What is the best way to help improve your c-section scar?

For most new moms, once you get home with your baby, the condition of your scar will not be a priority for you or your doctor once the stitches or staples have been removed and the scar is closed. You feel grateful for the cesarean section, also called “c-section”, that may have saved your life as well as that of your baby, and complaining about its aesthetic quality, or any pain or itchiness may be the last thing on your mind.   And yet, for many, as the months pass, the scar will remain a constant reminder of a procedure you may have desired or not, and this scar of at least 4 inches¹ will evolve and remain for the rest of your life.

Ladies, if the appearance of your c-section scar is a concern, it is important to take care of it earlier versus later.  The wound healing and scar tissue remodeling process will go on for several months after surgery. Poor scar healing can lead to painful, itchy, pigmented, and raised scars – otherwise known as hypertrophic scars and keloids. 

So… How can you take care of your c-section scar?

Here Are Several Non-Invasive Solutions:

1. Drink a lot of water

It is essential to keep in mind that your body needs to stay hydrated. Dehydration has an impact on wound healing and may cause poor oxygen perfusion, essential nutrients not being delivered to the wound surface and draining inefficiency.²

There are three stages in a scar healing process: the inflammation stage, the proliferation stage, and the remodeling stage. Physical Therapist Amy Renken notes that, “All three components of tissue healing require water as a vessel to supply the needed component to achieve the goals of healing. Water is our body’s partner in helping to achieve the crucial stages to allow for healing.” ³

To keep a good level of hydration, you should drink 1.5 to 2 liters of water per day. So be sure to bring your bottle of water with you everywhere – in fact − consider it your best friend!

2. Protect your scar from sunlight 

Your scar is more fragile than the surrounding skin so you will need to take precautions if you want to enjoy the sunlight and sunbathe. To minimize preventable discoloration risks, your doctor will recommend to cover your recent scar (one that is still pink or red, and less than one year old), or use a good sunscreen for your old scar (one that is white and more  than 1 year old). 

Dr. Stuart Linder, a cosmetic, plastic & reconstructive surgery specialist in Beverly Hills, California explains, “it is very important not to expose premature, immature scars to sunlight. Ultraviolet radiation during early healing period can lead to increased risk of all scar formations including hyperpigmentation and hypopigmentation. Our patients are instructed not to have an exposure to the sun for up to one year in order to prevent increased pigmentation of the scars.” ⁴ 

3. Massage Your Scar

Scar massaging is a recommended therapy. It helps decrease scar tissue build-up, improve skin flexibility, reduce scar adhesions and helps regain feeling. The recommendation is a massage of 5-10 minutes, twice a day. ⁵

Massage your scar  in all three directions:  circular, vertical and horizontal with the tips of your fingers by applying as much pressure as you can tolerate.⁶ You can use cream or oil (e.g. aloe vera) to nourish it at the same time. Aloe vera contains healing and anti-inflammatory properties.⁷

Do not massage your scar within the first three weeks following surgery. It is critical to allow adequate time for your scar to heal closed. That means your scar is dry, clean, uninfected, and properly closed. Typically, you can begin to massage your scar 3-6 weeks after surgery once your doctor says it is ok.

4. Use Heat Therapy 

Heat therapy, also called thermotherapy, is a safe way to speed up the healing process of your c-section scar. Applying gentle heat directly to the damaged skin produces vasodilation – the dilation or widening of blood vessels⁸ − which increases blood flow and, allows for better healing. 

Heat therapy is also known to relieve pain.⁹ Heat reduces pain by increasing blood supply. So, if your scar is itchy or painful, heat therapy can help. You can also combine heat therapy with massage by using an aid or tool such a warm massage stone. 

5. Use Silicone Sheets 

Silicone sheets provide hydration therapy and improve the appearance of scars through their action on collagen fibers.¹⁰ Wearing a girdle or taping down thicker silicone sheets can provide additional pressure or compression therapy which helps flatten your scar and prevent thickening of scar tissue. 

Silicone sheets have also been shown to address skin pruritus (itchiness) and pigmentation changes.¹¹ In 2014, an international team of experts concluded that silicone sheets are ‘gold standard’ therapy for the prevention and the treatment of hypertrophic scars and keloids, yet they should be used with a combination of other treatment options (e.g. heat, pressure, compression therapies) to provide patients with optimal outcomes.¹²  The key to all silicone scar sheet is to wear as much as you can, up to 23 hours if comfortable enough to help reduce scarring and hyperpigmentation. In any case, always make sure you scar is dry, clean, uninfected, and properly closed before treating it with silicone sheets.  

