Purpose <p>Postoperative scars in the head and neck region can significantly impact aesthetics and patient self-esteem. Silicone gel has been shown to improve scar quality, but evidence specific to this anatomical region is limited. This study aimed to evaluate the efficacy of silicone gel in improving scar outcomes in head and neck skin wounds.</p> Methods <p>A randomised, placebo-controlled study was conducted on 19 patients with head and neck skin wounds- incisions/Lacerations with minimum of two. Both scars of each patient were randomly allocated into two groups: the study group received topical silicone gel application, while the control group received a placebo gel. Scars were evaluated at 10, 30 and 90 days postoperatively using the modified Vancouver Scar Scale (mVSS). Statistical analyses were conceptually revised to reflect paired data design. Within-subject comparisons were analysed using paired ordinal methods and mixed-effects modelling, accounting for repeated measures. A <i>p</i>-value &lt; 0.05 was considered statistically significant.</p> Results <p>Silicone gel application resulted in statistically and clinically significant improvements in pigmentation, vascularity, pliability, and height scores compared to placebo, with higher patient satisfaction and no adverse effects. Blinded evaluation minimized detection bias, and analysis respecting within-patient design confirmed treatment efficacy. No adverse reactions were reported.</p> Conclusion <p>Topical silicone gel application being the most non-invasive modality, significantly improves scar quality in head and neck skin wounds. Early postoperative use is recommended to optimize aesthetic outcomes.</p>