Treating caesarean section scars

Named after Julius Caesar, who was said to be one of the first to be delivered this way, the invasive Caesarean section (or C-section) technique has been around for centuries, in which time technology and medical advancement have made them far safer and considerably less traumatic to the mother’s body.

So much so that the C-section has also become an option for mothers who may not want to give birth naturally for various reasons. According to data from NHS Maternity Statistics, in the UK between 2018 and 2019, 52% of deliveries were spontaneous vaginal births, 11% had instrumental assistance, 15% were elective C-sections and 19% were emergencies.

Still, the scar left after delivery, whether elective or emergency, can come with a host of impacts while healing, both physical and mental.

“The scar may be seen as a constant reminder of the surgery, even though the event had a happy outcome (the baby). If the mother feels the scar is unsightly, she may be embarrassed or unhappy about undressing in front of her partner,” says Rachel Myers, senior aesthetician at 111 Harley St, London.

“The very nature of caesarean surgery can be traumatic for an individual, particularly if performed as an emergency procedure,” agrees Dr John Quinn, founder and clinical director at Bristol-based Quinn Clinics. “The remaining scar can be a visible reminder of the trauma experienced and can amplify the distress suffered.”

Lenka Anthony, a clinic aesthetician working out of Tempus Belgravia in London, believes there has been a mental shift in how patients feel about pregnancy scars, with the rise in influencers doing more about empowering women and their bodies postpartum.

“However treatment is still popular for patients that want to see an improvement, to feel more like themselves,” she says.

The problem with caesarean scarring

Aside from any psychological or confidence issues that C-section scarring may cause, there are many physical and health reasons to work on these scars.

“Everybody heals differently and the body doesn't always heal as it should. Poor wound healing can happen because of genetics or an underlying medical condition,” says Myers. “For example, diabetes or obesity can affect wound healing. This can lead to uneven healing or cause the incision to separate and open instead of joining together.”

The location of caesarean scars is also problematic, as finding something to wear – even underwear – while the scar is still healing can be tough.

“Friction can cause inflammation very quickly, causing unpleasantness in both the appearance and feeling of the scar,” explains France-based LPG expert and physiotherapist Natalie Paradis.

“Medically speaking, everybody agrees after two years nothing much else will happen,” Paradis continues on of the life cycle of a scar.

“But, in those two years, you could get a keloid or hypertrophic scar… You can have adherence and inflammation which can be very painful… Often the problem with C-section scars is adherence,” she continues.

“To deliver a baby from the uterus, C-section surgery cuts right through the dermis, hypodermis and muscles. After stitches, everything can become glued together, causing tugging and pulling. This is adherence and it can cause a lot of pain. With any scar, there is what you see on the surface, but there is also what you don't see underneath.

“Adherence can go to organs… it's like a web of fibres. Being so deep, fibrosis of C-section scars can grow to the uterus, around to the bladder or even all the way back to the rectum, creating a lot of dysfunction like pain, constipation, incontinence, urinary infections and sexual issues."

The incidence of adhesion development after a first C-section varies from 46 to 65%, according to research, with adhesions becoming particularly thick and dense after several procedures.

The fibrosis, scar and procedure itself can also really impact the body’s circulation and lymphatic system causing bloating, swelling, weight gain, cellulite and fluid retention, not just in the stomach but in the legs and other areas too.

“I always ask women who come in wanting a solution for cellulite or weight gain if they have had a cesarean,” she continues. “Women often have no idea how much it can affect other areas of their health.”

“Due to the build-up of scar tissue sticking to muscles or organs, some women experience symptoms related to their C-section scar long after the operation and can feel pain, restriction, or a pulling sensation on or around their scar months or even years after surgery,” says Myers.

The caesarean pooch

A C-section pouch or "pooch" refers to the extra skin or fat that gathers at the bikini incision line after the procedure and tends to be resistant to diet and exercise, which can be very frustrating.

“It’s caused by scar tissue left behind by your C-section scar,” says Myers. “In some cases, the way your body recovers after surgery can cause excess fat to find itself in your lower belly area.”

A pooch occurs when the C-section scar is anchored down to the core abdominal muscles. That makes the stretched-out skin of the belly and the fat above it more noticeable. When the layer of fat between the skin and the muscle is disrupted during the surgery, the scar is not able to move freely. As a result, the pooch or bulging belly appears.

“Women will come in after their C-section with a little ‘double belly’ that they want to get rid of but that is just the adherence,” says Paradis. “It is like an anchor pulling everything down… remove the anchor and the pouch disappears.”

Surgical treatment is widely used to treat the adhesion of C-section scars and consists of cutting the scar along the original incision and releasing the adhesions between the subcutaneous fat and the abdominal wall muscle. However, these surgical treatments lead to a very high incidence of new adhesions and the formation of new scars.

