Objective To investigate the effect of tension-reducing tape combined with silicone dressing (SD) on incision scar improvement in patients undergoing open thyroid surgery. Methods A total of 200 patients undergoing open thyroid surgery admitted to our hospital from January 2024 to January 2025 were selected. According to different postoperative incision management, they were divided into the control group (n=100) and the observation group (n=100). The control group was treated with routine dressing, and the observation group was treated with tension-reducing tape combined with silicone dressing. The incision scar improvement, incision healing, cosmetic satisfaction and complication rate were compared between the two groups. Results The scores of VSS, total score and scar width in the observation group were lower than those in the control group (P<0.05). The incision healing rate in the observation group was better than that in the control group (P<0.05). The cosmetic satisfaction rate in the observation group was better than that in the control group (P<0.05). The incidence of complications in the observation group (10.00%) was lower than that in the control group (28.00%) (P<0.05). Conclusion Tension-reducing tape combined with silicone dressing can effectively improve incision scar formation after open thyroid surgery, promote incision healing, enhance cosmetic satisfaction and achieve good safety.