I love my kid(s), but not my C-section scar

There are many options for dealing with a C-section scar you’re not thrilled with, and the best approach depends on the problem you are having with your scar. We will take a deeper dive into the issues you may be facing and how to deal with them here. Before we get started down that path, however, I’ll point out that a popular sports adage applies to C-section scars as well: “the best defense is a good offense.” Specifically, a great deal can be done at the time of your C-section to improve the quality of the scar that you will end up with. It is not unreasonable to ask your OB if he or she would be open to having a plastic surgeon close your C-section at the end of the procedure. This happens more than you may think, and the difference can be noticeable.

Even with the best C-section closure, however, it is possible to have a scar that you may not like. There are several common characteristics that tend to make a scar problematic. We will address them here:

Red or Purple Scar: Scars can be red or purple due to an over-abundance of blood vessels in the scar tissue. While these colors tend to fade over time, they can be dramatically reduced with laser treatments. Lasers work by targeting and eliminating the blood vessels in the scar tissue, returning the scars to a lighter, less obvious color.

Wide Scar: A wide scar may result for a variety of reasons ranging from surgical technique to the incision being too tight (“under too much tension”) when it is closed. Wide scars can be improved with a minor surgical procedure called a “scar revision.” In this procedure, the old scar is removed, any tension on the wound is relieved as much as possible, and the incision is meticulously closed again using plastic surgery techniques to maximize the chances of achieving a narrow scar.

Uneven Scar: Uneven scars may result from patient anatomy, uneven tension on the wound, or surgical technique. Scar revisions performed for uneven scars focus on providing a meticulous closure that will balance tension on the wound and account for any variations in local anatomy.

High Scar: Sometimes C-section incisions are made higher up on the abdomen than would be aesthetically ideal. In this scenario, we can often perform a scar revision that will actually lower the scar on the abdomen, with the goal of having it be covered by your underwear or bathing suit bottom.

“Shelf”: A “shelf” occurs when the two edges of a C-section scar are not properly aligned, or if your scar heals in such a way that a small pouch of fat hangs over the scar. In the first instance, a minor scar revision can usually be performed that will better align the wound edges. In the second case, a mini-abdominoplasty (more here) may be necessary to address this extra bulge of fat.

In general, scar revisions are minor, reasonably priced procedures with minimal downtime and very gratifying results.

Also, remember that scars continue to change (usually for the better) over time. For this reason, I recommend waiting at least 3 months before trying anything non-surgical and 6 months before trying anything surgical to improve the appearance of a scar.

Why is it ok to try something non-surgical sooner than something surgical? Two reasons: 1) trying to surgically revise a scar prior to 6 months is difficult due to the immaturity of the scar tissue and 2) many scars will improve enough by 6 months that you may not want the surgery any longer. However, if by 6 months after your C-section you are still dissatisfied with the appearance of your scar, it may be worth considering a revision.

Office of Darren M. Smith, MD

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