Whether performed under emergency or elective circumstances, a cesarean section (or “C-section”) delivery can sometimes result in an unsightly scar along the lower abdomen.
Tethering of underlying scar tissue or poor alignment of abdominal tissue layers can sometimes lead to deep creases and step-offs that may be visible even through clothing.
Increased skin laxity and weight fluctuation that occur naturally with age may make the scar deformities more pronounced over time. A C-section scar revision removes the old C-section scar and addresses any contour irregularity with a simple outpatient procedure, which may be performed either awake or under anesthesia.
The procedure involves removal of all scar tissue and precise repair of tissue layers one by one to create a smooth natural lower abdominal contour. The resulting incision remains low along the bikini line, without the creasing and step-offs that may have been previously visible even through clothing.
The procedure may be easily combined with a mini tummy tuck to address skin laxity along the lower abdomen. Both procedures may be performed while awake and do not involve placement of drains.
The recovery is speedy, with most patients returning to work within a couple of days. Performing the procedure while awake also reduces recovery time and mitigates risks associated with anesthesia. If you are unsatisfied with the appearance of your C-section scar, please schedule a complementary consultation to discuss your options!
What Is a C-Section Scar Revision?
A C-section scar revision addressesvisible contour irregularities along the lower abdomen stemming from previous C-section deliveries.
A common finding among C-section scars is a step-off, often due to poor alignment of underlying abdominal tissue layers. Some C-section scars also have significant underlying scar tissue that tethers the scar deep toward the abdominal musculature and creates a visible crease.
These effects tend to become more pronounced over time, as skin and tissue laxity further push down on the scar. Thankfully, all of these concerns can often be addressed with a simple outpatient procedure, often performed while awake.
A C-section scar revision excises the old scar and underlying scar tissue, and artfully reapproximates all tissue layers to correct any contour irregularities.
Where Is the Incision Placed for C-Section Scar Revision?
The final incision after C-section scar revision will be minimally longer than the original C-section scar, in approximately the same location along the lower abdomen. This ensures that all surrounding scar tissue is thoroughly removed.
The resulting scar hides beautifully within the bikini line and avoids the contour irregularity that may have been previously visible. When combined with a mini tummy tuck, the incision may be somewhat longer, depending on how much lower abdominal skin is being removed; in general, the more skin we remove, the longer the incision would need to be for that procedure.
C-Section Scar Revision or Mini Tummy Tuck?
C-section scar revision and abdominoplasty (“tummy tuck”) are very complementary procedures that are frequently combined. Both a C-section scar revision and mini-abdominoplasty (“mini tummy tuck”) may be performed while awake and generally do not involve any drains after the procedure.
The primary difference is in the extent of skin laxity addressed along the lower abdomen. A mini tummy tuck involves removal of excess skin from the lower abdomen, in addition to repairing the C-section scar.
This frequently results in a slightly longer incision, although it remains hidden within the bikini line. There are no other incisions (such as around the belly h4) for either procedure.
A full abdominoplasty (“tummy tuck”) is a perfect option to address greater degrees of skin laxity, particularly along the upper abdomen.
It also allows Dr. Kachniarz to repair any muscle separation (“diastasis”) and narrow your waistline. Most tummy tucks will involve placement of drains to minimize the risk of infection and fluid build up under the skin.
The drains generally are removed in clinic after 1-2 weeks. Another difference is that a tummy tuck may also involve an additional incision hidden within the belly h4, and is usually performed under general anesthesia.
Overall, the decision between C-section-scar revision, mini tummy tuck, and tummy tuck will depend on your individual anatomy and aesthetic goals. Each procedure entails its set of pros and cons, which will be thoroughly discussed at your surgical consultation with Dr. Kachniarz.
What Causes C-Section Scar Step-Offs?
Several different factors contribute to the unsightly appearance of C-section scars, and a thorough understanding of anatomy is imperative in addressing all of them correctly. Common causes of contour irregularities along C-section scars include:
- Scar tethering that pulls the skin deep towards the muscle
- Misalignment of the different tissue layers within the abdomen
- Natural changes that occur with aging, including weight fluctuations and tissue laxity
During C-section delivery, various tissue layers, including skin, fat and fascia, are incised and closed within a single line. This leads to aligned areas of scarring within the different tissue layers, from skin all the way down to the muscle.
Scar Tethering
As the original incision heals, the underlying scar tissue retracts and pulls the skin down toward the abdominal musculature. This process results in a tethered scar with a deep visible crease, which may be notable even through clothing.
Misalignment
Secondly, it is important to note that the abdomen has a number of distinct tissue layers, including the skin, deep and superficial fascia layers, as well as several distinct layers of fatty tissue.
On occasion, the different layers may not be aligned precisely during C-section incision closure, resulting in a visible step-off as the area heals. Although the various tissue layers may appear difficult to distinguish to the untrained eye, plastic surgeons are trained to identify and repair them one by one with precision.
