Many women who have had children by Cesarean have difficulty with their C-section scar after they are no longer having children. Although a Transverse incision, easier to hide, is most commonly used, many patients have had a Vertical incision which is very visible in a Bikini.
Many patients complain of the following problems including:
• Pain-Pain is more common early after surgery. The incision line can become raised, red, itchy and painful. These signs usually start at about 6 weeks after delivery.
• Tethered or Tight Scar-Longer term the incision site can become tight and depressed as the tissues become adherent to the underlying muscle fascia of the abdominal wall.
• A depression in the skin-the incision line can become depressed and if normal fat around the area has been damaged a divot can form deep in the area of the incision which is visible in clothing.
• A pouch or fold of skin on the lower abdomen-Many patients complain that they have a pouch or loose skin fold in their lower tummy after C – section. This is a fold of skin which forms above the transverse incision and is caused by wound contraction. It is called a “trap door” deformity and many patients complain that the tummy pouch or fold can be seen through clothing.
Options for Improving C-section Scars
• Steroid Injection – A painful red raised incision can often be treated with injections of a Corticosteroid solution. Typically 2-3 injections 6 weeks apart are required to reduce the size and redness of the incision line. Long term these injections can cause problems such as Fat Atrophy-the scar becomes depressed. In addition the growth of visible blood vessels on the skin can occur. For this reason we are now using Laser Treatments or IPL Treatments.
• IPL-Intense Pulsed Light- IPL is a light treatment similar to a Laser. IPL is an effective treatment for a red incision. The earlier treatment is started the more effective IPL will be. We can treat red incisions as early as 3-4 weeks and usually 3-4 treatments 6 weeks apart are required.
• 1540 Non ablative Fractional Laser– The 1540 Non ablative Fractional Erbium Laser is effective at smoothing raised or lumpy C-section scars. This is a very new modern treatment that we use frequently. 3-4 sessions 6 weeks apart are usually required.
• Surgical Revision-Simple excision of the old incision line with careful Plastic Surgical Closure can be very effective for many patients.
• Mini Tummy Tuck or Bikini Tuck-Many patients have excess loose skin on the lower abdomen after pregnancy that they cannot tighten no matter how hard they exercise or how long they diet. Patients who have C-section scars usually also complain of a lump or pouch in the lower abdomen that is very distressing, shows through clothing and will not go away with exercise and massage. For these patients a Mini Tummy Tuck or Bikini Tummy Tuck has the benefit of both tightening the tummy and correcting the pouch or lump.
Surgical Revision with Laser Assisted Liposuction– Depressed Vertical C-section scars are often adherent to the underlying muscle fascia and the surrounding fat has been damaged. In these cases, a simple excision and closure results in the area becoming depressed again after revision surgery. One solution is to excise the depressed area and use Laser Assisted Liposuction to reduce excess fat on either side of the C-section scar and break up the adherent tissue before closing the wound.
If you are considering treatment for your C-section scar be sure to discuss it with your Obstetrcian. If you plan to have surgery consult a Plastic Surgeon Certified by the American Board of Plastic Surgery.
Click here to see Before and After Photos of C-section scar correction.