Caesarean Scar Management - Dr. KWAN Kin Hung, Vincent

Q1. Will the scar look better if it is small and located lower in the abdomen?

The appearance of a caesarean section scar may not be good if the wound is too small or located low in pubic areas. Doctors need to stretch the skin more during operation if the wound is too small. This may cause dermal injury which is one of the causes of hypertrophic scar. On the other hand, if the wound is too low in the pubic area, hair and hair follicles might cause chronic irritation to the wound and result in chronic inflammation. This is the other cause of the hypertrophic scar.  To have a good caesarean section scar, the wound should not be too low. It should be placed at the skin fold of the low abdominal wall and should be kept away from pubic hair.
Q2. Why does my caesarean section scar look more obvious and unpleasant than others’? 
Whether the appearance of the scar is good or not also depends on the patient’s skin character, operation details and scar management.  The scar may not be a good one if the patient has keloid-prone skin. On the other hand, small caesarean wounds and wounds inside pubic hair are the common causes of hypertrophic scar. Finally, post-operative care is also important. Patients should maintain a balanced diet and avoid food such as blotched snakehead soup that could potentially induce hypertrophic scars. In addition, scar management products also help to improve the scar.
Q3. How is hypertrophic scar treated after caesarean delivery?
Prevention is more important than cure. Scar management products like silicone gel should be used once the wound is healed. It helps to prevent hypertrophic scar formation if hypertrophic scar is already there. Treatment choices also depend on whether you would like to have another baby.
If that is the case, conservation treatment like silicone gel, laser or steroid injection is preferred. If not, more aggressive treatment should be considered. Since the recurrence rate of hypertrophic scar is high with simple scar excision, adjuvant scar management is required after scar excision. Currently, scar excision with radiotherapy is the most effective way to control the hypertrophic scar with a recurrent rate being less than 20%.
If you worry about the side effects of radiotherapy and the scar is close to or inside pubic area, you may consider having laser hair removal first and then scar excision. The result after these treatments is often quite good.
Q4. Caesarean delivery, surgeries for slimming and liposuction leave scars after treatment. Should I have all in one go after delivery?
Theoretically we will not recommend undergoing caesarean section, liposuction and surgeries for slimming concurrently as they greatly increase the risk of operation. In fact, most mothers can get back in shape with a balanced diet and regular exercise. If necessary, they can consider liposuction and surgeries for slimming 6 months after delivery.   
Q5. Should I find a Plastic Surgeon for wound suturing after caesarean delivery?
For most people, the appearance of the caesarean scar does not have much difference whether the suture was done by a gynaecologist or a plastic surgeon. Since plastic surgeons focus on wound care and post-operative scar management for those with scar-prone skin, undergoing suture through the help of a plastic surgeon can yield better results.
For more information of HKSH Plastic & Reconstructive Surgery Centre, please click here.
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