Here Are Several Invasive Solutions:

1. Intralesional Corticosteroid Injection

You may want to consider a more invasive measure such as the use of intralesional corticosteroids in order to stop the multiplication of fibroblasts − a type of cell that is responsible for making the extracellular matrix and collagen¹³ − and collagen synthesis. Between 50% and 100% of patients respond to this treatment with 9–50% experiencing recurrence.¹⁴

2. Surgical scar correction

If you want faster results, you may opt for surgical scar correction which restarts the scar healing process. This is risky because the outcomes to the appearance to the scar can vary. If you are prone to keloid scars, it is important to talk with your doctor on how best to minimize recurrence (e.g. treat the scar area after surgery using a combination of methods). 

What is the best solution for your c-section scar?

As you see, there are many approaches – both non-invasive and invasive – for improving your scar.  Be sure to talk with your doctor first about your scarring history and your concerns. Ask about the varying out of pocket costs, potential risks and conveniences of each approach to ensure you make an informed decision.  Moreover, make it your primary focus to seek solutions that will help prevent a poor scar outcome in the first place! Investing in that first step make you feel and look better sooner. Plus, it will save you time and money in the long run. It’s a win-win!

References:

1. Weiss, R. (PhD) 10 Common Questions About C-Section Scars. VeryWell. November 25, 2019, https://www.verywellfamily.com/cesarean-scars-2758511
2.  How Hydration impacts wound healing. AdvancedTissue. June 27, 2014, https://advancedtissue.com/2014/06/hydration-impacts-wound-healing/
3.  Renken, A. (PT) Health Benefits of Water Intake During Injury Recovery. July 1, 2016, https://franklinrehab.com/2016/07/01/health-benefits-of-water-intake-during-injury-recovery/
4.  Linder, A. S. (MD) What happens if my scar is exposed to sun? https://www.sharecare.com/health/skin-injury/what-happens-scar-exposed-sun
5.  Conde, E. (MD, PHD) Compression therapy and scar massage in post-traumatic and post-surgical leg wounds. January 17, 2019, https://www.elenaconde.com/en/compression-therapy-and-scar-massage-in-post-traumatic-and-post-surgical-leg-wounds/
6.  Managing Your Scar. USF Breast Health. February 17, 2012, http://usfbreasthealth.blogspot.com/2012/02/managing-your-scar.html
7. Surjushe, A.; Vasani, R., and Saple, D.G. Aloe Vera: a short review. 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763764/
8. Definition of Vasodilation. BiologyDictionary.net. April 28, 2017, https://biologydictionary.net/vasodilation/ 
9. Prentice, William E. Arnheim’s Principles of Athletic Training: a Competency Based Approach. McGraw-Hill. 2008.
10. Bleasdale,B ; Finnegan, S.; Murray, K.; Kelly, S.; Steven L; Percival, SL. The Use of Silicone Adhesives for Scar Reduction. Adv Wound Care. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486716/
11. Borgognoni L.  Biological effects of silicone gel sheeting. Wound Repair and Regeneration: Official Publication of The Wound Healing Society [And] The European Tissue Repair Society. 2002;10(2):118–121.
12. Monstrey S, Middelkoop E, et al.  Updated Scar Management Practical Guidelines: Non-invasive and invasive measures. Journal of Plast Reconstr Surg. August, 2014
13. Mandal, A. (MD). What are fibroblasts. Feb 26, 2019, https://www.news-medical.net/health/What-are-Fibroblasts.aspx
14. Niessen, F.B.; Spauwen, P.H.; Schalkwijk, J., Kon, M. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg, 104. 1999, pp. 1435-1458

Sources:

1. Weiss, R. (PhD) 10 Common Questions About C-Section Scars. VeryWell. November 25, 2019, https://www.verywellfamily.com/cesarean-scars-2758511
2. Managing Your Scar. USF Breast Health. February 17, 2012, http://usfbreasthealth.blogspot.com/2012/02/managing-your-scar.html 
3. McClure, G. reviewed by Dr. Tiberi, J. (M.D., OS)  Scar Tissue Massage: When & How to Massage Scar Tissue After Surgery. https://www.peerwell.co/blog/2018/06/27/scar-tissue-massage-after-surgery/ 
4. Renken, A. (PT) Health Benefits of Water Intake During Injury Recovery. July 1, 2016, https://franklinrehab.com/2016/07/01/health-benefits-of-water-intake-during-injury-recovery/
5. Linder, A. S. (MD) What happens if my scar is exposed to sun? https://www.sharecare.com/health/skin-injury/what-happens-scar-exposed-sun
6. Bleasdale,B ; Finnegan, S.; Murray, K.; Kelly, S.; Steven L; Percival, SL. The Use of Silicone Adhesives for Scar Reduction. Adv Wound Care. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486716/