As a parent, your goal is for your baby to arrive in the world healthy and safe. And if that means it’s by C-section,[1] the resulting incision represents a miracle of life — your beautiful baby.
Still, it’s natural to want to do everything you can to ensure that the wound heals well and scar tissue is minimized. The good news: Most C-section scars heal nicely, leaving only a faint line just above the pubic hair line that's easily covered up by clothing, underwear and bathing suits.
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, in order to reach in and deliver your baby.
Your practitioner won’t need to cut your abdominal muscles — they can simply separate them to access the uterus, according to the National Institutes of Health (NIH).[2]
The type of incision on your abdomen may not be the same as the one on your uterus and instead 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 incision is down the middle of the uterus. It used to be common, but now is typically only reserved for certain situations. For example, it may be done in a preterm delivery, when the baby is nestled low in your uterus or in another unusual position, or in an emergency labor situation. Vertical incisions may be slightly more painful and take a little longer to heal.
The incision on your uterus will be one of the following:
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- Low-transverse incision
- Low-vertical incision
- Classical incision
How are C-section incisions 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 brings the incision together. While this method takes a little more time, some experts believe it could be a better option. "Studies show that using stitches to close the C-section incision results in fewer wound complications, such as infection and wound re-opening, compared to using staples," says What to Expect Medical Review Board Member Jessica Wu, M.D., a board-certified dermatologist in private practice in Los Angeles, California. From an aesthetic standpoint, staples and stitches result in similar scars, according to the NIH.
- 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. "Studies show that glue is equivalent to stitches, although stitches may hold the wound more securely if the skin is thicker or under greater tension," says Dr. Wu, who is an assistant clinical professor of dermatology at the USC Keck School of Medicine in Los Angeles.
Types of C-section scars
Most times, C-section scars heal properly, although they often appear darker than the surrounding skin — especially in people who have richly-pigmented skin tones, says Dr. Wu. Sometimes, however, your body’s healing process goes into overdrive, which can lead to problems with scarring.
The types of C-section scars and related issues 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. Keloid scars tend to be thickened, raised, and itchy, explains Dr. Wu. “If you’ve had a keloid scar elsewhere, you may be at higher risk of developing a more prominent C-section scar," she says.
- 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.
It’s often hard to tell keloid and hypertrophic scars apart, says Alexander Zuriarrain, M.D., F.A.C.S., a board-certified plastic surgeon and founder of Zuri Plastic Surgery in Miami, Florida.
"The major difference is that the keloid scar grows outside its original borders and has a ‘tumor-like’ quality in its appearance,” he explains.
How can you help a C-section scar heal?
How your C-section scar heals often has to do with factors that are out of your control. Still, you can follow these tips to help the process along:
- Keep it clean. Once a day (when you shower), let soapy water drip down your wound. There’s no need to waterproof it, but 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. You can try wearing a loose gown at night to get the air circulating, for instance. Just be sure to protect it with sunscreen and/or a bandage when you're out in the sun.
- Keep your appointments. If your incision was closed with stitches that don’t dissolve, be sure to go to your follow-up postpartum appointments so your practitioner can remove them. The American College of Gynecologists (ACOG) now recommends 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 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 vein thrombosis, or DVT (a blood clot that’s more common during pregnancy and the postpartum period). Once you feel up to it, pop your baby in that stroller and take a walk around your neighborhood.
How long does it take a C-section scar to heal?
By two weeks, your scar should look and feel much better, but it takes longer to heal.
“A C-section scar will reach 80 percent of its strength by week 6," says Dr. Zuriarrain. "At that point, it can be considered healed and is not at any increased risk of infection or injury." But it can take at least a year for the scar to settle into how it will look permanently, he adds.
Is there anything you can do to minimize C-section scarring?
Your C-section scar will fade on its own over time. But while some people are simply genetically predisposed to forming keloid or hypertrophic scars, says Dr. Zuriarrain, there are several techniques that may help minimize scarring, including:
- Silicone sheeting. “Once the stitches or staples are removed, silicone gel sheets should be used to help the scar heal more smoothly,” says Dr. Wu. You can buy these small sheets over the counter; they generally cost around $40 for a 12-week supply. 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 tend to form keloids or hypertrophic scars. Ask your doctor when you can start trying silicone sheeting. 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 and are also OTC for about $50 for a 30-ounce tube. 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.
