Types of C-section incisions
During a C-section, your doctor makes two incisions. The first is through the skin of your lower abdomen, about an inch or two above your pubic hair line. The second is into the uterus, which is where the doctor will reach in to deliver your baby.
The type of cut on your abdomen may not be the same as the one on your uterus. Each will be either:
. Horizontal. A low-transverse incision (or a “bikini cut”) is used in 95 percent of C-sections today. That’s because it’s done across the lowest part of the uterus, which is thinner — meaning less bleeding. It’s also less likely to split if you try to have a vaginal birth after a C-section (VBAC) when delivering a future baby.
. Vertical. Also known as a “classical” C-section, this cut is down the middle of the abdomen, usually from below the navel to the pubic hair line. It used to be common, but now is typically only reserved for certain situations. For example, it may be done if you already have a scar there from a previous surgery, if the baby is nestled low in your uterus or in another unusual position, or if an emergency requires immediate delivery. Vertical incisions may be slightly more painful and take a little more time to heal.
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About Iranian Surgery
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How C-section incisions are closed?
The incision on the uterus is always closed with dissolvable stitches, but the one on your skin may be closed in one of three ways:
. Staples. Your doctor uses a skin stapler to close the incision with metal staples — a popular choice because it’s the easiest and quickest option.
. Stitches. Using needle and thread, your doctor sews the incision together. While this method takes a little more time (about 30 minutes), some experts believe it could be a better option. Some research suggests that women whose C-section incisions are closed with stitches may be significantly less likely to develop wound complications than those whose incisions are closed with staples.
. Glue. Surgical glue seals the skin (no worries, it won’t wash away), which is then topped with a transparent dressing. Some experts say that glue heals fastest and leaves the finest, least visible scar. But it’s not always an option. Doctors can use glue depending on several factors, including how the C-section went, whether you had a horizontal incision, and the consistency of your abdominal skin and fat.
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Types of C-section scars
Most times, C-section scars heal properly. But sometimes your body’s healing process goes into overdrive, which can lead to problems with scarring — especially if you’re younger (under 30) and have darker skin. The issues that could crop up include:
. Keloid. A keloid scar occurs when scar tissue extends beyond the original boundaries of the wound, possibly resulting in lumps of scar tissue around the incision.
. Hypertrophic scar. A hypertrophic scar is thicker, firmer and usually more raised than a normal scar — but unlike a keloid, it stays within the borders of its original incision line.
Helping a C-section scar heal
Following these common-sense tips will help your C-section scar heal better:
. Keep it clean. Once a day (when you shower), let soapy water drip down your wound. There’s no need to waterproof it, and you should avoid vigorous scrubbing. When you’re done, gently pat the area dry with a clean towel.
It might be possible to use ointment and cover your scar. Some doctors say it’s okay to apply a topical antibiotic or petroleum jelly and cover the wound lightly with a bandage; others say it’s better to apply nothing and leave the wound uncovered. Talk to your doctor about which is best for your scar.
. Air it out. Air promotes healing in skin injuries, so whenever possible, expose your scar to air. That doesn't mean you have to walk around half-naked — wearing a loose gown at night is enough to get the air circulating.
. Keep your appointments. If your incision was closed with stitches that don’t dissolve, be sure to go to your follow-up postnatal appointments so your doctor can remove them. Leaving the stitches in for longer than recommended can lead to a funky-looking scar. We recommend that the first postpartum doctor's check-in happens within three weeks of giving birth instead of four to six as previous guidelines suggested, with another comprehensive checkup within 12 weeks of delivery. For C-section births, the timing and frequency of your doctor's visits might be different, so talk to your practitioner about when to come in after having the baby.
. Hold off on exercise. You need to take it easy to allow the scars on your uterus and your abdomen to heal. So avoid bending or twisting your body or making sudden movements as much as possible, and don’t pick up anything heavier than your baby. Get the okay from your doctor before resuming exercise.
