Having been through 3 years of Obstetrics training, I have seen, and also created many C-section scars.
Caesarean section scars are one of the most common types of surgical scars.
Other types of surgical scars include Abdominal surgery scars and appendicitis surgery scars.
I will discuss in this article some ways to reduce scarring post-operatively.
What is a Caesarean Section Surgery Scar?
You may want to understand how a scar forms to appreciate why some scars appear the way they do.
When there is an area of injury, the natural healing process involves scar formation. Scarring tissue is composed of the same collagen fibres but lacks elasticity and are of poorer quality as they are typically aligned in a single direction. .
Different type of scars form depending on how and how much collagen is laid down, which is affected by age, gender, skin colour, genetics, size, depth and location of injury.
Different type of scars warrants different treatment
Uneven surfaced scars
An atrophic scar feels like a little grove and this usually presents together with a post-inflammatory hyperpigmentation surrounding the hypo-pigmented scar. To treat such scars, collagen stimulating fillers or agents can be injected into the sunken area and the colour can be improved with pigment lasers such as Nd:yag Q-switched lasers or Pico lasers. Other treatment like fractional RF and Airjet treatments can be used to induce micro-trauma that will promote collagen remodeling.
These are raised scars confined to the boundary of injury. The overproduction of collagen causes the raised scars as a consequent to prolong healing time, wound infection or closure of wound under excessive tension. To treat these scars, ablative lasers, such as Co2 lasers, can be used to smoothen the raised surfaces and make the scars less noticeable.
The worse scar to have and to treat is a keloid scar. A keloid scar grows beyond the boundary of injury and can continue to grow even years after the initial injury. The safest treatment would be steroid injections into and surrounding the edges of the scar. Any other treatment that involves breakage of the skin e.g. in ablative lasers or surgical removal of the scar would be creating a new injury, which may eventually worsen the original appearance.
Depending on the type of scars, the recommended treatment will vary. These treatments can be expensive and usually will require repeated treatments for best results. In the most extreme scenario, one might consider undergoing scar revision, usually by excising the scar or performing plastic surgery techniques, for example in a Z-plasty, that redirect a scar into better alignment to minimize skin tension and repositioning it on a natural skin fold.
Uneven colour scars
When a scar tissue is formed, it can lose some of its normal function – like losing hair follicles, oil secreting glands. The other issue is losing the function of producing the normal colour of the skin. The overproduction of melanin can lead to a hyperpigmented scar and the reverse can result in the hypopigmented scar.
A fractional Co2 laser can be used to hypopigmented scars. It does so by producing multiple zones of microscopic thermal injury, allowing the intact ‘normal’ epidermal and dermal cells to migrate into the zones of damage and promote up-regulation of collagen and melanin production . Latanoprost is also known to cause hyperpigmentation by increasing melanocyte density of the epidermis. The combination to CO2 laser with topical latanprost application in the treatment of hypopigmented scars has been proven to be safe and possibly give a better result.
Treating a hyperpigmented scar – sometimes known as PIH (Post-inflmmatory Hyperpigmentation) has a very different approach. We can try more conservative treatments such as applying topical Vitamin C, antioxidants, retinol, or chemical peels to increase the skin turnover, encourage collagen-remodelling, as well as decreasing the overproduction of melatonin in response to damage or injury. The effects of topical agents usually can only be seen after consistent use over months. Lasers like Pico lasers can be done concurrently to achieve a more synergistic effect. The light energy directly acts on and break down existing melanin. They also enhance the absorption of these topical agents and encourage collagen remodeling by producing microchannels in the skin.
How to minimize C-section scars
You should only start to massage the scar only after the superficial wound has closed and the scab has fallen out. This is typically 2-3 weeks after the operation and you can continue massaging scars up to 2 years. There is very little evidence to support the efficacy of this but this is at no cost, no side effects, and no downtime. What have you got to lose?
Preventing infection is key in the initial stages of wound healing. Especially site of the caesarian can hide in the holds of the skin, which can be moist and conventional confinement practice like no air conditioning can leave the dressing soaking in sweat! This is the best kind of environment that bacteria strive in.
Wound care advice is usually given post-operatively and reinforced in the ward. You should watch out for early signs of wound infection and seek medical attention early. Some of the symptoms include excessive pain around the wound (usually worse with pressure), warmth and redness around the wound, offensive smell, yellowish or greenish discharge.
Dressings and topical silicone
It is common practice that a pressure dressing is applied after C-section to prevent scar dehiscent and minimize tension on the wound. After which, silicon creams and dressing are widely available over the counter at the local pharmacy. Evidence suggests that these silicon dressings are somewhat useful but there is an element of biasness as these studies are funded by the companies producing these dressings. A general consensus would be that moisturizing a scabbed or dried up wound improves wound healing.
Before you decide to start on any treatments, perhaps you may want to consider if this is going to be your last pregnancy. Chances are if you have delivered via C-section before, your following children will be delivered the same way. So you might want to hold it off till your family is completed. If you are planning for your next delivery already, discuss your concerns with your obstetricians so that extra precaution can be taken. For example, in the case of a hypertrophied scar or keloid scar, the scar could be excised and a pressure or silicon bandage can be applied to allow tension-free healing. Some surgeons would even give a prophylactic steroid injection during closure. Research shows that lone excision of keloid scars can have recurrence rate of close to 50%. The chances of a keloid recurrence despite best efforts are high.
Price of C-Section Scar Removal Treatment in Singapore
Price/ Cost of Surgical Scar Removal Treatment starts from $150 for Pico Laser treatment.
Not sure which other treatments you need to lighten your post-surgical scar?