it.

You’ve looked for ways to make the scar fade so it’s not so noticeable, but how can you sort out the good information from the pure marketing efforts and questionable products?

Should you buy Mederma, get silicone sheets, or order yet another scar removal product?

After all, there are so many products and brands available and the advice given is even more divers.

To make matters even worse,  even people you should expect would know, such as medical personnel and store owners, don’t know what helps and what doesn’t.

If you were to ask various individuals their thoughts on how to remove a scar you would probably get different answers of which most don’t make any sense.

The result? Confusion galore.

I know what you are going through since I have been there myself.

I have tried many of these so called effective remedies. Not only am I amazed there are still so much misconceptions but I also am displeased about the fact that many professional medical practitioners such as my doctor, the nurses, and even the surgeons did not know what to prescribe or advice to someone who wants to treat his or her scars.

In my case, I was first recommended to use Biodermal PCLE cream and Calendulan cream.

Now, maybe these work for fine lines and wrinkles but they are certainly not appropriate to treat my surgical scars and scars from cuts.

After some research you have limited your choice to two of the most popular products and now you are wondering, shall I use Mederma or silicone scar sheets?

 

Scar Treatment Misinformation

scar treatment fairy tales are abundant sadly enough
scar treatment fairy tales are abundant sadly enough

Yep it’s true, scar treatment fairy tales, sadly, are abundant.

For example you better forget about rubbing vitamin E capsules onto your scar. This is a typical scar removal myth.

Vitamin E capsule use is actually discouraged by dermatologists because they did show to cause skin rash and other irritations in study subjects.

In some cases these bad reactions might actually make a scar worse.

Another common myth is that scar creams have to be expensive to work.  Aloe vera gel and Palmer’s Cocoa butter are commonly thought to be proven effective scar remedies but they are not. (there’s limited research on aloe vera showing some benefits.)

One more misconception, it is commonly thought that sunshine helps fade scars which is not true because immature scars (approx. up to 1,5 to 2 years) should be kept out of the sun because the radiation will worsen them.

Back to the Mederma or silicone sheets dilemma.

Should you use Mederma or silicone gel sheets for your scar?

Mederma cream is an onion extract based cream which is claimed to work on old and new skin marks resulting from injury, surgery, burns, and stretch marks.

As the company says itself the cream is the #1 doctor- and pharmacist-recommended brand.

Lets take a closer look at what Mederma cream is.

Mederma ingredients:

  • Cepalin – Onion Extract  ( allium cepa)
  • Hyaluronic Acid – Hydrating Agent
  • Centella Asiatica – Leaf Extract

 

Here’s what studies say about Mederma for scars

Mederma scar creamSome animals and limited human studies have shown it to have some benefits.

Onion extract gel has shown to have little benefit in one study on rabbits.

One 2008 human clinical trial among patients with surgical scars from keratosis removal found that:

..onion extract gel significantly improved scar softness, redness, texture, and global appearance.

And another study demonstrated that

onion extract gel is safe and significantly improves scar appearance after four weeks of once-daily application.

However, a 1999 study among MOHS surgery patients found that:

Topical onion gel extract was ineffective in improving scar erythema and pruritus in our patients.

Note: scar erythema is redness and pruritus means  itch.

Another study, conducted in 2007, examined the effects on onion extract on keloid and hypertrophic scars and specifically focused on elevation, redness, hardness, itching and pain.

The researchers concluded that:

Onion extract improved hypertrophic and keloids scars via multiple mechanisms. However, it was statistically ineffective in improving scar height and itching. For this reason, onion extract therapy should be used in combination with an occlusive silicon dressing to achieve a satisfying decrease in scar height.

What’s more..

A in 1996 conducted study into the therapeutic values of onion and garlic found that they may act as an anti-inflammatory and bacteriostatic agent. Reducing inflammation is what is thought to help reduce scar thickness and elevation.

Another study conducted in 2002 showed Mederma improved collagen organization after injury in rabbits. Additional studies however have shown topical onion extract unable to improve scars.

To make matters more confusing, some sources state that “products containing onion extract or allium cepa should not be considered as an effective scar treatment. But one study showed Mederma improved collagen organization after injury in rabbits.”

This might be an indication it could work on stretch marks since these are most commonly the result of a disruption of collagen. Fact is, that, as far as I know, there are no independent studies proving this claim.

Mederma vs Vaseline

Vaseline is cheaper and shows to be at least just as good at hydration (which appears to be what makes scars improve).

A randomized, double-blinded, split-scar study showed no more improvement after the use of Mederma as the onion extract gel on scars compared to a petroleum based ointment (such as Vaseline).

It concluded that:

“the onion extract gel did not improve scar cosmesis or symptomatology when compared with a petrolatum-based ointment.”

Another study actually showed petroleum jelly to be beneficial in scar improvement.

Petroleum jelly / Vaseline’s ability to lock in moisture is what is theorized to be its method of action. (similar to the way silicone sheets work). In other words, it has potent  hydrating properties which is what scar appearance seems to benefit from.

 

“a significant reduction in scar erythema (redness) was demonstrated in control patients who used a petrolatum-based ointment for 1 month, possibly because of the effects of petrolatum on scar hydration.”

Do you still get it? So many studies. So many conclusions.

 

Wrapping it up, the pros and cons of Mederma

Research on Allium cepa, or onion extract, the active ingredient in Mederma cream has not shown undisputed clinical efficacy in scar treatment but also no side effects have been reported.

  • Mederma® Advanced Scar Gel is a more concentrated, advanced, onion extract gel formulation than some onion extracts used in the clinical trials.
  • Mederma scar cream is one of the most popular scar removal products and appears to have some clinical evidence behind it.
  • There have been only two randomized comparison trials of Mederma, with a combined total of 38 participants.
  • Mederma has Centella Asiatica as active ingredient which has been documented to aid wound healing in a large number of scientific reports. Its most beneficial effect appears to be:

the stimulation of maturation of the scar by the production of type I collagen and the resulting decrease in the inflammatory reaction and myofibroblast production.

  • Mederma scar gel is very well-reviewed, popular and sells for about 17$ making it one of the most affordable scar products.
  • If you let customer ratings and reviews and sales numbers decide, Mederma Cream with SPF 30 is an Amazon bestseller with a rating of 4 stars out of 5 making it one of the most popular scar removal products available.

 

Here’s what research indicates about Silicone scar sheets

silicone scar sheetsVarious studies on this over the counter treatment have been done. Again, some are positive while others do not indicate any benefits of using silicone gel.

Some studies indicate silicone helps increase scar elasticity, reduce elevation, itch and pain and help prevent hypertrophic and keloid scarring.

Other researchers have concluded that silicone gel creams and sheets are not beneficial and speak of weak evidence and poor quality of research.

According to Wikipedia (as well as many other sources) it is in fact the only non-invasive option for which evidence-based recommendations have been made for both scar treatment and prevention.

“Overall, the success rate (somewhat improved to greatly improved) for the treatment of hypertrophic and keloid scars is high (95%).”

And another study found that:

Topical silicone gel is safe and effective treatment for hypertrophic and keloidal scars. It is easy to apply and cosmetically acceptable.

A Cochrane review however concluded:

Trials evaluating silicone gel sheeting as a treatment for hypertrophic and keloid scarring showed improvements in scar thickness and scar colour but are of poor quality and highly susceptible to bias.

In addition to the Cochrane review some more research did not find any scar improvement upon silicone gel therapy.

One study examined silicone gel sheeting combined with vitamin E. The study reported that the combined action of vitamin E and silicone gel sheets was more succesful than silicone gel alone.

Wrapping it up, the pros and cons of silicone sheeting

I have always been positive about silicone scar sheets and promoted them since I know from personal experience what they do.

At the same time I have been critical about creams such as Mederma because there’s less clinical evidence for their efficacy.

In all honesty and although more research needs to be done, several studies on onion extract seem to indicate this may work too. I still keep favoring sheets over any cream but I’m not as biased anymore as I have been.

I do think that when you take a look at many user experiences and customer reviews it seems like people generally use Mederma for less obtrusive (i.e. flatter) scars than those who use silicone gel. This may cause users to be more positive quickly since such scars fade faster on their own. This however is just a hunch of mine.

when a scar improves after months of  OTC treatment, it’s hard to know whether the treatment or just time made the difference

  • Silicone gel is often called the clinical gold standard in OTC scar treatment.
  • Silicones have been used by burn centers and some hospitals since the 1980’s and are often referred to as the only clinically proven effective home treatment.
  • I have used silicone gel sheets and I noticed my scars getting smoother, less itchy, flatter, softer already after a few days. Redness took longer to improve but eventually did fade too as a result of wearing the sheets. (I noticed that initially the redness disappeared but came back when not wearing the sheets. Prolonged use resulted in permanent toning down. In other words, I saw relatively quick improvements upon applying silicone sheets.
  • ScarAway is one of the most popular silicone sheeting brands on Amazon. It scores a 3,5 out of 5 stars review rating.
  • At about 27$ it is slightly more expensive than Mederma.

