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Three Part Question

In [adult patients presenting to ED with traumatic facial lacerations], does [advising topical silicone gel] improve [cosmetic and symptomatic outcomes]?

Clinical Scenario

A 26-year-old patient presents to ED with a facial laceration following a drunken fall. After clearing them from a head injury perspective, you close the wound with six stitches. As you prepare for discharge, you wonder whether advising the use of topical silicone gel could improve cosmetic and symptomatic outcomes of the laceration.

Search Strategy

EMBASE and Ovid MEDLINE(R) ALL databases were searched (1974 to March 2025) using the Ovid interface and the following keyword strategy with no date or language restrictions:

(silicone gel.mp. OR exp Silicone Gels/ OR dermatix.mp.) AND (laceration.mp. OR exp Lacerations/ OR repair.mp. OR suture$.mp. OR exp Sutures/ OR stitch$.mp. OR scar.mp. OR exp Cicatrix/ OR wounds.mp. OR exp ‘’Wounds and Injuries’’/) AND (face.mp. OR exp Face/ OR facial.mp. OR exp Facial Injuries/)

A supplementary search was carried out using the Cochrane database. The Google Scholar ‘cited by’ function was used to find studies that had referenced the papers we identified. The citation lists of relevant papers were screened for any studies missed by our search process.

Search Outcome

Our search identified a total of 44 papers, with no duplicates. After title and abstract review, 34 papers were excluded. An additional 8 papers were excluded after full-text review: one case report and seven were not relevant to the three-part question. They either included patients with wounds on other areas of the body (n=4), or they included patients that had surgical facial scars from scar revision, or mass excision (n=3).

Two randomised controlled trials (RCTs) were included in the final analysis. The key results of these studies are summarised in table 1. The studies all included patients with traumatic facial lacerations requiring suturing. However, one study had missing figures, and attempts to obtain the data from the British Library were unsuccessful due to a recent cyber-attack and we were unable to get the contact details from Research Gate for the author.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Shenoi et al 2024 India	Patients with maxillofacial lacerations sustained from a road traffic accident (RTA) (n=88) Age range: 18- 50 Male (n=48) and female (n=40) Two groups: A –silicone gel twice daily B – no gel Follow up period: 4 months	Single-centre, (RCT) Level 2	Cosmetic outcome of the scar, using the Stony Brooks Scar Evaluation Scale (SBSES)	Better SBSES scores at 7 days, 30 days, 60 days, 90 days and 120 days in group A (p<0.05) compared to group B	Only included lacerations of the maxillofacial region from RTAs. Did not include other facial areas or other mechanisms No patients over 50, a common age group attending ED with facial lacerations. Convenience sampling which is prone to selection bias and is non-generalisable SBSES can be subjective. No mention of how many assessors used or who they were SBSES focuses on objective characteristics. Does not incorporate patient reported symptomatic outcomes SBSES is a binary scoring system which may oversimplify scar assessment and fail to capture subtle variations Patients were not blinded as no placebo gel was used Unclear who performed wound suturing. May not be representative of ED doctors
			Time taken for wound healing	Significant difference in wound appearance from baseline noted from day 30 in group A and only from day 90 in group B (p<0.05)
Nair et al 2020 India	Patients with traumatic facial lacerations presenting within the first two weeks of wound healing (n=52) Age range 12-60 Mean age: 28 Male (n=35) and female (n=17) Three intervention groups: A – silicone gel twice daily B – coconut oil twice daily C – coconut oil in the morning and silicone gel nightly Follow up period: 6 months	Single-centre, RCT Level 2	Cosmetic outcome of the scar, using the Vancouver scar scale (VSS)	VSS score in group A was significantly improved at 1 month compared to group B and C (p<0.05)	No data on baseline characteristics across groups, unclear if they excluded patients with co-morbidities that could affect outcomes 81% of the patients were Fitzpatrick type IV and V Some aspects of the VSS are subjective No data on who is carrying out the VSS or whether they were blinded Unclear whether statistical tests were done to compare the scores achieved on the VAS for pain and pruritus as no p values stated Small sample size and single institution study Attrition bias, as 29.7% of patients did not complete the follow-up
			Pain and pruritus using the visual analogue scale (VAS) reported by patients	VAS showed lower scores with group B compared to group A and C

Comment(s)

The studies in this review suggest that topical silicone gel leads to improved cosmetic outcomes based on characteristics such as pigmentation, height, width and overall appearance if used twice daily for at least once month. Silicone gel also appears to improve scar appearance faster than normal wound care alone. Unfortunately, there is insufficient evidence to comment on whether silicone gel provides any superior symptomatic relief in facial wound healing. Although encouraging, these results should be interpreted with caution as there are significant limitations. Both RCTs are single-centre studies with questionable external validity. One study uses a non-randomised sampling technique and both studies have small sample sizes and a low heterogeneity participant population with regards to skin type and age. Furthermore, although the longest follow-up period was 6 months, scar maturation can continue for years and evidence suggest it is in this period where disturbances can occur, resulting in hypertrophy or keloid scar formation. As such, the long-term benefit of silicone gel in traumatic facial lacerations remains unclear. There is a significant paucity of patient involvement in scar assessments. No reports clearly utilise patient measures of scar appearance or comment on compliance or the feasibility of gel application. Patient adherence plays a crucial role in the success of treatment and application may be more challenging for certain groups of patients. Moreover, both studies failed to report on attrition rates, despite one study highlighting a 30% loss of patients to follow up. It is possible this was greater in the intervention group due to compliance being a challenge. The exact mechanism of silicone gel in reducing scar formulation is not fully understood. It is thought to protect the wound from bacterial invasion, hydrate the wound bed, regulate fibroblasts, and reduce collagen synthesis. While numerous studies analyse silicone gel’s effectiveness on hypertrophic scars and keloids, few focus on the application of it over sutured facial wounds. There is even less literature focusing on traumatic facial lacerations. Many hospital NHS websites recommend silicone gel to improve scar appearances but there are no national recommendations other than recommending the patient to keep the wound clean and dry and monitor for signs of infection. Silicone gel is a low-cost, safe, available and non-invasive intervention, making it a reasonable consideration. Further high-quality, prospective studies focusing specifically on traumatic facial lacerations in a more representative population are needed to provide stronger recommendations. More research comparing silicone gel with other scar management options, such as petroleum jelly or bio-oil, would also be valuable for clinicians and patients.

Clinical Bottom Line

Silicone gel appears to improve cosmetic outcomes of post-traumatic facial scars when used for at least a month. There is minimal data for symptomatic outcomes.

References

1. Shenoi R, Kolte V, Karmarkar J, et al Efficacy of Silicone Gel in Healing of Lacerated Wounds in Maxillofacial Region – An Experimental Study J. Maxillofac. Oral Surg 2024 ;23 :509-516
2. Nair VV, John JR, Sharma RK A prospective randomised comparative study of facial scar modulation using topical silicone gel versus coconut oil Nigerian Journal of Plastic Surgery 2020 ;16(2) :51-60