Natural Changes
Finally, the imperfections stemming from scar tissue tethering and step-offs may become more pronounced over time due to natural changes in the tissues with aging. As we age, both the skin and underlying tissues develop a degree of laxity.
This may lead to decent of the lower abdominal skin over the C-section scar, making it more pronounced. Weight fluctuations, such as weight gain along the lower abdomen, may also exacerbate any step-offs along the scar.
The Solution
Overall, a nuanced understanding of these processes and abdominal tissue anatomy is imperative in addressing contour irregularities stemming from prior C-section deliveries.
During your revision procedure, Dr. Kachniarz will excise the old incision with its underlying scar tissue, and precisely reapproximate the abdominal tissues to correct any contour irregularities.
The procedure may be easily combined with a mini tummy tuck or full tummy tuck to address any skin laxity, stretch marks, or muscle separation (“diastasis”). Schedule your free consultation to discuss all of your options with Dr. Kachniarz.
Who Is a Good Candidate?
You may be a good candidate for C-section scar revision if you previously had a C-section delivery and are unsatisfied with the appearance of your scar. Ideal candidates will have either tethering/creasing of their scar, a visible step-off, or other deformity that may be addressed with the revision.
Patients with excess lower abdominal skin may be great candidates for combining the scar revision with a mini tummy tuck or full tummy tuck. You will discuss all of your options during your surgical consultation.
Patients who prefer to undergo the procedure under anesthesia will also need to be healthy enough for general anesthesia. A preoperative clearance with basic bloodwork is generally required in preparation for anesthesia as a safety precaution.
How Much Does a C-Section Scar Revision Cost in Miami?
C-section scar revision in Miami costs approximately $2,000 – $5,000. This includes all related costs, including surgeon fees, anesthesia fees, and facility fees.
A C-section scar revision may sometimes be combined with a mini tummy tuck to address lower abdominal skin laxity; the combination procedure costs approximately $6,000.
Possible Risks
C-section scar revision is a very safe outpatient procedure, generally performed with numbing medicine while awake. Although very rare, there are potential risks of any procedure that patients should thoroughly understand.
Possible risks of revising a C-section scar include:
- infection
- pain
- bleeding
- scarring or recurrence of contour irregularity
- possible need for additional revision surgery
Dr. Kachniarz will discuss risks and benefits of any procedure during your consultation visit.
What To Expect on the Day of Surgery?
All C-section scar revisions are performed at an accredited ambulatory surgical facility. It may be performed under either local anesthesia (awake with numbing medicine), or under anesthesia, depending on your preferences. The procedure itself takes approximately one hour.
During the procedure, Dr. Kachniarz with carefully excise the old C-section scar and all of the surrounding scar tissue. He will release any tissue that may have been tethered from the prior procedure.
He will then artfully reapproximate each tissue layer one by one to close the area with minimal surface irregularity. The incision will have no surface stitches, and will be covered with surgical tape and a compressive garment.
Whether performed under anesthesia or awake, you will need someone to drive you home following the procedure. Dr. Kachniarz will call you the evening of your procedure to check on you and answer any questions.
Postoperative Recovery Process
Recovery from C-section scar revision is minimal, and you may resume gentle activities, such as walking, immediately following the procedure. Most patients return to work within a couple of days, and begin gradually increasing their activity level 2 weeks after surgery.
By 6 weeks, the incision is fully healed and there are no further activity restrictions. Dr. Kachniarz and his surgical team will discuss strategies to optimize healing and minimize scar formation after the procedure.
Common strategies include incision taping immediately after the procedure, gentle massage, silicone gel/sheets, and sun protection. Full scar maturation may take up to a year, during which time it will continue to fade. Silicone sheeting and sun protection are particularly important during this time.
Finding a Qualified Surgeon
Finding a qualified surgeon for C-section scar revision is an important step in the process. A successful procedure requires an experienced and knowledgeable doctor who can accurately assess your condition, has a thorough understanding of anatomy, and is well-versed in the techniques used to correct C-section scar deformities.
Frequently Asked Questions
How Long Does a C-Section Scar Revision Take?
On average, a C-section scar revision takes approximately 1 hour. Combining the procedure with a mini tummy tuck generally adds another 1 hour to the procedure. Both procedures may be performed either awake or under anesthesia, depending on your preferences.
Will I Have Drains After a C-Section Scar Revision?
No, we generally do not use drains for a C-section scar revision or a mini tummy tuck. A full tummy tuck does generally require placement of two drains for 1-2 weeks.
How Long Is the Recovery After C-Section Scar Revision?
You may resume gentle activities, such as walking, immediately following the procedure. Most patients return to work within a couple of days, and begin increasing their activity level gradually after 2 weeks. The area is fully healed at 6 weeks, at which time there are no further activity restrictions.
References
[1] Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. National Institute of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779640/
[2] Scar Tissue after a Cesarean Section—The Management of Different Complications in Pregnant Women. National Institute of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8620716/