. Get moving. Just because you can’t train for a marathon right now doesn’t mean you can’t stay active. Increased blood flow, in fact, helps healing and decreases your chances of developing deep venous thrombosis, or DVT (a blood clot that’s more common during pregnancy and the postpartum period). As soon as you feel up to it, pop baby in that stroller and take a walk around your neighborhood.
Signs of C-section scar infection: when to see your doctor
If you experience any of the following symptoms, contact your doctor immediately:
. Redness or swelling of the incision or skin surrounding it
. Fever higher than 100.4 Fahrenheit
. Oozing or drainage from the incision site
. Foul smell from the area
. The wound becomes hard or you feel increasing pain around the wound
. Pain or tenderness in a specific spot of the incision (note that while some pain is normal for the first few weeks, it should be generalized — not pain that you pinpoint to a specific spot)
. Your incision splits open
How to minimize C-section scarring
By two weeks, your scar should look and feel much better. That said, it can take anywhere from six weeks to three months before you’re fully healed.
Though the C-section scar will fade on its own over time, a few simple tricks can help improve its appearance:
. Silicone sheeting. It’s unknown exactly how silicone sheeting works to improve scars, but some research has shown that it may help soften and flatten scars, especially if you have a tendency to form keloids or hypertrophic scars. Silicone sheeting can begin three or four weeks after your C-section (ask your doctor); you may see results in a month (though you might need to use them longer for more aggressive scars).
. Silicone gels and creams. Silicone gels and creams serve the same purpose as silicone sheets. Again, always ask your doctor before trying any treatment for your scar.
. Limit sun exposure. Sunlight can cause a scar to be more noticeable by making it darker or lighter than the surrounding skin, so try to keep it out of direct sunlight for the first year and apply sunscreen thereafter.
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C-section scar treatment options
Maybe your scar didn’t heal like you thought it would, or maybe you just want it gone. While there’s no way to erase a scar completely, there are a few options that can improve its look and feel.
With these procedures, there’s not a long waiting period before you can get started:
. Laser therapy. Some lasers can remove discoloration, while others help soften the texture. You can begin once any stitches are removed from your C-section (and your doctor clears you) — and you’ll likely have a better outcome if you get laser therapy sooner rather than later. Consult a dermatologist or plastic surgeon, you might need between one and four treatments before the scar reaches its final look.
. Steroid injections. For more aggressive scars (those that have formed keloids or become hypertrophic), an injection of a long-acting steroid can reduce inflammation and help the scar to flatten and become less noticeable. Your doctor can inject the incision site at the time of your C-section to (hopefully) prevent hypertrophic or keloid scarring. If you have already had your C-section, you can get your first injection as soon as the scar heals. You’ll need to get injections monthly for anywhere from three to six months, depending on the severity of the scar.
Because a scar’s appearance may improve, doctors generally won’t do any repairs before six to 12 months after a C-section. If you’re still interested in surgical options then, talk to your doctor about whether any of the following options could work for you:
. Scar revision. With this procedure, a surgeon removes the skin around scar completely and then, with precision, sutures the new wound — leaving a thinner and less visible scar. A scar revision may help if your C-section scar is wide or has thickened, if you’ve formed a keloid or hypertrophic scar, or if you simply don’t like it and want something less noticeable. Removal of the scarred tissue and reclosure may be covered by insurance on a case-by-case basis. The cost of scar revision depends on the length of the scar and whether it can be done with local anesthesia or if it requires sedation.
. Tummy tuck. If you have excess, loose skin on your stomach, an abdominoplasty might be worth considering. During the procedure, a surgeon cuts away extra fat and skin (including the C-section scar) and carefully stitches the incision together. This probably isn’t a good choice if your C-section scar is small, since a tummy tuck scar is typically longer. But if your scar really bothers you (is large, discolored, raised, etc.), a tummy tuck could be right for you. Costs vary widely depending on where you live and whether you need a mini-abdominoplasty versus a full abdominoplasty, as well as whether you're also getting liposuction.