It’s been 3 weeks since my Mohs surgery, and I’m becoming addicted to this little tube of silicone gel that my plastic surgeon gave me to use.
“Apply this 2-3 times a day to prevent scarring and redness” he said, uncapping the tube, smearing it’s contents on my newly-healed Moh’s incision and then gently rubbing it in. “Rub it in, pressing down to the bone. Let it dry, then you can apply make-up over it.”
As I left, his nurse commented – “Ah – I see you got “The Tube”. He loves that tube!”
It’s pretty cool that I can actually do myself to help the healing process along. It’s also oddly comforting to stroke my scar and feel the silicone covering on it. But the other night, as I applied the silicone gel, I found myself curious as to how this stuff worked. Was it just a little plastic surgery witchcraft or was it really doing something to prevent scarring and redness? So I headed to Pub-Med and did a little reading.
What I found was that this stuff really does work. Numerous controlled trials have shown that silicone sheeting treats hypertrophic scars or keloids and prevents such scars in the first place if used prophylactically. There is less data on silicone in other forms, such as gels and creams, but several studies suggest that they work as well as the sheets. My tube is just one of many brands of silicone products that now sell over the counter. I don’t know if there’s a difference between brands, thought I suspect they are probably all the same.
How do silicone sheeting and gels work to prevent scars?
No one knows for sure, but here is the current thinking – When a wound heals, the new skin that is made is immature and not as good an osmotic barrier as older skin. Thus, water is lost from the deeper layers of the skin. It is theorized that water loss from the stratum corneum leads to production of cytokines, which in turn increases the amount of collagen laid down by the fibroblasts there. (Collagen is the stuff of which scars are made.)
Silicone sheets and gels are thought to create an osmotic barrier that prevents evaporative loss of water from the wound, thus leading to decreased collagen and scar formation. Silicone sheets are the most studied, but are harder to use on the face where visibility is a problem and on joints where movement dislodges them. Silicone gels have the advantage of being easy to use, and the gel dries nicely to create a countered covering. Some specialists recommend using the sheets at night and the gels during the day.
Can’t I just Use Vaseline?
Nope. Apparently, Vaseline does not work to prevent scar formation. Nor do plastic sheets and other occlusive dressings. There is something about the osmotic barrier in silicone sheets and gels that makes it “just right” for the job. That something may not be the actual silicone itself, but the vehicle or matrix that it forms. Indeed, more recent studies using some non-silicone gels have shown similar efficacy to silicone, suggesting that the gel’s the thing.
What about steroid injections?
The other well-proven treatment for hypertrophic scars is steroid injections. But steroid injections are used on already formed scars, as opposed to silicone gel, which can be used to prevent scarring.
How about the rubbing?
The rubbing that I am doing is also helping my wound heal prettily by preventing the formation of collagen bands in the scar.
This young girl, whose parents have a wonderful site showing the evolution of her cleft lip and palate from birth through repair to age 10, rubbed cocoa butter on her scar. She looks great – a testimony to the use of pressure and rubbing (or 10 year old skin…)
Comments? Corrections?
This is my own little foray into a completely different field of medicine from that for which I was trained, so I hope that I have not made any glaring errors. I would love to know what my plastic surgery colleagues think about this topic (RL?). I don’t know, for instance, if one brand or type of gel is better than another, or what one should look for in a gel to be sure it will work.
That’s it? No shocking photos of scar tattoos?
Oh, all right – here. Just don’t say I didn’t warn you.
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I’m mostly with the little girl and her parents–scar massage and lots of it. Sunscreen while it’s pink/red. Use the silicone is “some” better, but can be expensive. It’s mostly a matter of using something. The tubes of silicone stuff or cocoa butter or Vit E won’t do the scar any good if not used.
TBTAM–I think your nose is looking great!
That’s pretty impressive. I wish I had been given something 30+ years ago for a horrific surgical scar on the inside of my leg. Is it too late to do something now?
RL – Thanks. Agree- the silicone stuff is expensive.
Anonymous – I have no idea. Why not see a plastic surgeon and find out?
Wow, I learn a lot on this blog…maybe the silicone will help my Mohs nose scar. Still not thrilled with it
You should have asked your TRAM flap patients – we know about this!!! It’s great.
Thanks for those great links. I loved the uplifting little girl and her scar evolution. The scarification was just plain creepy. Good luck with your nose.
Isn’t it great when as a medical person you find something that validates something you are taking? I was drinking a “sleep aid tea” a few years ago until I read an UpToDate article saying it was essentially placebo….so gave it to someone who wouldn’t research it, so that they could enjoy the placebo effect which had been spoiled for me…
Nice writing… I got much to learn
thanks you
Saç Ekimi
This really hit home. I had mohs surgery to remove a squamous cell carcinoma on my nostril; site was a little smaller than a dime, and the plastic surgeon performed a nasolabial flap. Your scar looks great; mine, on the other hand, being the notril, may require a second stage of surgery to reduce the flap size to create a more natural looking nostril. I liked your attitude, and know there are plenty of people out there going through much worse shit….but then again, this is MY shit, and MY nose, and it does matter to me. I hope to become better grounded as time passes. Thanks for sharing.
A very helpful post as I counsel a friend about minimizing scar formation… actually found this gem of yours from 5 years ago apparently through a random google search. Good to get info from a trusted “friend.” 🙂
Thanks
3 months ago I had surgery because it is clogging my nostrils. But it was worse than the former. A difficult surgery. Thanks for sharing.
Gel strips were recommended by my surgeon and so was the Dr Max Powers Scar Serum. Teh Strips did NOT work, but the Dr Max Serum did work. The scar does look better, and I could see a difference when I would remove the gel strip. Also, I would feel a faint stinging when it was on, which I felt meant it was doing its magic.
IMPORTANT TO KNOW – you should use the serum TWICE per day. I saw a big difference when i used the dr max serum TWICE per day, not once per day.
I used Dermalmd serum after trying some silicone scar tape. This is less work for me because with my physically active job the tape would roll-up. I use it twice a day. This serum works very well I can see quite a difference in the scar on my abdomen after about 6 weeks of using it.