Treatments for improving caesarean scars

Massage

Our experts recommend that the first thing to begin healing a caesarean scar is the use of silicone gel patches. Then, Paradis says that avoiding or undoing the adherence of the caesarean scar is important to free the mobility of the joints, organs and skin.

In France, the treatment of any caesarean scarring is built into a mother’s pregnancy plan.

“You usually have 10 sessions with a physio as part of a post-care programme,” explains Paradis. This can include anything from improving the strength of the pelvic floor or the massage of caesarean scars.

Self-massage is often recommended to mothers after a C-section scar is well on the way to healing.” This may disrupt the fibrotic tissue and increase the pliability of the scar,” says Myers.

This should use comfortable pressure to move the scar but should not be painful. Gently massaging and applying pressure to the scar itself and the area around it will help loosen any scarring or fibrosis from the tissue.

Mechanical massage

As a physiotherapist, Paradis swears by LPG medical endermologie technology for breaking down fibrosis and improving lymphatic flow and healing.

Mechanical lipo-massage, or endomassage technology, harnessed by devices like LPG’s Endermologie, uses motorised rollers to grip and knead the skin for a massage deep in the tissue that helps to stimulate circulation and collagen production and reduce adipose tissue.

It targets the connective tissues, including skin, muscle, blood and lymphatic circulation, working to reactivate stagnant cellular activity below the skin’s surface and improve the appearance of cellulite, skin tone and scarring.

“The device can do much more than what the hands could do alone. With this technology, there are many health benefits on top of improving the appearance of a scar – it works much deeper,” she says.

LPG offers a non-invasive approach to treating recent or old scars, thanks to a painless mobilisation of tissues. “It's never too late to do something about it,” says Paradis. “Even 15 years after a C-section, you can still improve and break down that adherence non-invasively.”

Despite this, Paradis says earlier intervention is better, ideally once the wound has healed enough so that it is longer inflamed. It should be noted that the use of Endermologie for C-section scars requires specialist training.

Radiofrequency micro-needling for caesarean scarring

“Scars and stretch marks created in the last six months respond well to laser treatments and especially well to micro-needling and radiofrequency,” says Myers, who uses radiofrequency micro-needling (RFM) device Potenza to treat scars and stretch marks.

“Combining both technologies ensures minimal downtime and the best results,” she says, adding that, ideally, women should treat their C-section scar within six to eight weeks with several treatments spaced out at a minimum of four weeks.

“Everyone’s scars are different, some with hyperpigmentation around them and some without. We aim to make the scar as thin as possible without any pigmentation around it that draws attention to it.

Scars are compact collagen from the body’s natural healing process protecting itself. The idea is to stimulate more elastin in the area and tighten the scar by stimulating it with fine needles and radiofrequency. It is a fast procedure, which is important for new mums”

Treating caesarean scars with laser

“There are various treatment modalities available, but in my opinion laser scar therapy is one of the most effective non-invasive ways to treat and improve the appearance of c-section scars to address skin texture and pigment as well as functional aspects,” explains Quinn.

“Ablative laser resurfacing has been proven to effectively treat scars and provide consistent and significant functional improvement as well as measurable cosmetic benefits. Fractional skin resurfacing is also proven to be effective on some surgical scarring and can effectively treat textural and pigment concerns.”

Ablative lasers generate beams of coherent light that the body’s tissue absorbs as energy. The energy is delivered through a narrow range of wavelengths, and in the target area, the energy causes temperature elevation, resulting in tissue evaporation or ablation.

The body’s natural healing processes then replace the damaged skin with new and healthy tissue.

“Although several types of ablative laser exist, differing mainly by wavelength, CO2 lasers have long been considered the industry’s ‘gold standard’ for ablation, delivering an exceptional ratio between ablation and coagulation (heating tissue without evaporating it),” continues Quinn, who uses the Lumenis Stellar M22 ResurFX fractional non-ablative device to significantly improve scar appearance.

Cryotherapy for C-section scars

Anthony says that the bottom line is that the correct treatment of a C-section scar varies from patient to patient however at Tempus Belgravia she typically would start the cesarean scar treatment journey with the Gelida Cryo 21 device to aid the removal of any additional adipose tissue around the scar itself. "This treatment will also help to tighten the area which will both lift the skin around the scar as well as help to improve the appearance of the scar itself," she says.

"I think it is amazing that we have this month of awareness for mothers who have had a C-section... the scar is not just an issue of aesthetics," concludes Paradis who hopes for increased education and understanding around the health impacts of the procedure that can be greatly improved with non-invasive intervention.