Twenty five consecutive Saudi patients who underwent treatment of hypertrophic scars using Cica-care silicone gel sheets were included. The scars were secondary to burns or traumatic friction injuries. There were 15 females and 10 males with a mean age of nine years. Patients were given detailed instructions in applying and washing the gel and attended a review clinic regularly. At each visit, problems and scar assessment using the Vancouver scale were documented by an experienced occupational therapist. Problems associated with gel sheeting were common and included persistent pruritus (80%), skin breakdown (8%), skin rash (28%), skin maceration (16%), foul smell from the gel (4%), poor durability of the sheet (8%), failure of the sheet to improve hydration of dry scars (52%), poor patient compliance (12%) and poor response of the scar to treatment (24%). Most of these problems were eliminated by temporary interruption of treatment, more frequent washings of the gel sheet, better skin hygiene and occasionally by changing the brand of gel sheets. Permanent discontinuation of treatment occurred in only one patient and was because of lack of response to treatment. The modes of action of silicone gel in the treatment of hypertrophic scars are discussed.