 

Mederma or silicone scar sheets, my recommendation

Honesty compels me to say that I have not used Mederma myself. I do hear and read a lot of positive reviews about this product which makes me hesitate  in dissmissing it as utterly useless.

Maybe it could work for me too. Maybe it does work for you..

Study findings contradict each other and there’s also the practice that studies may be paid for by commercial companies. This of course, is the case with any product, also silicones.

All considered, I myself would stick with silicone scar sheets. Just because I know for sure these work and seem better at shrinking raised scars.

  • Another aspect that makes me favor silicones over Mederma is that occlusion is what is thought to play a role in making scars softer, flatter, and less discolored.
  • Studies indicate that scar occlusion:

was able to decrease dermal fibrosis by hydrating the epidermis and altering the pro- and antifibrotic signals produced following injury.

  • Silicone gel, by creating a thin film, and more so, silicone sheets offer occlusive therapy whereas Mederma does not.
  • Other reasons I favor silicone scar sheeting is that these are used by  many burn centers and cosmetic surgery clinics and because there’s research proving their efficacy.
  • Key in proper wound and scar healing is moisture. Make sure to keep your wound as well as the scar moist.

 

What do you think? Which one will you try? Mederma or silicone scar sheeting?

If you want to use both as complementary remedies, keep in mind that you can’t use them at the same time. I can imagine you’d wear the sheets during the night and Mederma at daytime.

I would love to know about your experiences so let me know what you think or how the scar healing process goes for you.

 

Image credit: Mizunoryu | Wikimedia Commons

 

 

 

7 Home Scar Removal Remedies – Proven Effective Remedies To Fade Your Scar

Here are some over the counter scar removal remedies based on studies and clinical trials. No old wives tales or snake oil potions here. You may know what I am talking about but for the sake of clarity, lets give an example.

Vitamin E oil.

Rubbing this on your scar is commonly believed to improve its appearance. It’s a persistent rumor that roams the internet, birthday parties, and the minds of many disinformed home scar treaters.

Studies show it does not help and caused skin irritation in a large part of test persons which worsened scar healing en cosmetic outcome.

If you do a quick search online for information on how to fade your scar you will find the most divergent advice.

From lemon juice, to potato and tomato extract. From olive oil to slices of cucumber. Even ice cubes, seriously, ice cubes, are said to be scar remedies.

It’s sad there’s so much disinformation.

Enough about what does not work. Here is what works.

Research backs these claims and my own experiences as well as those of others who did side-by-side comparisons.

These home scar removal remedies do not only consist of topical applications (e.g. creams, ointments, and strips or patches but also of things you can do. Actions that will help fade your dreaded scar.

 

Remedy 1. Optimal wound care is very likely to reduce scar tissue.

Obviously this cure can only be used in case of a new scar but if you do have the chance make sure to keep your wound moist and clean.

Moist wound healing environments lead to up to 30% faster wound healing and preventing infections helps reduce scar tissue creation.

Dr. George D. Winter found that, contrary to the conventional wisdom that wounds should be allowed to dry out and form scabs to promote healing, wounds instead healed faster if kept moist.

A wound that heals quickly without infections or other complications will scar less.

My favorite way to care for a wound you worry may scar is to use Medihoney dressings. Especially after surgery but also in case of other serious wounds this powerful stuff will boost the healing process and prevent complications.

Apart from that it also reduces inflammation which are all major factors in scar creation.

Other wound care tips:

  • If you don’t want to use Medihoney dressings you can also apply petroleum jelly or another moisturizer and very gently massage it in a few times a day. This will keep the wound moist while it is healing. Or just keep it covered with bandaids or hydrogel strips.
  • Vitamin C plays an essential part in wound healing. Taking additional vitamin C can be helpful as an indirect scar remedy. The vitamin, also called ascorbic acid helps the body make collagen and enhances the wound healing process as indicated by studies.
  • Hydrogen peroxide and antibacterial creams like Neosporin help preventing wound infection but you should avoid using it on large or deep wounds or on burns. If you do use them, use them as scarcely as possible since these are harsh substances that interfere with natural healing too.

 

Remedy 2. Start scar treatment as soon as possible

The sooner you start the younger the scar tissue is and the more efficient remedies will be. It is at this stage when your skin cells are forming collagen responsible for unsightly scars.

Right after wound closure, meaning when the scab has gone, you should ideally start scar treatment of your choice.

 

Remedy 3. Use silicones

Okay, you know it’s recommended to start a remedy right after the wound has closed.

What should you do? Which of the many products is best?

The answer is short and simple. Use silicone sheets.

They are clinically proven to work and are often refered to as FDA class 1 medical devices.

The only downside is that they work on raised and discolored scars only. (there may be some exceptions but don’t count on it).

“The Golden Standard” in home scar remedies as well as in hospitals and burn centers requires being used for weeks on end and to be worn for 12 to 24 hours a day.

Silicone scar gel comes in liquid gel that dries up to a thin film on your skin or in patches. Studies indicate that liquid silicones are less effective than the patches but in some cases it’s more convenient to use the gel.

For example in case of scars on the face or in the neck. Area’s where patches are difficult to keep attached.

Here’s more info on the best silicone scar sheets to buy.

 

Remedy 4. Go for non-invasive treatments first

You may have heard that (cortico-)steroid injections and laser therapy work which may have convinced you to start with such an invasive treatment. They do work, however, I would strongly advice not to do this.

The reason?

Because these treatments are known to have side effects whereas silicones do not (except for the very exceptional skin irriation).

Steroid injections may cause the surrounding tissue to become depressed and sometimes discolored. Also laser therapy may cause ugly cosmetic side effects.

Surgical revision or surgical excision are procedures designed to make your scar less obvious. As with all remedies, no scar will disappear completely. In case of restorative surgery there’s also the new incisions that will cause skin injury and subsequently, scar tissue.

Side effect free scar remedy..

If silicones turn out not to work for you (they work for most people but there’s always exceptions) you can always opt for an invasive treatement such as steroid injections, laser, cryotherapy or surgical excision.

Here’s an overview of all the different types of scar treatments.

 

Remedy 5. Natural extracts, oils, and other botanical therapies

Some limited evidence exists for a few complementary and alternative medicine therapies, also called CAM therapies.

These modalities appear to have some evidence for potential benefit. CAM therapies that may be beneficail include bromelain, honey, propolis, arnica, vitamin C and bioflavonoids, chamomile, aloe vera gel, grape seed extract, zinc, turmeric, calendula, chlorella, lavender oil, and gotu kola.

These substances have been reported to promote wound healing, reduce redness (edema ) or purpura (purple color), and provide anti-inflammatory effects however,

most published studies have been small and often have design flaws

If you would opt for one of these I would personally go for one of these since they seem to be most convincing.

Grape seed extract, a popular health supplement that evidence shows may build new blood vessels and help vitamin C enter cells, strengthening cell membranes and prevent scarring in tissue.

Turmeric has been used for centuries in India to provide glow and luster to the skin. It has antimicrobial, antioxidant, astringent, and other useful effects that help to heal wounds and reduce scarring (Chaturvedi 2009).

Several case reports and animal studies demonstrate that aloe vera decreases burning, itching, and scarring associated with radiation dermatitis (Klein and Penneys 1988).

However, effects are often subtle and it’s not for no reason professional institutions commonly use silicone scar sheeting as the preferred modality and not CAM therapies.

 

Remedy 6. Scar massage

Gently massaging your scar may help improve it. Start only when your wound has closed completely and start out very carefully. The scar tissue is still very delicate.

Scar massage will stimulate blood circulation in the tissue making it softer.  To make the process more pleasant and avoid friction, use an ointment or cream of your liking.

It doesn’t matter whether you choose an onion cream such as Mederma or a vitamin B based lotion.

 

Remedy 7. Take precautions

If you want to reduce the chance on an ugly scar forming you should be cautious. Things to keepin in mind are:

  • Avoid exposure to UV rays. Protect your scar from sunlight and other forms of ultraviolet light since it irritates the scar making it worse. Wear sunscreen or patches or take other measures to block sunlight because solar radiation will damage the tissue or cause hyperpigmentation (discoloration). Keep doing this until your scar is mature meaning in its final state. This may take up to 18 months.
  • Do not pick your wound or its scabs while it is healing. As a matter of fact, try to prevent scabbing all together. Scabs interfere with the healing process. See remedy 1.
  • Keep tension on the wounded area as limited as possible. This means refrain it from moving as much as possible because this can aggravate and widen the wound. For this reason SteriStrips are often used. They keep the wound borders close and reduce stress.

