Can Silicone Gel Help an Old Scar? The Science of Silicone and Mature Scar Tissue

Quick Summary Scar tissue remains biologically active long after a wound closes - collagen remodelling can persist for a year or more, and hypertrophic scars may stay responsive for even longer. Medical-grade silicone gel appears to work by creating an occlusive environment that influences the signalling between skin cells, which may help soften, flatten, and reduce symptoms in established scars. Results are gradual and vary between individuals. Older scars may respond more slowly, but dismissing treatment as "too late" is not supported by current evidence.

The Sceptical Question Most People With Old Scars Are Asking

You’ve had the scar for five years. Maybe ten. It's raised, or tight, or it still itches occasionally despite the original wound being long healed. You've largely made peace with it - but you've also started wondering, quietly, whether anything could actually help at this point.

And then you read about silicone gel. And the first thought is: "Surely it's set by now."

It's a reasonable assumption. We tend to think of scars the way we think of set concrete - once the structure has hardened, the window for change has closed. But scar tissue is not concrete. So can silicone gel help an old scar? In many cases - particularly raised or hypertrophic scars - it may offer gradual improvement when used consistently.

This article explains the science clearly: what scars are made of, how silicone gel is thought to work, and what realistic improvement looks like for an old scar.

How Long Do Scars Actually Remodel? Longer Than Most People Think

To understand whether silicone can help an old scar, you first need to understand how long scars remain biologically active.

Wound healing occurs in three broadly overlapping phases - inflammation, proliferation, and remodelling. The remodelling phase is the longest and least understood. According to research published in International Wound Journal and Advances in Wound Care, this phase begins around three weeks after injury and can last for months to over a year, during which fibroblasts continue to cross-link and turn over the initially deposited collagen matrix.

During remodelling, the temporary type III collagen laid down during proliferation is gradually replaced by type I collagen. The structure becomes more organised and tensile strength increases progressively over months, but never returns to 100% of normal skin. What remains is the scar.

In hypertrophic scars, this process is disrupted. Research in International Wound Journal describes how fibroblasts in these scars show elevated production of TGF-β1 and VEGF that peaks in the proliferative phase but can persist well beyond the typical remodelling window. This means hypertrophic scar tissue remains biologically more active - more responsive to signalling - than a flat, mature scar.

The practical implication: scar tissue is living tissue. It contains active fibroblasts, capillaries, and ongoing low-level cellular signalling. That activity is reduced compared to a fresh wound, but it does not switch off on a fixed timeline. An old scar is quieter than a new one - but it is not inert.

What Silicone Gel Actually Does - Mechanism, Not Marketing

Silicone gel does not dissolve scar tissue. It does not "break it down," penetrate the dermis, or work like a pharmaceutical drug. The mechanism is more indirect - and more interesting.

Research published in Aesthetic Plastic Surgery and a PubMed review by Mustoe (2007) describes the likely mechanism as follows: silicone gel applied to scar tissue creates a semi-occlusive barrier that reduces transepidermal water loss from the stratum corneum. This increased hydration of the outer skin layer appears to trigger a signalling cascade between keratinocytes (the surface skin cells) and dermal fibroblasts beneath them.

In simplified terms: well-hydrated keratinocytes appear to send different signals to fibroblasts than dehydrated ones do. Those signals may modulate the production of growth factors - including TGF-β, which plays a key role in collagen overproduction. The result, over consistent application, may be a gradual regulation of collagen production and a softening of the fibrous architecture of the scar.

Silicone also reduces itching in hypertrophic scars, which is likely related to both the moisturising effect and a reduction in nerve fibre activity at the scar surface. If you've ever wondered why old scars sometimes still itch years after the wound healed, our article [Why Does My Scar Itch Years Later?] covers that question in detail.

What silicone does not do is equally worth stating: it does not erase scars, it does not produce dramatic overnight results, and it is not effective for every scar type. Credibility requires saying that plainly.

Does Silicone Work on Old, Established Scars?

This is the central question, and the honest answer is: it may - with lower and slower expectations than for a fresh scar.

Most of the clinical research on silicone gel focuses on prevention and early-stage treatment, where evidence is more robust. Studies on established scars are fewer in number and often of modest methodological quality, as noted in the Cochrane Database review (O'Brien & Jones, 2013). That review found improvements in scar thickness and colour with silicone gel sheeting but acknowledged the evidence base has limitations.

What does appear reasonably supported is that silicone can produce meaningful improvement in hypertrophic scars even when they have been present for years. The key distinction is between scar types:

Flat, pale scars (atrophic or normotrophic) have limited response potential to silicone. These scars involve collagen loss rather than excess, and silicone's mechanism - regulating overactive fibroblast signalling - is less directly applicable. Some people notice improved softness and texture, but structural change is unlikely.

