Caesarian Scar Revision

Overview
Most women are happy with the scar left after a Caesarian section. However, in some cases the tissues beneath the scar were not repaired adequately leaving a dent. The appearance may be worsened be the normal accumulation of fat that occurs on the lower abdomen in women in their mid-thirties/ early forties. If the general abdominal contour is good, a Caesarian scar revision can improve the scar and lower abdominal contour. A major advantage is that it can be performed under local anaesthesia.

Who is a candidate?
Slim patients with a localised problem with the scar and lower abdominal contour may be a candidate. In some cases, women who have had a difficult labour and an emergency Caesarian find that the scar becomes an unpleasant reminder of what should be a happy event. Any tethering of the skin to the deeper tissues can be improved and special suture techniques and dressing should result in a fine scar. If there is significant fat or muscle laxity then a mini-abdominoplasty is more appropriate.

What are the consequences?
The operation leaves a scar in the lower abdomen, just above the pubic hairs and slightly longer than a traditional Caesarian scar. Some patients make better scars than others and in any case all scars are red initially. You will be advised of special measure that you ca employ to improve scar formation.

What are the limitations?
The operation will not remove excess fat on the abdomen- if there is significant excess fat, then liposuction may need to be added. If there is muscle laxity and mild skin excess, then a mini-abdominoplasty needs to be performed instead. A further pregnancy will of course stretch the skin again, although probably not to the same degree.

What are the risks?
This operation is usually performed as a day case under local anaesthetic. The scar will need to be supported with tape for a couple of weeks but there are no other specific risks of this relatively minor surgical procedure.

What would you need to do before the operation?
If you are overweight you would be well advised to diet as best results are obtained in people who are the correct weight for their height. If you smoke there may be a slightly greater risk of poor wound healing.

What you should expect at the time of the operation?
The surgery is performed under local anaesthesia. If you desire, you may have sedation. The operation takes 45-60 minutes and you may wish to bring your favourite music with you to listen to on headphones during the operation. There should be no pain immediately after the operation as a long-lasting local anaesthetic injection is used. Later you should take simple over the counter painkillers such as paracetamol. Your abdomen will feel tight for the first week or so and you should avoid strenuous exercise during this time.

Recuperation?
Light activities are comfortable immediately but strenuous exercise is not advisable for about 10 days. The scar will initially be a fine line, but may become raised and red temporarily. When it has fully settled, it should be pale, fine and flat. Mr Nduka will advise on ways to improve scars that are not settling.