 

What Is Scar Tissue?

Scar tissue is basically any tissue that grows over an injury. It is made up of fibrous connective tissue, generally thicker, paler and less functional than the original tissue. It allows for less range of movement, has a reduced blood supply and is more vulnerable to damage from UV rays than normal tissue.

Damage to the skin can produce types of scars: Contracture scars that are common after burns and can interfere with normal motion, hypertrophic scars that stay grow abundantly but within the boundaries of the original wound, and keloid scars, which can keep growing even after the wound is covered and form a growth similar to a tumor.

Different Scars, Different Treatments

The scar types I just mentioned (contracture, hypertrophic, and keloid) can be improved with silicone gel pads and/ or silicone gel ointments.

Other types, such as indented ones, are harder to fade. It must be noted that keloids are very hard to remove effectively and most home remedies just don’t work. (silicones may help prevent keloids but once they have formed even silicones often don’t effectively remove these tough scars. Then more invasive procedures are necessary.)

Minor cuts and scrapes like skinning your knees generally don’t create much in the way of scar tissue. Serious injuries, surgery, and certain diseases produce more obvious scarring.

For more advice, read my silicone scar sheet review.

 

 

 

Scar Treatment, What Are Your Options?

Many misconceptions circulate about (over the counter) scar treatment. I know from experience it can be very hard to find the information you need. Both online and offline.

Emblematic for this segment of health care is the lack of knowledge of both medical professionals as well as among patients. This often leads to inappropriate choices of treatment which may, in some cases, worsen scar appearance.

I did a lot of research when I wanted to treat my own scars which, eventually, led to a rather successful treatment. Had I known then what I know now I could have gained better results in the end.

Another reason I deliberately use the word ‘rather’ is because scars will almost never disappear. Their appearance can be made less prominent though. And problematic scars can be avoided and treated.

This article is about what I know about scar treatment. With appropriate, unbiased, information at hand, and if necessary, consulting a good dermatologist who can offer support and, possibly, more invasive treatment, various things can be done to improve scar appearance.

Why Scar Treatment?

How a scar looks depends on a number of factors, including the type of trauma/ injury causing the wound, the wound site, the primary treatment and possible complications later on.

In an ideal situation a healed scar is flat, even with its environment, shows no difference in color and runs in relaxed skin lines or natural anatomical transitions. The optimal scar is also short and without unnatural straight sections.

In reality though many scars do not form this way. The skill of the surgeon, whether or not the surgery is performed under stress and hurry in case of emergencies, the overall health and lifestyle of the patient, genetic predisposition, and other factors all play a role in how a scar will form.

Apart from these aspects a scar is more or less likely to form excess scar tissue. Such scars are called problematic scars and a common reason for scar treatment.

Over The Counter Scar Treatment vs. Invasive Scar Treatment

Scar treatment can be divided into two areas. The first is non-invasive scar treatment also referred to as natural scar treatment.

It is strongly recommended to indulge in this type of treatment first. This because, as the word says it already, it’s non or less invasive. Over the counter scar treatment which is another denotation has little to no risks on side effects and worsening scar appearance.

This in contrary to invasive scar treatment. Effective non-invasive scar treatment exists of:

  • pressure therapy (compression)
  • silicone therapy
  • scar massage
  • hydrating ointments

Scar surgery, laser therapy, steroid injections, cryotheraphy (freezing), and radiotherapy are lined among invasive scar treatment.

Only opt for these kinds of treatment if non invasive treatments have no or not sufficient effect. This because there are risks of worsening scar appearance but also because in general this kind of therapy is far more expensive. Examples of invasive treatments:

  • laser therapy
  • surgery
  • steroid injections
  • cryotherapy (freezing scars)
  • radiation therapy

Effective Topical Scar Treatment

first line scar treatments backed by science

Evidence supports silicone sheeting, silicone gel ointments (several studies indicate ointments to be less effective than sheets) pressure dressings, and corticosteroid injections as first-line treatments.

Cryotherapy may be useful, but should be reserved for smaller lesions. Imiquimod cream, and ointments based on the the herb Centella asiatica (also known as Gotu kola) have demonstrated some benefits but more research is needed.

These are the only proven effective scar treatments. There is no evidence creams based on onion extract (such as Mederma), calendulan, vitamin E, or Palmer’s Cocoa butter are effective.

The popular and widespread topical use of vitamin E is discouraged by many dermatologists because this use has shown to cause side effects such as skin irritation and did worsen scar appearance in some cases.

Types of Scarring

different scar tissue types and their characteristics

In order to determine the appropriate treatment for certain scar tissue it is necessary to be aware of the type of scar. A description of the various scar types:

Flat, Pale Scars

This type is most common and these scars are the result of the natural healing of the body. In the beginning it is possible that they are red or dark and that they protrude above the normal skin level. Over time, these scars paler and thinner until finally a white, flat scar remains. This process can take up to 2 years and almost always a visible “memory” of the wound will remain.

Red, Raised Scars – Hypertrophic scars

Hypertrophic scars are red and thick/ raised and may itch or hurt. These scars generally from relatively quick after the skin trauma. They don’t extend beyond the injured site. If situated near a joint, they might hinder movement.

Young people (below 30 years of age) and people with dark skin are more susceptible to this kind of scars. Inherited factors determine whether or not people are prone to developing these scars.

It is not possible to completely prevent these scars but treatments such as silicone sheeting, and in lesser amount compression, ensure a hypertrophic scar to be converted into a flat, white scar faster.

Thick, Lumpy Scars – Keloid scars

As hypertrophic scars, keloid scars also are the result of unbalanced, excessive production of collagen in a healing wound. Unlike hypertrophic scars, keloid scars grow out of the borders of the original wound and continue to grow indefinitely. That way relatively large areas of skin can get covered. They are thick and can be itchy and painful. It is even possible they will not improve.

Keloidal scars may result from any type of injury; scratches, injections, insect bites and tattoos included. Anyone can get keloid scars and they can exist anywhere on the body but are very rare on eyelids, penis, and breast areola.

Yet young and people with dark skin are more sensitive to these scars. Especially the skin above sternum (chest), abdomen, shoulders, upper arms, back, earlobes, the neck and face are most susceptible to developing these scars.

Indented, Depressed, Sunken Scars – Atrophic scars

In these scars, there is a very thin layer of scar tissue. The scars are sunk into the skin also referred to as a “cigarette paper’ texture. They arise when the healing process of the skin is broken and as such lack of new skin fibers are formed.

They can also be caused by the skin itself. By the loss of underlying fat, but are generally the result of skin lesions after viral or fungal infection (Viral, fungal), immunity diseases (such as lupus erythematosus) and radiation therapy.

Scars after Acne or Chickenpox

Acne  and chicken pox are often the cause of depressed/ sunken scars. This often results in deep wells in the skin. It is important to know that these scars can develop to keloid scars. These scars are not always atrophic.

Stretched Scars

These scars form when the skin surrounding the scar has been under tension. In the beginning the scar is similar to a normal scar, but the constant tension the scar expands and dilutes it for the next weeks or months, until a stretched scar is formed.

This happens for instance when the scar is close to a joint is located and is tensioned during movement. Once stretched will the scar never narrow. The most common causes are injuries and operations. Another cause is the poor healing due to a poor general health or poor nutrition.

Contracture scars

These scars occur in case of large wounds. The skin quickly heals up and uses an inelastic tissue instead of normal skin tissue to close the gap. These scars can even deform the underlying muscle impeding movement.

Sometimes they even attack the nervous system. This type of scars can be very severe and  difficult to treat. Many can only be improved by surgery.

Stretch marks

This type of scarring occurs when the skin is stretched rapidly, e.g during pregnancy or sudden rapid growth of an adolescent. Also hormonal changes seem to influence the formation of stretch marks. In the beginning, these stripes appear red or purple, but they get paler over the years.

Raised, Hypertrophic Scar Treatment

In general, hypertrophic scars develop soon after the trauma or surgery. A distinction between linear hypertrophic and widespread hypertrophic scars is made.

This type of scarring is the result of an overproduction of collagen which leads to the raised appearance of hypertrophic scars. Other characteristics are redness, itch, and sometimes pain.

Widespread scars commonly develop after burn wounds. They are also red and elevated but are wider. Also overstretching can result in widespread scarring.

