Topical silicone for eyelid surgical scars: a systematic review of efficacy and clinical outcomes

Purpose To evaluate the efficacy and safety of topical silicone for upper blepharoplasty scars and determine whether routine postoperative use is supported by robust evidence.Methods A systematic review of PubMed, Embase, and Cochrane databases was conducted per PRISMA guidelines. Due to the small number of eligible studies (n=3) and severe structural, methodological, and outcome heterogeneity across trials, quantitative meta-analysis was precluded a priori, and a qualitative narrative synthesis was performed.Results Three studies comprising 472 patients (944 eyelids) were included, with findings varying by methodological design. In the high-quality prospective, randomized, double-blinded, split-face RCT, silicone gel showed no clinical superiority over petrolatum ointment (p > 0.05) across 6 months regarding erythema, elevation, pigmentation, or patient satisfaction. The second prospective physician-blinded study demonstrated time-dependent scar resolution across all cohorts, with silicone accelerating contour improvement at 3 months (p = 0.012). Conversely, the retrospective study reported fewer secondary intralesional injections with a multicomponent silicone cream (22.9% vs. 43.9%; p < 0.05); however, these results were severely limited by a high risk of bias, selection confounding, and structural non-comparability.Conclusions Current evidence does not demonstrate clinical superiority of topical silicone over simpler, lower-cost postoperative topical therapies (such as petrolatum) for upper blepharoplasty scars. Favorable periocular tissue dynamics and vascularity render general stratum corneum hydration and occlusion more critical than silicone-specific chemical properties. Standardized prospective randomized trials are required.