The best, and actually only proven effective, risk-free, treatment for raised scars is topical silicone gel sheeting. In this study, published in Dermatologic Surgery in 2001 researchers conclude:
Topical silicone gel sheeting, with a 20-year history of satisfaction in dermatology, now appears to be useful in the prevention of hypertrophic scars and keloids in patients undergoing scar revision.
Also other studies confirm such claims. This type of therapy has been used for a few decades now, initially in burn centers and hospitals.
Not only to prevent excessive scar formation but to improve cosmetic appearance as well. Some dermatologists and other medical professionals refer to silicone sheeting as ‘The Golden Standard in Scar Treatment’.
Another treatment for raised scars that works is the, more invasive, use of steroid injections. Generally multiple injections are required to get the desired effect.
Downside are the possible side effects. Such steroid injections (e.g. Kenalog) may deform the scar and surrounding skin by causing dents (skin atrophy). Other complications include; lightening of the skin (hypopigmentation), and red spots on the skin (telangiectasia).
Because of these side effects and the non-invasive character of silicone gel sheeting it is often recommended to use these. Most scars improve upon using this modality.
Raised scars can be white, red, purple, or even darker colored. The most common types of raised scars are keloids and hypertrophic scars. Hypertrophic scars are more common then keloids. The elevation of scar tissue is a result of excessive fibroblast creation. Fibroblasts are connective tissue cells the body creates to repair the wound.
Keloids only occur in 10% of people. They look like mounds growing above the skin surface. Sometimes they are mistaken for benign tumors. Their symptoms are itchiness, pain, unusual sensations, redness and skin pigmentation. They grow out of the normal boundaries and can be triggered by wounds, pimples, insect bites, tattoos, and even simple scratches. Keloids are hard to treat effectively and recurrence is typical. These scars are often treated with combinations of laser therapy, steroid injections, and silicone sheets. As a last resort surgery can be performed but more scar tissue may form afterwards.
- Hypertrophic Scars
Hypertrophic scars have a slightly similar appearance but do not grow as big as keloids. They may restrict movement when located close to a joint. They are more likely to fade in time, generally within 1 or 2 years. This type of scar tissue may develop into keloid scar tissue in some people. Therefore preventive treatment is recommended. (Surgical) wounds are commonly covered with paper tape to reduce wound tension and thus minimize scar tissue creation. (and the risk on keloid development) Scars (wounds that have closed) can be treated effectively by pressure therapy (garments) and silicone gel sheets.
How Do Silicones Work?
Silicones are thought to act by downregulating fibroblast creation thus reducing the amount of collagen deposit in the tissue. They are theorized (their precise method of action isn’t clear yet) to mimic the occlusive barrier function of healthy skin thus increasing hydration.
Hydration seems to be essential in improving (raised) scars therefore it is recommended to keep the scar and surrounding skin hydrated.
They can also improve the appearance of burn and contracture scars.
My Experiences With Silicones for Scars.
I have used silicone sheets myself on the several scars I had when I had been stabbed and needed surgery to safe my life. The sheets made my scars smoother, less itchy, flat, and more skin colored. I therefore recommend ScarAway .
You can also use a silicone gel cream such as ScarAway Serum or Kelo-cote scar gel. A gel is more convenient and once applied is less obvious which makes it more useful to wear during the day. (in case your scar is not covered by clothes.)
Sheets, also known as pads or patches seem to be slightly more effective though. I myself used both. Sheets at night and the gel during daytime.