- Scar massage. Drs. Wu and Zuriarrain recommend massaging the scar tissue as soon as the stitches or staples are removed and the skin has healed over — usually around two to three weeks after surgery. "This increases circulation, breaks down scar tissue, and helps encourage the collagen fibers to grow more parallel to the skin surface, which makes the scar smoother," says Dr. Wu. "Everyone’s healing is different, so be sure to check with your surgeon before starting massage." Using unscented body lotion, gently rub the skin with the pad of your fingers in a circular motion until the skin blanches, moving back and forth over the full length of the scar. Ideally, you’ll aim to massage the scar for a few minutes twice daily. Continue until the scar flattens. Stop massaging any areas if you noticing blistering, open skin, or a rash.
Although scars generally settle into what they'll look like permanently 12 months after C-section surgery, some can continue to improve after the first year. “If you continue to see improvement, it’s worth continuing massage and other measures, such as silicone patches,” says Dr. Wu.
Are there cosmetic options to minimize a C-section scar?
Maybe your C-section scar didn’t heal like you thought it would, or maybe you just want it gone. While there’s no way to erase a C-section scar completely, there are a few options that can improve its look and feel.
Non-surgical procedures
With these procedures, there’s not a long waiting period before you can get started:
- Laser therapy. "Laser can be used to fade red scars or smooth irregular scar borders," says Dr. Wu. 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) — you’ll likely have a better outcome if you get laser therapy sooner rather than later. (Dr. Zuriarrain recommends starting one month after surgery.) Check with your OB/GYN (some perform laser therapy), or consult a dermatologist or plastic surgeon. You might need between one and four treatments before the scar reaches its final look. $1,000 per session, or $3,000 for three sessions, according to Dr. Zuriarrain. But rates may vary significantly depending on the clinic and where you live.
- Steroid injections. “If the scar is raised, lumpy or itchy, your doctor may inject cortisone to help flatten it,” says Dr. Wu. Injections are mainly used for keloid scars and are not effective for hypertrophic scars, says Dr. Zuriarrain. An injection of a long-acting steroid can reduce inflammation and help the scar 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 about 30 days after surgery, says Dr. Zuriarrain. You’ll need to get injections monthly for anywhere from three to six months, depending on the severity of the scar. Steroid injections may be covered by your insurance, but it’s approved on a case-by-case basis. Each injection usually costs about $50.
Surgical procedures
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 the 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. Prices can range from $1,000 to $2,500.
- Tummy tuck. "Tummy tuck isn’t typically used to treat a C-section scar, though tightening the surrounding skin can sometimes make a C section scar less noticeable," says Dr. Wu. Your doctor may recommend abdominoplasty — commonly known as a tummy tuck — if you have “enough skin that it can be removed and closed at a level that is below the original C-section,” says Dr. Zuriarrain. If you have excess, loose skin on your stomach, your doctor may recommend abdominoplasty. 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, 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. Tummy tucks aren’t covered by insurance.
Is it normal for a C-section scar to itch?
Itching is very common, since the nerves in the area have been disrupted. Avoid scratching. To calm itchy skin, you can apply a minimal amount of sunburn cream to the skin around the scar. Or hold an ice pack (or ice wrapped in a towel) to the area for about five to 10 minutes.
Is it normal for a C-section scar to smell?
As long as you keep it clean, the area shouldn’t smell — so if it does, check with your doctor, as it could be a sign of infection.
Is it normal for a C-section scar to feel numb?
Yes. Many women experience numbness or a tingling sensation in the area, which usually goes away with time, according to ACOG. Mention it to your practitioner if you’re concerned.
Signs of C-section scar infection: when to see your doctor
If you experience any of the following symptoms, contact your doctor immediately:
- Redness, warmth, 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
Rest assured that infections are fairly rare; just keep an eye on your scar as it heals, treat it by following these tips, and check in with your OB/GYN or midwife if you have any questions or concerns. Remember that your C-section scar is a sign of the beautiful baby you brought into this world, and will fade in time.
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