“Hypertrophic scars may increase rapidly in size for 3-6 months and then, after a static phase, begin to regress. Mature to have an elevated, slightly rope-like appearance with increased width. Full maturation can take up to two years.”

Recommended treatment: silicone sheeting, possible in conjunction with steroid injections when sheeting doesn’t have effect.

Red, Purple Scars

hyperpigmented scars

Fresh or immature scars generally are red or purple colored. Causes for this hyperpigmentation are increased blood flow, inflammation, and the presence of broken blood vessels. Mature scars commonly are paler than the surrounding skin because of limited blood circulation and pigmentation.

Keloid Scar Treatment

benign scar tissue treatment and side effects

Contrary to hypertrophic scars keloids may not develop for many months after after initial trauma ( injury or surgery). Keloids are more prevalent in individuals with darker skin.

Data from the National University of Singapore indicate that keloid scars are three times more common in Chinese patients than among Caucasian patients. Healthcare professionals make a distinction between minor and major keloids.

A minor keloid is a focally raised, itchy scar that extends over normal tissue. It may develop up to one year after injury and does not regress without treatment. A major keloid extends over normal tissue and can continue to spread over many years. In general, keloids are less responsive to treatment than hypertrophic scars.

Results of silicone sheeting treatment are variable. Some keloids are reduced in size while in other cases silicone sheeting has little to no effect on keloid scars.

In those cases (cortico)steroid injections (also referred to as intralesional steroids) might offer a solution. Although this treatment is relatively safe it can be slightly painful. There are also some possible side effects.

The scar may become depressed (skin atrophy), discolorization, and increased scar redness might occur. Steroid injections are usually given each 4 to 6 weeks until the desired appearance (flattening of the keloid)

Sometimes steroid injections are administered in conjunction with laser treatment and cryotherapy (freezing). Cryotherapy is done with liquid nitrogen. This treatment may flatten keloid scars but often darkens the tissue.

“Citrus limon (lemon). Lemon’s role as an antimicrobial agent has been widely reported. However, despite numerous anecdotal reports, there is only one case report in the medical literature involving the use of lemon juice on keloids.”

(Rueter, G. Treatment with lemon juice in the prevention of recurrences of keloid. Zentralbl Chir. 1973;98(16):604-6. )

Also see Aldara iquimod cream further on this page. It has shown to be effective in reducing keloidal scar tissue in some cases.

Surgical keloid treatment involves risks because the incision can cause the keloid to grow back (est. 80%) and the operation might cause an even bigger keloid scar to form. In some cases the surgery is combined with steroid injections, radiation, and pressure dressings immediately after the surgery. Surgical excision is often followed by recurrence.

“When used in combination with steroids the recurrence rate is much better – less than 50%.” (Berman and Bieley, 1995, Urioste, Arndt and Dover, 1999).

Here’s good keloid treatment info based on a study on earlobe keloids but provides good info on general treatment as well.

Painful and Itching Scar Treatment

Additonal positive effect of silicone sheeting is that is prevents and reduces pain and itching in hypertrophic and keloid scars.
Other ways to reduce pain and itching are massage, and the use of anti-itch creams such as antihistamine cream, and creams containing hydrocortisone which is a type of steroid.

All OTC anti-itch creams contain 1% hydrocortisone, also those labeled as maximum strength. Prescription creams may contain more.

Old Scar Treatment

Although over the counter scar treatment works both on and new scars it is recommended to start treatment as early as possible. Older scars will generally take longer to improve. Scar treatment with the use of aforementioned measures can be started right after the wound has closed but certainly not before. There must be no open areas, scabs, or oozing.

Contracture Scar Treatment

Scar contractures cause a permanent tightening of the skin (tissue shrinkage) and are generally the result of burn wounds. Contractures may hinder movement of joints and muscles. These are very problematic scars which generally need intensive treatment in order to achieve improvement. Some studies indicate silicone sheeting treatment improves contracture scars.

Evidence That Use of a Silicone Sheet Increases Range of Motion Over Burn Wound Contractures.  Wessling N, Ehleben CM, Chapman V, May SR, Still JM Journal of Burn Care and Rehabilitation 1985/6, p503-5

Silicone Gel: a New Treatment for Burn Scars and Contractures. Perkins K, Davey RB, Wallis KA Burns 1982; p 201-204

Types of Treatments

Silicone Gel Scar Treatment

topical treatment and prevention of problematic scars

Silicone gel sheets were developed in the 1980's. Initially used exclusively by hospitals, burn centers, and other medical practitioners they are now used worldwide as the most effective over the counter scar treatment available.

It is a painless method of treatment and is now routinely used to treat hypertrophic and keloid scars that arise from thermal burns, surgical procedures and traumatic events (Perkins, Davey and Wallis, 1983, Sawada and Sone, 1990, Carney et al., 1994).

This over the counter scar treatment works both curative as well as preventive. It has demonstrated to prevent problematic scars such as hypertrophic and keloid scars from developing. For an optimal preventive effect in surgical scars the sheets should be applied right after the sutures/stitches are removed.

Silicone gel sheets are both waterproof and flexible and look and feel like transparent gelatin. They can be cut into the shape of the scar and are marketed as comfortable and easy to apply even in difficult places. But in reality this isn’t always true. Although they are sticky they can be hard to keep attached. Many times additional tape is necessary to keep the sheets sticking. Especially on moving parts of the body or on the face it can require some dedication to keep wearing the sheets.

The exact mechanism remains disputed but research suggests that silicone gel sheets work by hydrating the scar area and the exit. Researchers also think the gel sheets decrease fibroblast activity (the process responsible for excessive scar tissue growth.) This helps reduce the scar and the color and improve its elasticity. Research also indicates that these improvements are permanent.

“The results from a number of randomised, controlled clinical trials clearly demonstrate that silicone gel sheeting is a safe and effective management option for hypertrophic scars and keloids.” (Mustoe et al., 2002).

“The application of silicone gel improves the redness, itching, texture and thickness of hypertrophic and keloid scars in 60% to 100% of cases.” (Poston, 2000).

Medical Grade Silicone Scar Treatment

It is recommended to silicone strips as a first attempt at treatment. They are non-invasive so there are no side effects. The strips can be washed and reused, sometimes for an entire course of treatment which makes them relatively affordable.

Opt for well-reviewed, reputable manufacturer dimethicone silicone, medical grade, doctor approved products. Not all brands contain the same quality silicones.

Read this post to see which brands I recommend.

Scar Treatment Creams and Lotions

The only scar treatment creams with some data behind them as effective topical treatment options for scars are silicone gel creams and ointments containing the botanical ingredient Centella asiatica (Gotu Kola). The latter is not available in the USA.

Silicone Gel Ointments

“Silicone gel has also shown to soften and reduce hypertrophic scars much faster than pressure therapy without affecting pressure, temperature or oxygen tension. While silicone gel sheeting is suitable for some parts of the body, it cannot be easily used on the face and other places where the contours of the body make it difficult to ensure adequate contact and coverage.”

Creams vs. Dressings

Interestingly, the use of silicone cream alone compared with silicone cream with occlusive dressing showed 22% and 82% scar improvement, respectively, with respect to erythema, tenderness, pruritus, and hardness. These results supported that occlusion may be synergistic in wound healing and suggested that silicone gel alone may not be as effective as silicone sheeting.

Silicone gel in a tube makes it possible to use silicone gel on scar located on area’s where sheets are difficult or otherwise inconvenient to attach. For example on the face where the gel from tubes doesn’t appear as prominent as sheets.

This type of home treatment is relatively easy to use, sheets or gel are self-drying and can be used on old and new scars. Gel often dries to an invisible sheet and once dry will also accept cosmetics. It is particularly valuable in softening the skin and reducing the dragging sensation which many patients report following the removal of stitches after eye, lip or nasal surgery.

Scar Treatment with Hydrating Ointments

hydrating scar tissue with oils, creams, and lotions

Some studies show that scar hydration is beneficial to scar healing. They point out that keeping scars hydrated for long periods of time is what appears to improve the appearance of scar tissue.

Damaged skin will lose water more rapidly then healthy skin. Hydration is believed to reduce water vapor loss and to restore the homeostatic process in the scar.

“We have found that the provision of support and hydration and especially in addition with an enhanced wound healing constituent acts together to provide surprisingly improved scar management and maturation” source: patentstorm.us

Other clinical studies show that scar hydration is effective in decreasing scar symptoms (i.e., pain, itching, and tightening), but their efficacy in improving scar appearance (i.e., size, color, and texture) is unclear. One of theses trials involved hydrocolloid dressing treatment so a conclusion on hydrating ointments can’t be made based on this particular trial. Source:plasticsurgery.org

The notion that, according to the most recent scientific insights, the mechanism of silicones is assumed to be due to the control of scar hydration contradicts the theory that hydration only influences symptoms and not appearance.

