Silicone-based gels and sheets are the closest thing to a proven scar removal cream. They’re the internationally recommended first-line topical treatment for raised scars, backed by more clinical data than any other over-the-counter option. But “best” depends on what kind of scar you’re treating, how old it is, and what you realistically expect a cream to do.
Why Silicone Tops the List
Silicone gels and sheets work by mimicking the barrier function of healthy skin. When skin is damaged, the outer layer loses its ability to retain moisture. The body interprets this dehydration as a signal to keep producing collagen, which is how raised, thick scars form. Silicone restores normal hydration levels at the scar site, essentially telling those collagen-producing cells to calm down.
That’s not the only mechanism. Silicone also redistributes tension along the edges of a healing wound, which reduces the likelihood of abnormal or keloid scarring. It limits blood flow to the scar site, preventing the exaggerated healing response that makes scars look red and swollen. There’s even evidence that the friction between silicone and skin generates a mild static charge that helps collagen fibers align more normally, flattening raised scars over time.
Silicone gel sheets tend to outperform silicone ointments in studies. The American Academy of Dermatology notes that sheets appear to work better than the ointment form. For practical purposes, though, sheets can be awkward on visible areas like the face or neck, which is where a silicone gel cream becomes more convenient. Products like ScarAway, Mepiform, and Kelo-Cote are widely available without a prescription.
How Long Before You See Results
Silicone gel should be applied once or twice daily for at least three to four months. Silicone sheets or tape need to stay on as close to constantly as possible for the same duration. If the scar is still red and raised after that window, continued use may be recommended for longer.
Scars themselves take 12 to 18 months to fully mature. During that remodeling period, a scar that looks concerning at month two can improve dramatically by month ten, even without treatment. This natural timeline is worth keeping in mind: some of the improvement you notice while using a product may simply be your body’s normal healing process at work. Starting silicone early, ideally once the wound has fully closed, gives you the best chance of influencing the final result.
Onion Extract: Modest but Real Benefits
Onion extract is the active ingredient in Mederma, one of the most widely marketed scar creams. It does have clinical support, though the effects are more subtle than silicone’s. In a controlled trial published in The Journal of Clinical and Aesthetic Dermatology, scars treated with onion extract gel once daily showed statistically significant improvements in redness, texture, softness, and overall appearance compared to untreated scars after four to eight weeks of use.
The improvements were real but incremental. After eight weeks, investigator-rated redness scores averaged 2.61 out of 3 for treated scars versus 2.11 for untreated ones. Subjects themselves rated redness improvement at 1.93 versus 1.41. These are meaningful differences, but they suggest onion extract nudges healing in the right direction rather than transforming a scar. It’s a reasonable option for minor scars or for people who find silicone sheets impractical, but it isn’t a substitute for silicone on raised or more prominent scars.
Centella Asiatica (Cica) Creams
Centella asiatica, often labeled as “cica” in skincare products, has a growing body of evidence supporting its role in scar healing. The plant contains two active compounds that work on different parts of the healing process. One reduces fibroblast activity in a dose-dependent manner and dials down the signaling pathways that lead to excess collagen production. The other inhibits the migration of scar-forming cells, particularly in keloid-prone tissue.
Together, these compounds promote healthier collagen synthesis. They improve the tensile strength of new skin while stimulating the production of the type of collagen found in normal, mature tissue rather than the disorganized collagen typical of scars. Cica-based creams are widely available in Korean and general skincare lines, though formulations vary significantly in concentration. Products that list centella extract or its derivatives (asiaticoside, madecassoside) high on the ingredient list are more likely to deliver meaningful amounts.
Vitamin E: Skip It
Vitamin E is one of the most popular home remedies for scars, and one of the least supported by evidence. In a double-blind randomized trial, topical vitamin E combined with an emollient performed no better than the emollient alone. Nearly a third of patients developed contact dermatitis from the vitamin E. The researchers concluded that vitamin E sometimes worsened the cosmetic appearance of scars and recommended against using it on surgical wounds.
A separate study of 159 patients recovering from burn surgery found no benefit from four months of topical vitamin E application. Scar thickness, cosmetic appearance, and range of motion were all unaffected. Despite its reputation, vitamin E is one ingredient you can confidently skip.
Your Scar Type Matters More Than the Cream
Over-the-counter creams are primarily useful for raised scars: hypertrophic scars and, to a lesser extent, keloids. These are the scar types where silicone, onion extract, and centella have the most evidence. If your scar is flat but discolored, the most important thing you can do is protect it from the sun. Newly formed scars less than 18 months old are highly susceptible to UV damage, which triggers excess pigment production and structural changes in the collagen. Wearing sunscreen with at least SPF 30 over the scar for 12 to 18 months significantly reduces hyperpigmentation.
Indented scars, like the pitted scars left by acne, are a different challenge entirely. No topical cream will fill in lost tissue. These scars typically require in-office procedures: dermabrasion, chemical peels, collagen injections, laser resurfacing, or punch grafts for deeper pits. If you’re searching for a cream to fix acne scarring, the honest answer is that creams won’t get you there. A dermatologist can assess the depth and type of your acne scars and recommend procedures with a realistic chance of improvement.
A Practical Approach
For a new surgical or injury scar that’s starting to raise, silicone gel or sheets are your best first step. Apply daily for at least three to four months, starting as soon as the wound is fully closed. Adding sun protection with SPF 30 or higher protects against discoloration during the 12 to 18 months your scar is actively remodeling.
If silicone sheets aren’t practical for your scar’s location, a silicone gel cream applied once or twice daily is the next best option. Onion extract gels like Mederma are a reasonable alternative for minor scars, and centella-based products offer additional support for collagen normalization. Layering a silicone product with consistent sun protection gives you the most evidence-backed combination available without a prescription.
For scars that remain raised, red, or symptomatic after several months of consistent topical treatment, the next tier involves prescription options like steroid injections, which can soften and shrink stubborn hypertrophic or keloid scars. Laser resurfacing can further refine texture and color. These aren’t starting points, but they’re worth knowing about if over-the-counter products plateau.