Posted On May 04, 2023.

Caesarean section, also known as C-section, is one of the most common and vital surgical procedures, helping to prevent maternal and neonatal mortality when a vaginal delivery would put the baby or mother at risk.

Named after Julius Caesar, who was said to be one of the first to be delivered this way, this invasive 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 caesarean has also become an option for mothers who may not want to give birth naturally for various reasons. In the UK between 2018 and 2019, 52% of deliveries were spontaneous vaginal births, 11% had instrumental assistance, 15% were elective caesarean sections and 19% were emergency caesarean sections...

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. 

“The very nature of caesarean surgery can be traumatic for an individual, particularly if performed as an emergency procedure,”

 “The remaining scar can be a visible reminder of the trauma experienced and can amplify the distress suffered.”

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, in order to feel more like themselves.

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, 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 really tough.

“Friction can cause inflammation very quickly, causing unpleasantness in both the appearance and feeling of the scar. 

The fibrosis, scar and procedure itself can also really impact the body’s circulation and lymphatic system, 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. 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. 

The caesarean pouch/pooch

A C-section pouch or "pooch" refers to the extra skin or fat that gathers at the bikini incision line after a C-section 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, 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,” It is like an anchor pulling everything down… remove the anchor and the pouch disappears.”

Surgical treatment is widely used to treat 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 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.

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. 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. 

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

breaking down fibrosis tissue and improving lymphatic flow and healing.

Mechanical lipo-massage or endomassage technology, 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. 

Radiofrequency microneedling for caesarian scarring

“Scars and stretch marks created in the last six months respond well to laser treatments and especially well to microneedling and radiofrequency, 

“Combining both technologies ensures minimal downtime and the best results,” adding that, ideally, women should treat their C-section scar within 6-8 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 caesarian 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. 

“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

The bottom line is that the correct treatment of a C-section scar varies from patient to patient. 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”