Pressure (Compression) Scar Treatment

after-surgery and burn scar treatment

Scar treatment by compression has been used since the 1960's. This type of treatment is carried out either by using compression garments or by taping to reduce skin tension. These garments, a sort of elastic, tight fitting clothing need to be worn day and night for extended periods of time. Sometimes up to more than a year in case of burn scars.

Pressure speeds up the formation of collagen, flattens the scar, and reduces the number of cells in a given area. Compression therapy is commonly performed direct after surgery (e.g. tummy tuck surgery) to keep the pressure off the wound. In this case the tape and or garments are worn for several weeks or if necessary longer.

Scars older than 6-12 months do not respond to pressure therapy, or respond poorly. Pressure garments used in conjunction with silicone sheeting seem to be more effective.

Since silicone gel treatment has shown to soften and reduce hypertrophic scars much faster than pressure therapy this is the recommended therapy.

“Pressure therapy is used primarily to control hypertrophic scar formation after burns but can also be used to treat keloids.” (Rayner, 2000, Mustoe et al., 2002).

Scar Massage Treatment

Scar massage is commonly used as an additional treatment. Goals are to increase scar pliability, suppleness, blood circulation and thus oxygen supply, and desensitization. Scar pain and itch can be reduced by regular scar massage.

Only a few limited clinical studies have been done but currently there’s no scientific evidence to proving the benefits of scar massage. Many anecdotal reports, as well as the fact that scar massage is commonly recommended by health care professionals, indicate the positive effects of massaging scar tissue.

Microporous, Hypoallergenic Paper Tape Treatment

Commonly used direct after surgery. Can also help reducing tension of the scar tissue and thus prevent scar widening. This type of treatment has modest evidence to support its efficacy.

Supposed mechanism of adhesive microporous hypoallergenic paper tape are semi-occlusion, hydration, and pressure.

Paper tape treatment is useful in treating fresh surgical incisions and scars several weeks out, but its efficacy was less than that of “more established treatments such as silicone gel.” (meta-analysis by Mustoe et al, source:Journal of American Society of Plastic Surgeons)

Non-Silicone Occlusive Scar Treatment Dressings

Various studies show silicone sheeting to be more effective than non-silicone sheeting. However, studies concluding the opposite also exist. Nonetheless silicone sheeting remains the most recommended and accepted treatment commonly referred to as the Golden Standard in Scar Treatment.

“Results from a meta-study of 27 separate trials indicate that silicone is more effective than other occlusive dressings such as polyethylene or polyurethane.”

Additional Scar Treatment Measures

pressure, oxygen, and warmth

Studies have shown that silicone sheets do not change pressure, temperature, or oxygen tension at the wound site. But, according to scientific research these factors seem to influence scar treatment in a positive way.

This leads me to think optimal scar treatment can be expanded by meeting this criteria. Application of pressure, raising temperature, and boosting oxygen supply e.g. by massage might be beneficial.

Invasive Scar Treatment

surgical treatments, laser treatments, steroid injections,

If over-the-counter treatments won’t work, surgical treatments might offer a solution. Collagen and steroid injections, as well as laser treatment, can all help improve the appearance of scar tissue.

When indulging in invasive treatments a dermatologist, cosmetic surgeon or other type of health care provider is the right person to help decide which invasive therapy is appropriate.

Surgical Scar Treatment

Scar surgery is also referred to as incisional scar revision or surgical excision. Its goal is to minimize scar tissue for cosmetic or functional reasons. For the most problematic scars which are hard to treat with other types of therapy surgical intervention will be the last solution. Examples of such scars are wide (widespread) scars, hypertrophic scars, and keloids.

Types of surgical intervention are excision, scar narrowing, and Z- or W-plasty (objective: change the tension of the scar). procedures.

Although surgery can remove the scar tissue recurrence occurs. Even worse, many times a larger keloid will form. Because of this counterproductive element scar surgery is often combined with silicone sheeting, surgical taping, compression, radiotherapy, and intralesional steroid injections.

“Surgical excision is the most longstanding, simplest, and only definitive way of removing keloid tissue and reducing the width of the scar. However, its effectiveness as a single mode of treatment is limited and sometimes counterproductive. In fact surgery for the treatment of keloid scars has been relegated mainly to a second-line therapy for lesions unresponsive to steroids or pressure, and for large lesions requiring debulking.” (Mustoe et al., 2002).

Redevelopment of keloids within the first two years after surgical scar revision (in case of single mode treatment) has been reported to be over 80%. (Berman and Bieley, 1996, Darzi et al., 1992).

When used in combination with steroid injections recurrence has shown to be significantly lower, (less than 50%). (Berman and Bieley, 1995, Urioste, Arndt and Dover, 1999).

Reduction of tension on the wound bed and scar tissue is recommended although the recurrence rate won’t drop considerably.

Surgical revision of hypertrophic scars consists of two approaches: excision and narrowing of scars, as is done for widespread scars, and Z- or W-plasty designed to change the tension of the scar.

Surgical excision combined with surgical taping and silicone gel sheeting can be successful for the treatment of hypertrophic scars resulting from excessive tension or wound complications.

 

More Info on Surgical Scar Treatment Techniques

A variety of different approaches exist to achieve cosmetic improvement for existing scars. While no scar can be completely erased, dermatologic surgeons can operate to achieve more esthetically pleasing scars. Classification of a scar abnormality guides the choice of surgical treatment technique.

Examples of such techniques based on the classification: Geometric broken line closure (GBLC), punch excision, punch elevation, subcision, Z-plasty, W-plasty, fusiform/elliptical excision, and serial partial excision are all specific surgery techniques to reduce scar appearance.

More info on which surgery for which scar type is recommended here: Surgical Techniques for Scar Revision

Steroid Injection Scar Treatment

Steroid injections are either used alone or in conjunction with other treatments. (Mustoe et al., 2002). Corticosteroids are derived from a substance naturally produced in the human adrenal cortex. Topical use of steroids (e.g. creams) seems to be less or not effective. Depending on the strength of the ointment.

Steroid injections are a first-line therapy for the treatment of keloids and a second-line treatment for hypertrophic scars that have not responded to other treatments (Rockwell et al., 1989, Urioste et al., 1999).

Kenalog injections

Steroid injections reduce excessive scar tissue and offer relief from the pain caused by scar inflammation. Reports on the pain caused by the injection vary from minimal tot really painful. This has, for a large part, to do with the scar location and of course ones sensitivity to pain. Sometimes local sedation can be administered. Otherwise taking a painkiller previous to the procedure might help.

Steroid injections are an effective way of reducing excessive scar tissue. Recurrence rates after steroid injections vary from 10% to 50%. The injections are typically administered with intervals of 4 to 6 weeks depending on how well the skin responds. Some patients respond to steroid injections very quickly whereas others require more extended treatment.

Possible side effects are pain on injection, depression in the skin caused by thinning of one of the top two skin layers (skin atrophy), fatty plaque deposition, loss of skin color (hypopigmentation), and telangiectasia (small dilated blood vessels near the surface of the skin). Appearance of the latter complication can be diminished by laser treatment.

Hypopigmentation from Corticosteroid Injections

loss of skin color

Hypopigmentation is the loss, or lightening of skin color. (the opposite of hyperpigmentation where skin color gets darker) This lightening of the scar tissue and possibly surrounding skin can be caused by steroid injections. This results of this side effect can be hard to treat.

Laser Scar Treatment

The potential of laser therapy has always been confined by the limitations of laser technology. The past years technological advancement and refinements have resulted in more effective laser scar treatments with less adverse effects.

The principle of laser scar treatment is using high-energy light to reshape or remove scar tissue. Various types of laser treatment exist. Each individually suited for a specific type of scar.

Hypertrophic (raised and red), and keloid scars are best treated with pulsed dye laser. Laser treatment of hypertrophic scars typically takes about 2 to 4 sessions whereas improvement of keloids in general takes 2 to 6 treatments.

The chance on optimal results are generally higher if laser therapy is conducted in conjunction with other types of therapy such as steroid injections, cryotherapy, and or compression. Silicone sheeting is commonly used to reduce the risk of recurrence.

Dermabrasion Treatment

Dermabrasion can be administered by needling or chemical peeling. The purpose of (Micro)dermabrasion is to resurface the tissue by gradually peeling/ needling off the top layer of the tissue.

