Silicone-based products are the most effective topical option for fading scars, backed by decades of clinical evidence. Beyond silicone, a handful of other ingredients and techniques can help, while some popular remedies (like vitamin E) don’t hold up under scrutiny. What works best depends on your scar type, how old it is, and how consistently you use the treatment.
Silicone Gel and Silicone Sheets
Silicone is the gold standard for topical scar treatment. It comes in two forms: adhesive sheets you place over the scar and gel you apply like a lotion. Both work through the same mechanism. When a wound heals, the new skin layer is immature and loses moisture much faster than normal skin. That dehydration triggers a chain reaction: skin cells send chemical signals that tell deeper cells to produce excess collagen. That surplus collagen is what makes scars raised, thick, and discolored.
Silicone mimics the barrier function of healthy skin. It restores normal moisture levels in the scar tissue, which dials down the overproduction of collagen. Interestingly, research published in Advances in Wound Care found that silicone doesn’t just trap as much moisture as possible. It provides a level of hydration similar to normal skin, which is why it works better than heavy occlusive dressings that can actually have a detrimental effect by creating too strong a moisture barrier.
You can start using silicone sheets or gel on the day a wound is closed (after sutures or surgical tape are in place), and the recommended duration is three to six months of consistent daily use. Sheets are typically worn 12 to 23 hours a day. Gel formulas are more practical for visible areas like the face or neck, and for scars on joints or irregular surfaces where a sheet won’t stay put.
Sunscreen on Healing Scars
This one is easy to overlook, but UV protection is critical for any scar you want to fade. Scar tissue lacks the normal levels of melanin that shield healthy skin from the sun. Without that protection, UV exposure causes hyperpigmentation (darkening) or hypopigmentation (lightening), either of which can make a scar permanently more visible. UV rays also break down collagen and elastin and trigger inflammation that changes the scar’s long-term appearance.
Use a broad-spectrum sunscreen with SPF 30 or higher on any healing scar whenever it will be exposed to sunlight. Start about two to three weeks after surgery or injury, once the wound has closed enough for normal activity. Continue for at least 18 months, which is roughly how long a scar remains in its active remodeling phase. Physical sunscreens containing zinc oxide or titanium dioxide tend to be gentler on sensitive scar tissue.
Onion Extract Products
Onion extract is the active ingredient in several popular over-the-counter scar gels. Clinical evidence is mixed. A study on surgical scars in Asian patients found that onion extract significantly reduced scar height at both four and 12 weeks compared to untreated skin. However, it made no measurable difference in scar redness, pliability, or overall cosmetic appearance. So while it may help flatten a raised scar, don’t expect dramatic improvements in color or texture. These products can be started immediately after wound closure and are generally used for one to three months.
Retinoids for Depressed Scars
Retinoids (vitamin A derivatives like tretinoin) work differently from silicone. Instead of calming excess collagen, they stimulate new collagen production, which makes them useful for atrophic scars, the kind that sit below the skin’s surface. Acne scars, chickenpox scars, and certain stretch marks fall into this category.
Tretinoin improves skin texture and elasticity by boosting collagen synthesis in the deeper layers of skin. A prospective study on post-burn facial scars found that a year of tretinoin use significantly improved skin flexibility and softness. For newer red stretch marks, tretinoin at standard concentrations shows clear benefit, though it has limited value for older, white stretch marks where the tissue has already fully matured. Retinoids require a prescription in most formulations and can cause irritation, peeling, and sun sensitivity, so they pair especially well with diligent sunscreen use.
Why Vitamin E Doesn’t Work
Vitamin E is one of the most commonly recommended scar remedies, and one of the least effective. In a clinical study of surgical scars, topical vitamin E either had no effect or actually worsened the cosmetic appearance of scars in 90% of cases. On top of that, 33% of patients developed contact dermatitis, an itchy, inflamed skin reaction, from applying it. The researchers concluded that topical vitamin E on surgical wounds should be discouraged. If you’re currently using it, switching to silicone gel is a better use of your time and money.
Honey and Other Natural Options
Manuka honey has legitimate wound-healing properties. Its antibacterial and anti-inflammatory effects can help a fresh wound close cleanly, which matters because better initial healing generally means a less noticeable scar. However, a randomized controlled study on thyroidectomy scars found no clinical benefit to applying Manuka honey for scar reduction after surgery. The only measurable improvement was a modest effect on pigmentation. As a scar-fading treatment specifically, honey doesn’t deliver much beyond what basic wound moisture provides.
Scar Massage
Starting about two to three weeks after surgery or injury, gentle massage is a simple and free way to improve a scar. Massaging the scar with moderate pressure helps break up collagen fibers that are binding too tightly, improving flexibility and flattening raised areas over time. The recommended approach is twice daily for about 10 minutes each session, continued for at least six weeks. You can combine this with silicone gel application for a practical two-in-one routine.
When Topical Products Aren’t Enough
Not all scars respond to what you can put on them at home. Understanding your scar type helps set realistic expectations.
Raised scars come in two varieties. Hypertrophic scars stay within the boundaries of the original wound and often start to flatten on their own after about six months. These respond well to silicone, massage, and pressure. Keloids, by contrast, grow beyond the edges of the original injury, don’t regress on their own, and typically appear on the earlobes, chest, back, and shoulders. Keloids usually need professional treatment like steroid injections or specialized procedures.
Depressed scars, particularly from acne, vary in how well they respond to treatment. Rolling scars (broad, wave-like depressions) show the best improvement with professional treatments like fractional CO2 laser, with one study reporting roughly 43% improvement. Boxcar scars (wider depressions with sharp edges) improved about 36% with the same laser. Ice-pick scars, the narrow deep pits, are resistant to nearly every treatment, improving only about 3% even with laser resurfacing.
A Practical Treatment Timeline
The first two to three weeks after injury are about keeping the wound clean and moist. Petroleum jelly applied two to three times daily is effective and inexpensive for this phase. Silicone gel or sheets can also be started from day one.
At the two to three week mark, once the wound has closed and pain has decreased, add sunscreen for any sun-exposed scars and begin gentle scar massage. Continue silicone products daily. This combination of silicone, sun protection, and massage is the core routine for the next several months.
If your scar hasn’t responded adequately after three to six months of consistent topical care, professional options like laser treatments or dermabrasion typically begin at the two to three month mark. Surgical scar revision, when needed, is generally delayed until at least 18 months after the original injury to give the scar its full chance to mature and fade naturally.