Literature Review for the Highest Clinical Evidence of Common Topical Products Used to Reduce Post Incisional Scars

Literature Review for the Highest Clinical Evidence of Common Topical Products Used to Reduce Post Incisional Scars

A variety of topical products are available to surgeons to address postsurgical scarring; however, a consensus opinion about treatment superiority has not been reached. David B. Hom, MD, Director, Division of Facial Plastic and Reconstructive Surgery at the University of Cincinnati Medical Center, addressed this issue in the most up-to-date literature review recently published in Laryngoscope.¹ Hom adhered the highest clinical evidence, (level 1) investigating the most commonly used agents for scar reduction: silicone gel, paper tape, cyanoacrylates, onion extract (Mederma), and vitamin E. In this paper, the most recent randomized, prospective, and placebo-controlled studies were reviewed.

The article states during early healing of the incision, it should be kept moist, clean, and protected from tension and mobility to encourage epithelial closure. Paper tape and the cyanoacrylates can be applied at this time. After the incision has closed, a scar topical product such as silicone gel can be applied. This review found that silicone gel, paper tape, and cyanoacrylates were beneficial to reduce scarring.

However, the efficacy of other frequently used agents is not supported by level 1 clinical evidence to date. Onion extract gel (Mederma) and Vitamin E, both popular postsurgical scar treatments, did not show improvement in scarring in double-blinded studies. Further investigations are warranted in the treatment duration of these products.

The following table summarizes the findings of the contemporary review using the highest level of evidence (level 1) regarding these products.

Most studies have investigated single product ingredients. However, since most products contain a combination of ingredients, future studies should be undertaken to identify their combined effects as a whole. Hom stresses that a set of clear, consistent objective criteria is needed to evaluate scars in terms of width, thickness, contour, and color, as scar maturity occurs over six months.

Hypertrophic scar on the lower lip and chin. A scar revision was performed followed by application of paper tape for three months. Postoperative photo of the area with no makeup 12 months later.

This is a significant area of interest for Hom, as he is currently co-editing a multidisciplinary book on facial scar treatment with Dr. Regan Thomas from Chicago. This topic is a natural progression from his previous book, Essential Tissue Healing of the Face and Neck, which was favorably reviewed by the Journal of the American Medical Association.²

Scar reduction techniques are likely to evolve in the future, with the administration of cytokines prophylactically prior to surgery showing promise. Hom describes the potential for the treatment: “This would be similar to what we currently do with antibiotics in patients in clean-contaminated cases by administering antibiotics prior to surgery in order to reduce infection. In a similar scenario, the administration of TGF beta-3 given preoperatively may reduce postsurgical scarring from developing in patients who are at higher risk for scarring.”

David B. Hom, MD
Professor of Otolaryngology
Director, Division of Facial Plastic and Reconstructive Surgery
Medical School: University of California Los Angeles
(513) 319-0983
homdb@ucmail.uc.edu