Chemical Peeling

By applying a chemical solution to the skin, mild scarring may be treated. The procedure enables new, regenerated skin to appear, improving the appearance of the condition.

Chemical peels are generally recommended for discoloration, not for depressed scars. Commonly used chemical peels are glycolic and lactic acid, which are also available for home use.

Useful Scar Treatment Links

Review of Over-the-Counter Topical Scar Treatment Products

Postsurgical, traumatic, and burn scars can be painful, red, itchy, raised, and cosmetically unacceptable. Although a number of over-the-counter products are available to treat symptomatic scars, the peerreviewed data on the clinical efficacy of these products are limited and/or controversial.

Physician and patient choice of which product to use is often based on historical practice or anecdotal evidence. The aim of this review is to evaluate the evidence from published controlled clinical trials in humans on some of the most commonly used over-the-counter products for treatment of symptomatic scars.

Bottom line. What works? To summarize, silicone gel has the most data behind it as an efficacious topical, over-the-counter treatment option for scars, and is an option for patients who want something they can buy themselves.

Also, there is probably not any harm, and possibly some benefit, to rubbing honey onto healing wounds and scars. Further quality studies involving human subjects are needed for topical, natural preparations for scars, so in the meantime, encourage your patients to not waste their time or money on other natural products out there that claim to improve the look of their scars.

 

 

These Are The Best Silicone Scar Sheet Brands You Can Buy

silicone scar sheet
silicone scar sheet

Silicone scar sheets are low cost, (relatively) easy to use and help you improve hypertrophic scars.

If you do a quick Google or Bing search you will see there is a wide range of different brands. So which one to pick? More in a bit..

And if you do a quick PubMed search you will learn this is the only  clinically proven home remedy.

In case you didn’t know, you can recognize hypertrophic scars by an increased amount of scar tissue within the original wound boundary.

Keloids, a specific type of hypertrophic scars,  are scars in which the tissue grows beyond the original wound borders.

In layman’s terms, discolored, raised scars can be improved with silicones.

Most depressed scars do not seem to benefit from silicone scar treatment.

Proven effective..

A large meta study examining all kinds of home scar removal methods concluded that silicone gel sheeting had “marked benefit” while pressure therapy (use of pressure garments) and Imiquimod cream had “some benefit.”

Method of action (how they work)..

How the exactly work is still not entirely clear. Initially it was thought that increased temperature, pressure, and the silicone were what improves scars.

Nowadays it is theorized that oxygen tension and hydration reduce excess scar tissue. wound healing.

Before we try to determine which silicone brand is best, first a bit about whether you should buy sheets or a gel.

Sheets vs Gel?

Research shows that silicone sheeting works better than silicone gel or oil. Likely because  occlusion of the scar and subsequent hydration are responsible for toning down unbalanced fibroblast collagen growth (scar tissue).

Based on my own experiences as well as what studies show is that, if possible, go for sheeting in favor of a cream.

If you find it is hard or nearly impossible to keep sheets attached then opt for a gel. Or for example when you don’t want people to notice you are wearing silicones on your scar.

The Best Silicone Scar Sheeting Brands

These are my recommendations as a former user of silicone sheeting and someone who has been recommending these to friends and aquaintances for years now.

I have picked a most affordable product, a most convenient but slightly pricier one, the best brand if you have really sensitive skin or a troublesome / delicate scar, and a product that combines silicones with paper tape (the one I would use myself if I would need them right now).

ScarAway

ScarAway-silicone-scar-sheetsI  commonly recommend this brand because I used it myself and it worked well for me. It is rated 3,5 stars out of 5 on Amazon.

I feel this rating is a bit low but this may be due to the fact that you have to wear the sheets religiously. I mean at least 12 hours (and preferably longer – up to 24 hours) a day for weeks, if not months. Some people may not be able to do so and blame the product.

Scaraway sheets breathe (are permeable) thus allowing oxygen in the hydrated skin and reduce the chance on skin maceration or rash. Not all brands breathe.

  • Pros: works well, relatively well reviewed, made from safe dimethicone silicones, breathe, reputable brand, come in pre-shaped C-section sheets, more affordable at $23,99.
  • Cons: it’s not the brand with the highest adhesiveness. If you need really sticky silicone sheets than the next brand may be for you.

Cica Care

Cica-Care-silicone-scar-sheetsI haven’t used Cica Care myself but with a 4 out of 5 stars rating on Amazon it’s a serious contender to be called (one of) the best brand(s).

Being very sticky, Cica Care silicone sheets may be extra convenient on body locations such as the neck, chest, stomach, back, or even face (although I can imagine many people would rather use a cream for facial scars).

This is a big plus since silicone sheets tend to roll up. Which is annoying because you have to keep putting them in place again.

I mentioned before that silicone therapy does not work on indented scars. Cica care may be helpful though based on what a user wrote me:

.. I get the sense that this Cica Care pad is doing a better job of flattening by pulling up the sunken middle of my scar than the others. Because the gel conforms so well to the shape of the scar, it makes clingy contact with the sunken parts better than the others, and I think that tends to pull them up over time.

  • Pros: probably the best stickiness among brands, high customer rating, renowned brand, may help improve indented scars.
  • Cons: higher price. ($47,-)

Mepitac Silicone Tape

mepitac-silicone-tapeThis product is often recommended by surgeons and dermatologists. The advantage of Mepitac silicone tape is that it stays on very well.

Contrary to many sheets this occlusive sticks to your scar until you peel it off.  It even stays on in the shower or during swimming. Like with sheets you can re-use pieces.

Because of its strong attachment it may not be that suitable for delicate scar tissue. For example if you are concerned you may re-open the just healed wound or when you have sensitive skin.

Here’s why you may want to use this brand:

For alleviating tension on the scar and its surrounding skin. Tension on a fresh wound and new scar is known to increase scar tissue formation.

Because of its adherance, this silicone tape reduces tension, e.g. tear and stretch along the incision line which is known to minimize the degree of scarring in terms of spreading or thickening.

This product basically combines two proven treatments, silicone and skin adhesive tape.

Study: “taping of scars is a safe, effective and well-tolerated intervention that may significantly improve scar appearance at six months”.

There’s also personal preference, some people will prefer silicone tape while others may opt for thicker silicone sheets that provide more of a barrier and buffer between the scar and clothing or other external elements such as zippers, seat belts.

  • Pros: reduces tension which prevents widening and thickening of scars, offers the benefits of silicones, easily cut to size, sticks very well even when wet, relatively affordable ($27,39)
  • Cons: different feel, doesn’t have the solid occlusion that silicone sheeting offers

 

Mepiform with Safetac® Technology

Mepiform-Safetac-silicone-scar-sheetsAdheres gently to surrounding skin without use of traditional adhesives. Minimizes trauma to the wound on removal.

Mepiform with Safetac is relatively new to the consumer market. There are not a lot of reviews yet but the product does score the full 5 out of 5 stars (based on 18 reviews).

This brand is especially suitable for people with sensitive or delicate skin. Similar to other brands these sheets also flatten, soften and fade red and raised scars but the way of adherance is different.

Resulting in less risk on skin maceration (the white skin you may see after taking off a wound plaster) and being more gentle on fresh scars. If you know changing sheets is still painful or irritating or taking them off may tear the new tissue, thus interfering with the healing process, Mepiform may be your best bet.

  • Pros: gentle for very sensitive, delicate skin, well-reviewed on Amazon.
  • Cons: expensive ($82 for a 4″ x 7″ (10cm x 18cm) 5 Pack.

 

Large size silicone sheets for big scars

biodermis-epiderm-silicone-scar-sheets-1

Large scars are best treated with large silicone sheets because they may bedifficult to keep in place. If you have to work with several pieces it will be extra hard to keep them attached. Another reason is that it may be difficult to have them align perfectly thus running the risk of missing a spot.

Biodermis Epiderm offers large sheets. Their biggest size is 11″ x 15,75″. They also have 1,4″ by 11,5″ long tummy tuck scar sheets.

In comparison, ScarAway long is 7″ and Cica Care sheets are 6″.

Brands that offer pre-shaped silicone sheets

Sometimes pre-shaped sheets are your best option. Certain scars, e.g. a breast surgerly scar, have such typical shapes that you can not cut them properly yourself.

Biodermis Epiderm offer pre-shaped breast surgery anchor silicone sheets as well as vertical mastoplexy and breast areaopexy sheets.

This brand also has sheeting designed to perfectly fit the areola and anchor incision scar or other typically shaped surgery scars.

ScarFX is a brand that also offers these silicone sheets for specific types of surgery. For an overview of various large and pre-shaped gel sheets visit Makemeheal.

