How To Improve The Appearance Of A C-Section Scar
Many women wear the scar left behind by their cesarean section as a badge of honor — if only I were one of them! Mine makes me feel disfigured. After three c-sections, my scar is wider on one side than the other. It is also so indented that it looks like it’s stuck to the abdominal muscles underneath, which causes flesh to bulge above and below. Needless to say, it's not ideal.
While c-section scars usually involve a horizontal incision that is approximately five inches wide, the generalizations end there. "The overall appearance of the scar is dependent on a number of factors, including how skilled the surgeon is at sewing the incision closed, how many layers of sutures are used, and your genetics," says Richard J. Brown, MD, a board certified cosmetic plastic surgeon in Scottsdale, Arizona, and author of The Real Beauty Bible. "Some people just scar better than others."
It’s not uncommon for c-section scars to go a bit rogue during the healing process. Some women have redness or puckering at the incision site. Others may experience indented scars. Hypertrophic (a.k.a. raised) scars are also possible, as are keloid scars, which are similar to their hypertrophic counterparts except for the fact that they spread outside the confines of the original wound.
So, what are your options if you are unhappy with the mark you c-section(s) left behind?
If you don’t like your scar and are planning to have more kids, you can hire a plastic surgeon to come to your next cesarean delivery and close the new incision (yes, this is really a thing). Plastic surgeons are nothing if not meticulous sewers, and, most importantly, they close in layers.
In the case of a c-section incision, a plastic surgeon would begin by stitching the Scarpa's fascia (i.e. the type of fascia surrounding the abdominal wall) because the connective tissue has a high degree of tensile strength. By closing the fascia tightly and securely, it relieves tension on the above skin edges and helps to prevent scarring.
“I close the Scarpa’s fascia first, then the deep dermal layers, and then do the subcuticular closure on the top layer of skin," says Dr. Brown. But the expertise comes at a price. Plastic surgeons can charge anywhere from $3,000 to $5,000 for the suturing.
Since I don’t plan on having more kids, I have been talking to dermatologists and plastic surgeons about how to improve the appearance of my wonky scar. One thing to keep in mind before choosing a c-section scar treatment: timing.
If you just had a baby a few months ago, you likely want to give your body some time to heal (that is, unless you are showing signs of infection). "The common belief is that it can take one to one and a half years to see a more finalized appearance of a scar," says Gregory A. Buford, MD, a board certified plastic surgeon in Englewood, Colorado. "During that time, many patients will see early changes to their scars (redness, protrusion, itching, etc.), which then often improve over time."
But if you, like me, have been dealing with your scar defect for years, there are surgical and non-surgical procedures to improve its appearance — or remove it altogether.
Microneedling with Platelet-Rich Plasma (PRP)
Ever heard of the celeb-fave "vampire facial"? Well, consider this the c-section scar edition.
Microneedling alone involves using a handheld roller device covered in tiny needles (a.k.a. a derma roller) to make microscopic punctures in the skin. The process stimulates new collagen production, which, in turn, can improve the appearance and texture of a scar. While the treatment is most often associated with anti-aging, Dr. Buford says it can be helpful for scars as well.
Adding platelet-rich plasma to the mix further ups the ante. According to a study in the Journal of Cutaneous and Aesthetic Surgery, coupling PRP with microneedling intensifies the body's natural wound healing process by delivering concentrations of the person’s own growth factors to the site.
The treatment begins with a dermatologist or plastic surgeon collecting five to 15 milliliters of blood from a patient's arm before putting the sample into a centrifuge to isolate the platelets and create the PRP concentration. After numbing and microneedling the affected area, the practitioner will massage the blend into the skin so that it can penetrate the micro-punctures.
There’s minimal downtime — aside from a few days of minor bruising or inflammation — but three to six sessions (at around $500 each) are needed to see results.
If you are dealing with a hypertrophic or keloid scar, a dermatologist can shrink the mark by injecting it with a corticosteroid solution. Steroids break up the bonds between collagen fibers, which reduces the amount of scar tissue below the skin, and they also act as anti-inflammatories to help minimize swelling, redness, itching, and tenderness.
“These injections can be given every four weeks," says Dr. Brown, who notes that the shots can weaken the skin or potentially cause fat necrosis (i.e. lumps of damaged tissue) if not administered properly.
The upside? Each session is quick — usually lasting no more than 15 minutes — and costs about $50.
Lasers are another non-invasive option for improving the appearance of scars. “Pulsed dye lasers or light sources like IPL (intense pulsed light) can often be used successfully during the early healing period to reduce and potentially eliminate scar redness,” says Dr. Buford.
A pulsed-dye laser, for instance, uses a yellow light to fade redness and flatten raised scars. IPL, meanwhile, is commonly used to treat sun-damaged skin and is believed to work on scars by targeting the blood vessel proliferation associated with collagen overgrowth during the healing process.
In a study by Aesthetic Plastic Surgery, 109 participants with hypertrophic scars from various causes (including surgery) were given IPL treatments in two- to four-week intervals. A reduction of scar redness, height, and hardness was seen in nearly all the patients (92.5 percent), and over half of the participants had “good” to “excellent” improvement.
The number of laser treatments for a c-section scar varies, but Dr. Buford says “you usually need anywhere from two to six sessions for maximum effect.” Series range from $1,500 to $5,000.
C-Section Revision Surgery
If your c-section scar isn’t responding to other treatments, is indented like mine, or has a shelf of skin hanging over it (which is common), your best bet may be to have the scar cut out so the skin can re-heal. And, while it may sound intense, a c-section scar revision surgery isn’t nearly as painful or debilitating as a c-section itself.
Unlike a cesarean section, the corrective procedure doesn't involve the abdominal muscles or uterine wall. Instead, just the skin and tissue are snipped, which is a much less invasive process (especially when you consider that the body has already had time to recover from pregnancy).
"The challenge with the initial closure of a c-section scar is that the tissue itself has been stretched and is swollen when the closure is performed," says Dr. Buford. "Revising the scar at a later date allows us, as plastic surgeons, to operate on tissue that is now relaxed and more optimally positioned to create a nicer result."
To fix a shelf issue, Dr. Buford performs a "full thickness excision of the scar" that he extends to cover a greater area by converting it into an ellipse-like shape. "By doing this, I am removing not only the scar itself but also some of the lax skin around it," he says. "This can provide not only a nicer appearance to the final scar but also tightening of the midline abdominal skin. Who has ever complained about a flat, tight abdomen?"
Removing the whole scar (including the tissue underneath) in an ellipsis shape can also fix indentation issues by reducing the tethering (caused by scar tissue) that is pulling the scar inwards. “It allows skin edges above and below the incision to come together in a more even manner,” says Dr. Buford.
In case you needed further proof that the revision surgery is nothing like an actual c-section: It's an outpatient procedure done under local anesthesia that will have you back at work the next day (though you can’t engage in strenuous exercise for six weeks). “By six weeks, a scar has reached 80 percent strength,” says Dr. Brown.
The cost for an in-office scar revision is generally between $500 and $1,000, but it can vary widely depending on the size and condition of the scar. It should also be noted that, in cases of extreme tethering, the plastic surgeon may have to cut down to the top of the muscle to release it, and the invasiveness could require an operating room and general anesthesia.