Hypertrophic scars - raised, firm, sometimes itchy, staying within the original wound boundary - appear to be the best candidates for silicone therapy in mature scars. Because fibroblast activity can remain elevated in these scars, silicone's signalling effect may still find a responsive target.

Keloid scars extend beyond the original wound boundary and behave quite differently from hypertrophic scars. Silicone can be used as part of keloid management but is generally considered first-line prevention rather than standalone curative treatment. Significant keloids are likely to require specialist assessment.

What Changes Are Realistic for an Old Scar?

This section matters most, because unrealistic expectations lead to abandoning treatment that might otherwise have produced meaningful results.

Outcomes that research suggests are plausible with consistent silicone use on mature hypertrophic scars include: reduced itching or sensitivity, improved softness and pliability, reduced tightness, and mild flattening of raised areas. Some people report a slight improvement in redness, though colour change in a long-established scar tends to be slower and less predictable than texture change.

Outcomes that are not realistic: complete disappearance of the scar, significant colour reversal in a scar that has been white or pale for years, or any dramatic change within the first few weeks of use. Results vary between individuals, and there is no way to predict in advance how responsive any individual scar will be.

Individual variation matters here. Skin type, the original cause of the scar, location on the body, age, and hormonal factors all influence how scar tissue behaves. Women going through perimenopause and menopause, in particular, may notice changes in existing scars - including increased sensitivity or altered texture. Our article [Why Do Scars Flare Up During Menopause?] explores the hormonal mechanisms behind this in more detail.

How Long Should You Try It - and How to Know If It's Working

The minimum meaningful trial period for silicone on an established scar is 8-12 weeks of daily, consistent application. Compliance is the single most important predictor of response in topical silicone therapy. This is not a conservative recommendation - it reflects the pace of the biological processes involved. Collagen remodelling is slow. Intermittent use does not sustain the occlusive hydration effect that appears to drive the mechanism, which is why sporadic application produces little benefit.

A practical way to assess progress is to photograph the scar in consistent lighting and position at the start of treatment and again at 8 weeks and 12 weeks. Changes in texture and height are often visible in comparison, even when they aren't obvious day-to-day. If there is no discernible change after a full 12-week consistent trial, the scar may not be particularly responsive to topical silicone alone.

If you're considering an evidence-based option, Genova Silicone Scar Gel is one topical silicone product formulated for consistent daily use on both new and established scars. More information on application is available at genovaskincare.com.au/products/genova-silicone-scar-gel.

Silicone Gel vs Silicone Sheets - What's the Practical Difference?

Both silicone gel and silicone sheets appear to work through the same basic mechanism - occlusion and hydration - and the clinical literature suggests comparable efficacy when used consistently. The main difference is practical.

Silicone sheets provide firm, consistent contact and may be preferable for flat surfaces like the abdomen or sternum. They can be washed and reused, which may offset their higher upfront cost. However, they are difficult to use on irregular surfaces, over joints, or on visible areas of the face and neck, and they can cause skin irritation in humid climates.

Silicone gels dry to a thin, breathable film and are more cosmetically acceptable for everyday use. They work on irregular surfaces, dry quickly, and can be worn under clothing or makeup. Research in JCAD suggests compliance tends to be higher with gels, which matters because inconsistent use is the most common reason silicone therapy fails to produce results.

For most people managing an old scar in day-to-day life, a gel is the more practical choice.

When Silicone Is Not Enough

Silicone is appropriately considered a first-line option in scar management - but it is not the only line. For scars that have not responded to consistent silicone use, or for more complex scar types, other options exist.

Intralesional corticosteroid injections are the most established alternative for hypertrophic scars and keloids. They reduce fibroblast activity more directly and can produce meaningful flattening, though they require clinical administration. Laser therapy, including pulsed dye laser and fractional ablative treatments, can address both vascularity and texture in established scars. For functionally limiting contractures, surgical revision may be appropriate.

Some specialists also use combination approaches - silicone with compression, or silicone alongside corticosteroids - particularly for resistant hypertrophic scars. If your scar is causing significant functional limitation, psychological distress, or has not responded to conservative measures, a referral to a plastic surgeon or dermatologist specialising in scar management is appropriate.

Myth vs Reality

"Old scars can't change." Not supported by the biology. Scar tissue contains living fibroblasts with ongoing low-level activity. Mature hypertrophic scars, in particular, can remain responsive to treatment. Change is slower and more modest than in fresh scars, but not impossible.