ScarAway c-section scar treatment strips are developed specifically for moms recovering from c-sections. Size of each sheet, 7″ long and 1.5″.

The best silicone gel cream brands

Most studies demonstrate that sheeting is more efficient than gels. Gels however are more convenient. They are barely noticeable and require less effort concerning application and keeping them on.

If you’re in the market for a gel I would recommend one of these three:

  • NewGel+E Advanced Silicone Gel for Scars
  • ScarAway Scar Repair Gel with Patented Kelo-cote Technology
  • Kelo-cote

 

Further recommendations

When it comes to choice of silicone scar sheet brand I recommend Cica-Care , ScarAway, and Molnycke’s Mepitac silicone tape.

If I would have a new scar I wanted to treat I think I would go for Mepitac because it combines the best of two worlds, silicone occlusion (and thus improved oxygen flow and hydration) as well as good old paper tape that reduces tension.

Other things to keep in mind..

Compliance in keeping these products on for at least 12 to up to  23.5 hours a day is the key to having them work.

Also make sure to buy the apropriate size. If your scar is long you may want to buy sheets that are large enough so you don’t have to put multiple strips on it.

Also remember that you should not use any creams under the sheets. This will prevent them from sticking and interferes with the action of the silicones.

Silicone sheeting and (paper) tape do work. (Based on international recommendations it is the first choice of hypertrophic scar treatment).

How fast you will notice improvements depends on your scar, how deep the cut or incision was, skin type, overall health, predisposition to scarring, if you smoke, et cetera.

Apart from cosmetic appearance these over-the-counter remedies also alleviate itching and tenderness of new scar tissue.

 

Silicone Scar Sheeting Before And After Pictures

Silicone sheeting can improve the looks of scars considerably. Especially when they are used in the first 6 months after wound closure.

Here are some before and after pictures of the results.

scar before and after silicone sheets
1. before and after silicone sheets

As you can see on the photo to the right scars will not get much smaller once they have a certain width.

That’s why it is important to reduce tension on the wound and scar tissue during the first healing phase.

A common method to keep tension at bay is by taping the wound/scar. Often paper tape is used for this purpose.

 

facial scar before and after
2. facial scars often improve a lot

Silicone sheets are cumbersome to use on the face. That’s why most people opt for a silicone gel cream.

After application a thin film forms over the scar tissue. An alternative is to wear silicone sheets at night.

If necessary attached with silk tape (doesn’t irritate the skin). In case of severe facial scarring, silicone masks are used.

 

comparison of a scar with and witout treatment
3. with or without treatment

An example of how silicone sheeting makes a scar less elevated and less discolored.

Many scars will fade to a more normal state eventually but sometimes the opposite happens, keloids form. Silicones help prevent such abnormal scarring.

wide scar before and after silicones
4. wide scar has flattened and smoothened

Wide scars can not be made smaller (except by surgical treatment) but they can be blended in as you can see on photo 4.

 

 

 

scar-hypertrophic
5. hypertrophic scars can improve a lot

Hypertrophic scar before and after treatment.

 

 

Image credits

photo 2. Source.

photo 3. Source.

photo 4. Source

Silicone Scar Sheets FAQ, 19 Frequently Asked Questions

silicone scar sheetSilicone sheeting is the only proven effective home scar treatment. If you haven’t heard before about this remedy some questions may come to mind.

Here’s what you need to know about this risk-free, affordable, and effective scar treatment.

An overview with the most frequently asked questions regarding silicone sheeting.

18 Frequently Asked Questions about Silicone Scar Sheets

1. Do silicones for scars work?

Yes, in fact there are only two scar treatments that are backed by well-designed studies with an adequate control group that have sufficient evidence proving they work. Silicone sheeting is one of those two. The other is steroid injections.

2. How do they work?

What exactly the mechanism is behind their action is not entirely sure. Initially it was thought that they improve moisture content in scar tissue or that raised temperature was responsible for their effect.

Nowadays experts agree that silicone occlusion reduces the excessive growth of scar tissue because it influences so called fibrogenic cytokines. Here’s more.

3. Which types of scars can be improved with silicones?

Sadly not all scars benefit from silicone sheets. In general raised, discolored scars can be treated. Such scars are called hypertrophic scars.

4. Are there any unwanted side effects?

No there are not. Of course, with any product you put on your skin, a reaction such as a mild rash may occur. This is because everybody is different and reacts different. In one study out of 150 test persons, two individuals developed an allergic skin reaction.

5. Are they on prescription or are they available over the counter?

Silicones sheets and ointments are available over the counter. They can be purchased online on Amazon, MakeMeHeal, and in stores such as CVS, Walgreens, etc.

6. Do silicone scar sheets expire? How long can I store them?

Yes, Silicone gel sheets have expiration dates. Check the package for more info.

7. How to use them, can you give me instructions?

Most need to be worn throughout the day or night (or both) for a prolonged period of time. They are self-adhesive and should be worn on dry, clean skin. See the instructions on the package for more detailed info.

8. Do they work on indented scars?

No generally speaking they do not work on depressed scars. I have heard however of at least one person who used Cica Care sheets. Because these are extra sticky he thought that the patch lifted his depressed scar up and improved its appearance.

9. Are there any trustworthy reviews?

Yes there are lots of honest reviews. Most people who used them are positive (I am one of those) One thing should be noted, most scars can not be removed. Their cosmetic appearance can be improved but most of the time they will stay visible. For an indication, see these before and after photos.

10. Where to buy silicon scar sheets?

See question #5.

11. Where can I see before and after pictures?

Check out this post with a wide range of before and after pictures.

12. Do they work on wrinkles and fine lines?

As far as I know they do not. There is some anecdotal ‘evidence’ they do but I haven’t heard of clinical trials or studies confirming such claims.

13. Do silicones for scars work on wounds?

Silicone sheeting is not intended to use on wounds. Other types of occlusives are known to speed wound healing. Examples of proven effective wound dressings are Medihoney dressings and hydrocolloid dressings.
14. When do I use silicone scar patches? When should I start using them?

In general you can start using silicone patches as soon as the wound has closed. So after the wound has healed.

15. My silicone pads don’t stick to my skin.

Sometimes it is hard to keep them attached to your scar. Depending on the location -on your face for example is hard to keep them in place- you may want to use tape to keep them attached. Silk tape is often used for this purpose because it is less skin irritating.

16. Do they work for stretch marks and acne?

Not as far as I know.

17. What is the best brand of silicone scar sheets?

Personally I like ScarAway but other people may prefer other brands. Here’s an overview of silicone scar product brands. Check out reviews to see if the particular product appeals to you.

18. Can I use them in combination with sunscreen or makeup?

No. At least not at the same time. If you apply the sheets your skin has to be dry and clean . If you are not wearing the sheets you can apply sunscreen or put on makeup.

19. Do they work on keloids?

Silicone is known to prevent keloid formation. Once a keloid exists it is very hard to get rid of. Some people have had good results with silicone only. Others have to fall back on other (more invasive) treatments.

 

Benefits Of Silicone Ointments For Scars

one of the best reviewed silicone ointments on Amazon
well-reviewed silicone scar ointment

When it comes to OTC scar treatment you basically have to options,  ointments or sheets.

Different names for the same type of products may cause confusion.

When we talk about silicone ointments we talk about products such as Kelo-Cote, Xeragel, Dr. Blaine’s ScarCare gel, Spenco 2nd Skin Scar Gel, or Zeraderm to name a few.

Silicone gel is the main component in these products. Silicone gel however, is also present in silicone gel sheets.

Ointments are also called creams, gels while sheets are also referred to as patches, pads, and plasters.

A logical question that rises, which are better?

Answer: It depends on the situation.

What About Silicone Gel Ointments? When to use..

Silicone gel comes in tubes, is self drying, and forms a very thin occlusive layer over the scar tissue which makes it very easy to use. Once dry even cosmetics can be applied.

 

Studies have demonstrated that

“the use of silicone cream alone compared with silicone cream with occlusive dressing showed 22% and 82% scar improvement”

This improvement was focused on softness, pliability, itch, skin irritation, and redness of the scar tissue.

Therefore it was concluded that occlusion may be synergistic in scar healing and suggested that silicone gel alone may not be as effective as silicone sheeting.

However,

Sometimes it is best to use an ointment instead of sheets.

While silicone gel sheeting is suitable for some parts of the body, it cannot be easily used on the face and other locations such as face and close to joints.

That’s why silicone gel creams come in handy. They ensure adequate contact and coverage which makes them a useful addition to strips.

Apart from that the gel, when applied, is hardly noticeable which makes it ideal for use on uncovered parts of the body when out in public.

