After surgery — whether a lumpectomy, mastectomy, tummy tuck, or any other procedure — the question patients ask most consistently in the weeks after their incision closes is: what should I put on my scar? The skincare aisle and the internet offer an overwhelming number of answers, many of them contradictory and most of them driven more by marketing than by clinical evidence.
This post cuts through that noise. As physical and occupational therapists who specialize in scar management and soft tissue rehabilitation at Thera Physical and Occupational Therapy in Midtown Manhattan, we are asked about scar products constantly — by patients recovering from breast surgery, lumpectomy, mastectomy, cosmetic procedures, and C-sections. Here is what the clinical evidence actually says, what we recommend, and what to avoid.
First: what topical products can and cannot do
Topical scar products work at and just beneath the skin surface. They can hydrate the scar, reduce transepidermal water loss, create a microenvironment that supports organized collagen maturation, and in some cases reduce redness and thickness. What they cannot do is address the deeper adhesions between tissue layers — the binding of skin to subcutaneous tissue to fascia — that create the pulling, tightening, and restricted movement that many patients experience after surgery. Those require hands-on scar mobilization, which no topical product replaces.
The most effective approach to scar management combines consistent use of appropriate topical products with regular manual scar mobilization from a trained therapist. Topical products are not a substitute for clinical treatment. They are a complement to it.
What the evidence actually supports
Medical-grade silicone: the clinical standard
Silicone is the most evidence-supported topical scar intervention available. It is the product category most consistently recommended by plastic surgeons, dermatologists, and scar management specialists — and it is the only category with a substantial body of peer-reviewed clinical literature demonstrating meaningful benefit for surgical scars, hypertrophic scars, and keloids.
Silicone works by creating a semi-occlusive barrier over the healing scar that maintains local hydration and regulates oxygen exchange at the tissue surface. This sustained hydration environment reduces the signaling that drives excessive collagen production — meaning silicone actively supports the scar's transition toward a flatter, softer, less reactive state. Clinical studies have shown improvements in scar thickness, height, color, and flexibility with consistent silicone use.
Silicone is available in two forms:
- Silicone gel — applied directly to the scar as a thin layer that dries to a flexible film. Easier to use on irregular anatomical areas, can be worn under clothing without difficulty. Products such as BioCorneum (which also contains SPF), Strataderm, ScarAway Gel, and Mederma Advanced Scar Gel are widely used. Apply to clean, dry skin twice daily once the incision is fully closed and your surgeon has cleared you.
- Silicone sheets — adhesive silicone pads worn directly over the scar for extended periods. Particularly effective for flat, straight incisions where sustained contact is easier to maintain. Products such as Mepiform, ScarAway Silicone Scar Sheets, and Rejûvaskin Silicone Scar Sheets are commonly recommended. Worn for twelve or more hours per day, they are especially useful for patients who find gel application impractical.
Both forms are effective when used consistently. The most important factor is duration of use — most clinical protocols recommend a minimum of eight to twelve weeks of consistent daily use, with some scars benefiting from extended use of up to six months. Start as soon as your surgeon clears the scar for topical treatment — typically once the incision is fully closed and there is no active scabbing.
What does not work — despite widespread belief
Vitamin E
Vitamin E is one of the most frequently recommended home remedies for scars — and one of the most thoroughly refuted by the clinical literature. A landmark study published in Dermatologic Surgery found that vitamin E had no significant benefit for post-surgical scars and actually worsened scar appearance in approximately one-third of patients. A subsequent systematic review confirmed that there is insufficient evidence to support the use of topical vitamin E for scar treatment, and noted a meaningful rate of contact dermatitis as a side effect.
Despite this, vitamin E remains a popular recommendation because it has a positive reputation in general skincare and moisturization. Its antioxidant benefits for overall skin health do not translate to meaningful scar treatment. If you are currently using vitamin E on a healing scar, there is no clinical justification to continue — and some reason to stop.
Coconut oil, Bio-Oil, and similar plant-based products
These products have some moisturizing benefit and are not harmful, but they do not have the same level of clinical evidence supporting their use as scar-specific treatments that silicone does. They may be useful as general moisturizers in the scar area once it has matured, but should not be used as substitutes for silicone in the active scar management phase.
Pure petrolatum (Vaseline) as a long-term scar treatment
Petrolatum is excellent for protecting a freshly closed wound and preventing moisture loss in the very early stages of healing — this is the phase when your surgeon may recommend keeping the incision covered with a thin layer of ointment. Once the wound has fully closed and the active scar management phase begins, petrolatum does not provide the specific microenvironment that silicone creates for collagen remodeling. Use it during wound healing; transition to silicone once the scar is ready.
When to start and how to apply
- Before incision closure — keep the wound moist with petrolatum (Vaseline) or a surgeon-recommended ointment as directed. Do not use silicone on an open wound.
- Once fully closed, no active scabbing (typically 3–6 weeks post-op, with surgeon clearance) — begin silicone gel or sheeting. Apply to clean, dry skin. Consistency matters more than quantity.
- Weeks 6–12 — continue silicone twice daily. Begin scar mobilization with your therapist once cleared for manual work. The combination of silicone and scar mobilization consistently produces better outcomes than either alone.
- Months 3–6 — continue silicone as the scar continues to mature. Scar color typically peaks at three months and gradually fades. Silicone use through this period supports the maturation process.
- Sun protection — healing scars are highly susceptible to UV-induced hyperpigmentation. Apply broad-spectrum SPF 30 or higher to any scar exposed to sun throughout the entire maturation period (twelve to eighteen months minimum). BioCorneum includes SPF 30 in its formula.
The role of professional scar management at Thera
Topical silicone addresses the surface and immediate subsurface of the healing scar. Professional scar management — the hands-on manual work performed by your therapist — addresses the deeper tissue layers: the adhesions between skin and subcutaneous tissue, the restricted mobility between tissue planes, the tethered quality that creates pulling and restricted movement. These two interventions work at different tissue depths and address different components of scar healing. They are complementary, not interchangeable.
At Thera, our scar management program combines professional scar mobilization with guidance on topical products, compression, and home self-care. We treat scars after breast surgery (lumpectomy, mastectomy, reconstruction), cosmetic surgery (tummy tuck, liposuction, augmentation), C-section, and other procedures. Sessions are always one-on-one, and treatment is adjusted at each visit based on how your scar is responding.
If you have a scar that is thickening, pulling, restricting your movement, or simply not progressing as you hoped — or if you want to start on the right foot with a new scar — contact our team today.
Medical-grade silicone — applied consistently, starting as soon as the wound is fully closed — is the most evidence-supported topical intervention for post-surgical scars. Vitamin E does not work and may cause harm. Petrolatum protects wounds but is not a scar treatment. And topical products address only the surface of the scar — the deeper tissue work, the restoration of mobility between tissue layers, and the prevention of functionally limiting adhesions require hands-on clinical scar mobilization. Use both for the best outcomes.
If you are managing a post-surgical scar and want professional guidance on topical care, timing, and hands-on scar treatment, contact our team today to schedule an evaluation at our Midtown Manhattan clinic.
No referral needed · New York State allows direct access to physical and occupational therapy for up to 10 visits or one month without a physician's script.