"Silicone only works on new scars." The clinical application includes both prevention and treatment of established scars. Research on established scars shows improvements in thickness and texture, though evidence quality varies.

"If it hasn't worked in two weeks, it won't work." Two weeks is too short a trial by a significant margin. The biological processes involved in collagen remodelling take weeks to months. Eight to twelve weeks of daily use is the minimum meaningful trial period.

"Natural oils are just as effective." There is no comparable clinical evidence for vitamin E oil, rosehip oil, or similar topical oils achieving the same mechanistic effects as silicone. Some may support general skin hydration, but they do not create the sustained semi-occlusive environment that appears to drive silicone's mechanism of action.

"If a scar is flat, it's finished." Flat scars are generally less responsive to silicone than hypertrophic ones, but some improvement in softness, texture, or sensitivity is still reported by some people. The mechanism simply has less active tissue to work with.

FAQ

Does silicone gel work on a 10-year-old scar? It may, particularly if the scar is raised or firm. A 10-year-old hypertrophic scar retains some biological activity. Response is likely to be slower and more modest than for a recent scar, but consistent use over 8-12 weeks can produce improvements in softness and texture for some people. Results vary.

How long does silicone gel take to work on an old scar? A minimum of 8-12 weeks of daily application is recommended before assessing results. Some people notice changes in softness or itching sooner, but visible structural changes typically develop over months, not weeks.

Can silicone reduce scar itching? Research suggests it may. Scar itching is linked in part to nerve fibre activity at the scar surface and to skin dehydration. The hydrating and occlusive effect of silicone appears to reduce these symptoms in some hypertrophic scars. For more on why scars itch, see [Why Does My Scar Itch Years Later?]

Is silicone gel safe for long-term use? It appears well-tolerated in long-term use. Occasional skin irritation or maceration is the most reported adverse effect, which typically resolves when treatment is paused. There is no clinical evidence of systemic absorption or toxicity from topical silicone gel.

Can I use silicone on a C-section scar? Yes, and this is one of the more common applications. C-section scars can become hypertrophic. Silicone gel is suitable for use on healed C-section incisions and is often used to address raised, tight, or sensitive tissue. Confirm the wound is fully closed before starting.

Does silicone fade scar colour? Some improvement in redness has been reported in earlier-stage hypertrophic scars. In long-established pale or white scars, a significant colour change is unlikely. Silicone has more impact on texture, height, and symptom management than on pigmentation.

Is silicone better than vitamin E for scars? Current evidence does not support vitamin E as an effective scar treatment and some research suggests it may cause contact dermatitis in a proportion of people. Silicone has more clinical evidence behind it, though that evidence is imperfect. For established scar management, silicone is the more evidence-supported choice.

Should I use silicone gel on my scar during menopause? Hormonal changes during perimenopause and menopause can affect skin hydration, collagen density, and scar sensitivity. These changes may make some older scars more symptomatic. Silicone gel is safe to use during this period and may help manage itching or texture changes. See [Why Do Scars Flare Up During Menopause?] for more on the connection between hormones and scar behaviour.

Conclusion: Realistic Optimism Is the Right Framework

The question "is it too late to do anything about my old scar?" is understandable, but the biology suggests it's the wrong frame.

• Scar tissue is not a finished structure. It is living tissue that retains biological activity, especially in hypertrophic scars, long after the original wound has healed. The collagen remodelling phase can persist for a year or more, and fibroblast signalling in raised, firm scars may remain amenable to influence well beyond that.

Medical-grade silicone gel does not erase scars and should not be presented as though it does. What the evidence supports is more modest, and more honest: consistent daily use may produce gradual improvements in softness, texture, tightness, and sensitivity. Change is slow. Older scars respond more slowly than fresh ones. Results vary between individuals.

What silicone offers an old scar is not a dramatic reversal but a reasonable, low-risk, evidence-informed attempt at improvement. For many people, that is enough reason to try it - consistently, patiently, and with accurate expectations about what success actually looks like.

Related Reading:

• Why Does My Scar Itch Years Later?
• Why Do Scars Flare Up During Menopause?
  

Disclaimer: Individual results vary. This article is for educational purposes and does not constitute medical advice. If you have concerns about a significant or symptomatic scar, consult a qualified dermatologist or plastic surgeon.

Sources

1. O'Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database of Systematic Reviews 2013, Issue 9. DOI: 10.1002/14651858.CD003826.pub3
2. Mustoe TA. Evolution of silicone therapy and mechanism of action in scar management. Aesthetic Plastic Surgery 2007; 31(5): 495-500. DOI: 10.1007/s00266-006-0218-1