Ointments also seem to help reducing the dragging sensation which lots of patients experience following the removal of stitches after lip, eye, or nasal surgery.

Also wound tape might have the same benefit but I would prefer the far less noticeable silicone gel. Also because of its action.

Read this post if you’re not sure which is better for you to use, ointments or sheets.

Other brand names are; Dermatix, Valeant, and ScarAway serum.

Benefits of Silicone Scar Sheets

Using silicone scar sheets (or a silicone ointment) has several benefits over other types of scar treatments.

I know because I used them myself after I had been hospitalized and ended up with about 50 stitches all over my body.

After initially being adviced to use calendulan cream or Mederma I learn about silicone for scars. (I contacted a private cosmetic surgery clinic to ask what they thought was the best over the counter remedy)

The main reason silicone scar sheeting has benefits over other modalities is that many other therapies such as laser treatment, steroid injections, and surgical incision involve side effects. Because they are harsh, it is not uncommon for such treatments to actually worsen the appearance of the scar.

On top of that, silicone scar sheeting is not only non-invasive, it is also clinically proven effective. Too bad silicones only work on raised scars and not on depressed scars.

The benefits of silicone scar sheets.

Here’s a list of arguments on why this type of therapy is in fact the best way to treat scars at home:

    • prevent problematic scars from forming (scars that are less than three months old do not become hypertrophic when they are treated with silicone gel.)
    • thus they reduce the risk on developing unsightly keloid scars
    • reduce appearance of existing scars by shrinking, flattening, softening, and toning down the color
    • stimulate growth of new tissue and new blood vessels
    • non-invasive
    • relatively cheap when compared to invasive treatments
    • prevents and reduces scar pain and itch
    • increase skin elasticity
    • form a protective barrier between the (sensitive) scar tissue and your clothes a zipper or for example a seat belt.
    • little to no risks of side effects
    • not messy and will not stain
    • odorless
    • easy to use
    • many brands to choose from, some are more sticky others have other qualities.
    • pre-shaped sheets available for example for c-section scars
    • reduces the chance on bacterial infections of the scar tissue

A more scientific explanation of the benefits of silicone for scars.

According to this PubMed study:

Silicone gel exerts several actions which may explain this benefit in scars:

  1. It increases hydration of stratum corneum and thereby facilitates regulation of fibroblast production and reduction in collagen production. It results into softer and flatter scar. It allows skin to “breathe”.
  2. It protects the scarred tissue from bacterial invasion and prevents bacteria-induced excessive collagen production in the scar tissue.
  3. It modulates the expression of growth factors, fibroblast growth factor β (FGF β) and tumor growth factor β (TGF β). TGF β stimulates fibroblasts to synthesize collagen and fibronectin. FGF β normalizes the collagen synthesis in an abnormal scar and increases the level of collagenases which breaks down the excess collagen. Balance of fibrogenesis and fibrolysis is ultimately restored.
  4. Silicone gel reduces itching and discomfort associated with scars.

Are you planning on using silicones for your scar? Or do you have a question?

Drop your comment below or ask me. (I have personal experience with this over-the-counter treatment.)

 

The Best Silicone Sheets For Tummy Tuck Scars and 9 Other Questions Answered

Each year more than  100,000 people make the decision to undergo abdominoplasty, or tummy tuck surgery.

As with any surgery, scars are involved. Tummy tuck scars are known to worsen first before they improve. Luckily there is silicone sheeting.

Tummy tucks flatten the stomach by removing excess skin and fat, and tightening the abdominal muscles.

A full tummy tuck generally involves three incisions.

  • The first spans from hipbone to hipbone;
  • the second is a circle around the navel;
  • the third is a final incision that connects the first two.

As a result, there are scars left from these incision sites. Silicone strips are rapidly becoming the most popular way to treat and reduce these scars.

Here are answers on 10 Common Questions About Silicone Sheets for Tummy Tuck Scars

1. What are silicone scar strips?

Silicone strips are used to reduce the appearance of scars; specifically scars from tummy tuck procedures and other types of surgery. (in addition to strips they are also known as silicone sheets, patches, pads, gel, tape, clearpads, or sheeting)

The strips flatten, fade, and minimize keloid scars and hypertrophic, or raised, scars. Most silicone strips work by mimicking the natural barrier function of otherwise healthy skin. The silicones hydrate the scar tissue around the area, reducing excessive new tissue growth which softens the tummy tuck scar and helps to fade it.

2. What are the benefits of silicone sheeting for tummy tuck scars?

After using silicone strips, the tummy tuck scars should be faded and shrunken. After only just a few days, the scars should begin to soften, and your scar will continue to fade throughout the next few weeks.

Silicone strips can also help to relieve the symptoms that frequently go along with scars, such as itching, pain, discomfort, and burning sensations.

Another benefit, they prevent the formation of ugly, excessively growing scars such as keloids.

 A part of my scar is raised, will silicone sheets help?

3 Are they my best option, do they work?

Silicone strips have been proven to be more effective than creams or other treatments. In fact they are in many cases even more effective than more invasive treatments such as laser therapy.

Multiple clinical studies have shown the effectiveness of this over the counter remedy. In addition to these studies, there are numerous testimonials from people who have benefited from the silicone strips.

Users report smoother and softer skin around the scar area, flattened hypertrophic scars, and overall a diminished scar appearance.

4. What brands and types of silicone strips are there?

There are silicone pads, patches, and strips. Some brands of silicone strips are washable, so you can reuse them instead of throwing them away.

You can choose different sizes and shapes of the silicone strips to use one that fits your scar. There are also some silicone strips that can be cut into smaller pieces making it more economically feasible.

Some of the most well known brands are; Smith & Nephew’s CICA CARE Adhesive Gel Sheets; Johnson & Johnson’s BAND-AID Brand Scar Healing Strips; Mepiform, Biodermis, ScarAway Professional Grade Silicone Scar Treatment Sheets, and CURAD Scar Therapy Cosmetic Pads.

Here’s an overview of all the silicone products available.

Which brand is the best to buy?

5. The Best silicone sheets to use for tummy tuck scar?

In a study conducted with three other brands, the Curad silicone strips seemed to work the best in treating tummy tuck scars although online reviews don’t seem to match this view.

Personally I prefer ScarAway and CicaCare. (I didn’t undergo a tummy tuck but used ScarAway for my chest surgery.)

6. When should I start using silicone strips?

You should not use silicone strips until after the wound has healed, and you have cleared it with your plastic surgeon. This will generally be a few weeks after the surgery.

You can usually begin scar management by 2 to 4 weeks after surgery if your incision lines have healed. The silicone strips can only be applied after the incision is dry and healed, which will be about 3-4 weeks after surgery.

When will I see results?

7. How often do I have to wear the silicone strips?

The silicone strips should be worn continuously if possible for the best results. To help with the scar, silicone gel sheeting needs to be worn for 12-18 hours a day for several months.

Depending on the type, the silicone strips or pads can be held in place with paper hypoallergenic tape, because keeping them attached can be somewhat difficult sometimes. For example due to perspiration they may loosen and or curl up onder your clothes. This happened to me sometimes but I have to add that this was in summer when it was very warm so much sweating and the chest is a difficult location to keep them attached.

I already saw and felt improvement after a few days of wearing them. (e.g. a smoother scar that felt less sensitive) which motivates to keep on going. I also understand that since then, this was years ago, the adhesiveness of most brands has improved a lot.

8. What are the precautions that should be taken when using the silicone strips?

You should avoid sun exposure if possible while you’re using the silicone strips. Additionally, you should frequently self-check for skin macerations and fungal infections to be safe. Although this almost never occurs.

9. Are there any risks or side effects with using silicone strips?

Because the strips are being applied to the skin, there is always a risk of it having a reaction, causing a rash.

Can I use a cream under the silicone pads?

10. Can the silicone strips be used in combination with any other product?

Many tummy tuck patients wear a girdle or other compression garment over the stomach after the surgery. This helps hold the tissues very close to the body and helps the skin adjust, so the stomach will look more natural when it heals.

A question that is often asked is if the sheets can be used in combination with a cream. You should not apply a cream under the silicone sheets because this interferes with its action and may cause irritation.

Silicone strips, the best over-the-counter treatment for your tummy tuck scar

Overall, the silicone strips have many benefits in diminishing tummy tuck scars. The benefits are not only aesthetic, but also in terms of comfort, since they also relieve itching and burning associated with the incision site.

Silicone strips are an excellent choice for the reduction and improved appearance of tummy tuck scars. Actually, they are your best bet on improving your scar and preventing it from developing excess scar tissue growth such as keloids.