Silicone-based products are the best-supported option for improving surgery scars, with clinical trials showing up to 86% improvement in texture, 84% in color, and 68% in scar height. But the right treatment depends on how far along your scar is in the healing process, which takes 9 to 18 months to complete. Here’s what works, what doesn’t, and when to start each approach.
How Surgery Scars Heal
Your body heals a surgical wound in four stages: clotting (minutes to hours), inflammation (one to two days), tissue rebuilding (day three through about day 30), and remodeling. That final remodeling phase is the longest. Starting roughly six weeks after surgery, collagen continues to reorganize and strengthen for 9 to 12 months. During this entire window, the scar is actively changing, which is exactly why early and consistent treatment makes a difference.
A new scar typically looks pink or red and feels firm or raised. Over six to 18 months, it gradually softens, flattens, and fades closer to your natural skin tone. Most of the treatments below work by influencing how your body lays down and remodels collagen during this period.
Silicone Gel and Silicone Sheets
Silicone is the most extensively studied topical treatment for surgical scars. It works through several mechanisms at once. By increasing moisture in the outer layer of skin, it signals the cells responsible for producing collagen to slow down, which prevents the excess buildup that makes scars thick and raised. It also protects the healing tissue from bacteria, which can trigger overproduction of collagen on their own. And it helps rebalance growth factors that control how much scar tissue your body creates versus how much it breaks down.
You can find silicone in two forms: adhesive sheets that you cut to size and stick over the scar, or a gel that dries into a thin film after application. Both are available over the counter. Sheets work well for flat areas like the chest or abdomen, while gel is easier to use on curved or mobile areas like joints or the face. Beyond appearance, silicone also reduces the itching and discomfort that often come with healing scars.
In direct comparisons with petroleum-based dressings applied to identical surgical wounds on the same patient, silicone-treated scars came out thinner, with less redness and thickening. This suggests silicone does more than just keep the wound moist. You can typically start using silicone products two to four weeks after surgery, once the incision has fully closed and any sutures or staples have been removed.
Onion Extract Gels
Onion extract is the active ingredient in several popular scar gels. In a controlled trial where surgical scars on the same patient were split into treated and untreated sides, the onion extract gel produced statistically significant improvements in overall appearance, texture, redness, and softness after four weeks of daily use. By eight weeks, all four measures were significantly better than the untreated control scars.
Subjects noticed softness improvements as early as two weeks in. Results from the treating physicians took slightly longer to reach significance, but by four weeks the investigator ratings confirmed what patients were feeling. Onion extract gels are applied once daily, making them a low-effort option. They can be used alone or layered with silicone products, though if you’re choosing just one, silicone has the stronger body of evidence behind it.
Scar Massage
Massage is one of the simplest and most cost-effective tools for scar management. It works by breaking up adhesions, the bands of tissue that can form beneath a scar and tether it to deeper structures. This improves how the scar moves over underlying muscle and bone, reduces sensitivity, and can help flatten raised areas.
The most common recommendation from therapists is three times daily for five minutes per session, continued for about 12 weeks. You can start once the wound has fully closed, typically two to three weeks after surgery. Use firm, circular pressure directly on the scar, moving it in all directions. You should feel the tissue shifting underneath your fingers. It’s normal for this to feel slightly uncomfortable at first, especially if the scar is sensitive, but it shouldn’t cause sharp pain or reopen the wound.
Keeping the Wound Moist Early On
In the first one to three weeks after surgery, before you move to silicone or other scar treatments, the priority is keeping the incision moist and protected. Petroleum jelly applied three times daily is a simple, effective option during this window. Antibiotic ointments serve the same moisture-retaining purpose with added antimicrobial protection. Either approach helps new skin cells migrate across the wound faster, which is the foundation for everything that follows.
Once that protective skin layer is established and the incision looks closed (no scabbing, no drainage), you can transition to silicone products, onion extract gels, or both.
Sun Protection
UV exposure on a healing scar can cause permanent darkening that won’t fade on its own. This hyperpigmentation, sometimes called “tattooing,” is particularly common in scars that are still pink or red. You should apply sunscreen to the scar as soon as the incision is fully healed, and continue for as long as the scar remains pink, which can be anywhere from 6 to 18 months. Physical barriers like clothing or adhesive strips are even more reliable than sunscreen alone, especially during prolonged sun exposure.
Skip Vitamin E
Vitamin E oil is one of the most commonly recommended home remedies for scars, but clinical evidence tells a different story. In a study of surgical scars, topical vitamin E either had no effect or actually worsened the scar’s appearance in 90% of cases. Even more concerning, 33% of patients developed contact dermatitis, an itchy, inflamed skin reaction that can interfere with healing. Despite its reputation, vitamin E applied to surgical wounds should be avoided.
When Topicals Aren’t Enough
If a scar remains thick, raised, or rope-like after several months of consistent home treatment, professional options can help. Steroid injections are a common first-line approach for hypertrophic scars and keloids. They’re typically given every two to four weeks until the scar softens and flattens. Fractional laser treatments are another option, creating microscopic channels in the scar tissue that trigger the body to remodel it. In clinical trials, both approaches significantly improved scar appearance from baseline. Laser treatments can also be combined with steroid delivery to reduce the side effects associated with injections.
These professional treatments are generally considered when a scar hasn’t responded to silicone, massage, and time, or when the scar is causing functional problems like restricted movement or persistent pain.
Putting It All Together
Scar treatment works best as a layered approach that evolves as your wound heals:
- Weeks 0 to 3: Keep the incision moist with petroleum jelly or antibiotic ointment. Protect from tension and trauma.
- Weeks 2 to 3: Once the wound is fully closed, begin scar massage (three times daily, five minutes each) and start silicone gel or sheets.
- Weeks 3 through 18+: Continue silicone and massage consistently. Add onion extract gel if desired. Apply sunscreen to the scar before any sun exposure.
- Months 3 to 6: If the scar isn’t improving, consider professional treatments like steroid injections or laser therapy.
Consistency matters more than any single product. A scar treated daily with silicone for three months will almost always look better than one treated sporadically with a more expensive product. The 9- to 18-month maturation window is your opportunity to influence the final result, and the earlier you start, the more that window works in your favor.