Silicone-based gels are the best-supported option for treating surgical scars, backed by more clinical evidence than any other over-the-counter ingredient. They’ve been shown to reduce scar texture by 86%, color by 84%, and height by 68%. But which product format you choose, when you start applying it, and how consistently you use it all matter as much as the ingredient itself.
Why Silicone Gels Lead the Pack
Silicone works by creating a thin, breathable barrier over the scar that locks in moisture and regulates how your body produces collagen during healing. Scars form when the body overproduces collagen in response to a wound, and keeping that tissue hydrated helps prevent the thick, raised appearance of hypertrophic scars. In clinical studies, 60% of scars treated with silicone gel were graded as normal-looking by the end of treatment, with only 20% remaining noticeably raised.
You’ll find silicone in two main formats: gel tubes you apply like a cream, and adhesive sheets you press directly onto the scar. A systematic review of randomized controlled trials found no significant difference in effectiveness between the two. The choice comes down to practicality. Sheets work well on flat, easy-to-cover areas like the chest or abdomen, where they can stay in place for hours. Gels are better for joints, the face, or anywhere clothing would peel a sheet off. Patients in studies consistently reported that gel was more convenient to use, and convenience matters because you need to apply it daily for months.
Where Onion Extract Creams Fit In
Onion extract gels, the most well-known being Mederma, are the second most popular option. They contain a compound that reduces inflammation and helps break down excess collagen. In a randomized controlled trial, scars treated with onion extract gel showed significantly better improvement in overall appearance, texture, redness, and softness compared to untreated scars after eight weeks of daily use. Both investigators and patients rated the differences as statistically significant across every measure.
That said, these studies compared onion extract to no treatment at all, not to silicone. When the two have been compared head-to-head in other research, silicone generally comes out ahead for raised surgical scars. Onion extract creams are a reasonable choice for minor scars or for people who find silicone gels too sticky, but for a significant surgical incision, silicone remains the stronger option. If sun exposure is a concern, Mederma does offer a version with SPF 30 built in, which helps prevent the darkening that new scars are prone to.
Skip the Vitamin E
Vitamin E is one of the most common home remedies people reach for after surgery, and it’s also one of the least effective. A study on post-surgical scars found that in 90% of cases, topical vitamin E either had no effect or actually made the scar’s appearance worse. On top of that, 33% of patients developed contact dermatitis, an itchy, red skin reaction that can slow healing. Researchers concluded that topical vitamin E on surgical wounds should be actively discouraged.
When to Start and How Long to Continue
Timing matters. Basic wound care, like keeping the incision moist with petroleum jelly or antibiotic ointment, starts immediately after surgery. But scar-specific treatments like silicone gel are typically introduced once the wound has fully closed and any sutures or staples have been removed, usually around two to three weeks post-surgery. Starting too early on an open or partially healed wound can cause irritation or trap bacteria.
Once you begin, plan on applying your scar cream at least once daily for a minimum of two to three months. Many dermatologists recommend continuing for six months or longer, especially for scars on high-tension areas like the chest, shoulders, or joints. Scars continue remodeling for up to a year after surgery, so the longer you maintain treatment during that window, the better your final result is likely to be. Consistency is more important than the specific brand you choose.
Massage Makes a Real Difference
Applying scar cream with a gentle massage, rather than just dabbing it on, adds a meaningful benefit. Massaging the scar twice daily for about five minutes per session helps in two ways: the mechanical pressure breaks up dense collagen fibers, making the scar softer and more flexible, and it pushes the active ingredients into closer contact with the tissue. Research has shown that this combination of massage and topical treatment can shorten the time it takes for a scar to mature and flatten. Start massage about two to three weeks after surgery, once the wound is fully closed, and continue for at least six weeks.
Protecting Your Scar From the Sun
New surgical scars are highly vulnerable to UV damage. The fresh skin lacks the pigment protection of surrounding tissue, so even brief sun exposure can cause permanent darkening or redness that no cream will fully reverse. Starting around three weeks after surgery, apply sunscreen with at least SPF 30 to the scar area before any sun exposure. Keep this up for at least a year. Some scar gels include SPF, which simplifies the routine, but a separate broad-spectrum sunscreen works just as well as long as you’re consistent.
When Over-the-Counter Creams Aren’t Enough
Silicone gels and onion extract creams work well for typical surgical scars, the kind that are flat or slightly raised and gradually fading on their own. But some scars, particularly keloids (which grow beyond the original incision) or thick hypertrophic scars that haven’t improved after several months of topical treatment, may need stronger interventions. Corticosteroid injections are the most common next step for raised scars, flattening them by reducing collagen production directly at the site. For very stubborn cases, dermatologists sometimes use prescription-strength treatments that work at a cellular level to remodel scar tissue. These options are worth discussing if you’ve been consistent with silicone gel for three to six months and your scar still feels firm, itchy, or noticeably raised.