Caesarian (C-section) scar treatment and removal

Introduction

Welcoming a new life through a Caesarean section (C-section) is a life-changing experience. However, for many mothers, the Caesarian section scar left behind can be a source of emotional and physical discomfort. While some women heal with minimal scarring, others may develop hypertrophic or keloid scars are cosmetically unpleasant and impact confidence.

Fortunately, modern dermatological and aesthetic treatments offer a variety of effective options to improve the appearance of C-section scars. In this article, we'll explore the types of C-section scars, why they form the way they do, and the current treatments available, including topical creams, laser therapies, injectables, and even surgical revision.

What Are Caesarean (C-section) Scars?

A Caesarean scar (C-section scar) forms as a result of an incision through the lower abdomen and uterus to deliver a baby. Typically, the incision is made horizontally across the lower abdomen, just above the pubic hairline. This is often referred to as a “bikini line” incision and is preferred because it heals better and is less visible.

As the body heals, scar tissue replaces normal skin tissue, which can lead to changes in texture, colour and appearance. The appearance of the scar depends on a number of factors, including skill of wound closure, wound healing, infection, skin type, genetics and scar aftercare.

Types of Caesarean (C-section) Scars

Not all C-section scars look the same. Understanding the type of scar you have is essential for selecting the most appropriate treatment.

1. Flat Scar

• The most common and desired outcome.
• Thin, flat, and pale in colour.
• May have surrounding post-inflammatory hyperpigmentation
• Usually becomes less noticeable with time.

2. Hypertrophic Scar

• Raised, red or pink, and may feel firm or itchy.
• Caused by excess collagen production during healing.
• Typically stays within the boundaries of the original incision.

3. Keloid Scar

• Raised and thick like a hypertrophic scar, but extends beyond the original wound.
• More common in darker skin types and genetically predisposed individuals.
• Can be itchy, painful, or cosmetically distressing.

4. Atrophic (Indented) Scar

• Sunken or depressed due to tissue loss or poor collagen formation.
• Scar tissue causes a tethered and dimpled appearance
• It can occur after infection, poor healing, or improper suturing.

Treatments for Caesarean (C-section) Scars

While some scars improve naturally over time, most scars benefit from active intervention. Here’s a look at the scientifically supported treatment options for C-section scars.

Topical Scar Creams (Silicone Gel)

Best for: Fresh scars

Topical treatments are typically the first line of management, especially during the first 6–12 months post-surgery when the scar is still new and undergoing scar remodelling.

Key Ingredients for a scar gel:

• Silicone gel or silicone sheets: Standard of care for scar management; helps hydrate the scar and reduce collagen overproduction.
• Vitamin E: Vitamin E is a potent antioxidant, protecting skin cells from oxidative damage and reducing inflammation.

Topical Scar Creams containing Silicone Gel and vitamin E are best for fresh scars. Scar gels are most effective when applied daily over several months, with the optimal results occurring when used during the early healing phase. Scar gel won’t significantly improve established hypertrophic, keloid or depressed scars.

Fractional CO₂ Laser for Caesarean Scars

Best for: Mature, hypertrophic and keloid scarsFractional CO₂ laser treatment is a time-tested, non-invasive, non-surgical option for C-section scar treatment. Fractional CO2 laser resurfacing works by ablating microscopic columns of scar tissue, creating controlled micro-injuries in the skin to stimulate collagen production and scar remodelling. This treatment is effective for mature, hypertrophic and keloid C-section scars. Treatment of C-section scars with fractional CO2 laser typically requires 5-6 sessions spaced 4–6 weeks apart. After treatment, expect 5-7 days of skin redness, swelling, and mild peeling.

Rejuran Injections for Caesarean Scars

Best for: Flat or Atrophic scars with poor skin quality

Rejuran Healer is a skin-repairing injectable derived from polynucleotides (PNs) extracted from salmon DNA. It has potent regenerative properties that promote tissue repair, collagen remodelling, and hydration.

Rejuran healer skinbooster is injected directly into the scar tissue, where it stimulates fibroblast activity and angiogenesis (new blood vessel formation). Over time, Rejuran injections improve skin texture, tone, and elasticity.A typical treatment protocol with Rejuran injections involves3–4 treatment sessions spaced a month apart. Treatments have minimal downtime (mild swelling, bruising or redness for 2-3 days).

Steroid Injections for Caesarean Scars

Best for: Hypertrophic and keloid scars

Intralesional corticosteroids (e.g., triamcinolone acetonide) are commonly used to flatten and soften hypertrophic or keloid C-section scars by reducing collagen synthesis and inflammation.

Injections are typically administered monthly over 4-6 sessions until the desired outcome (scar flattening, less inflammation and itching) is achieved. Steroid injections are considered the standard of care for hypertrophic and keloid scars, offering quick relief and visible improvement in thickness, itchiness, and pain. However, intralesional steroid injections have a risk of skin thinning (skin atrophy) or hypopigmentation with prolonged use, so dosage must be carefully controlled.

Surgery for Caesarean (C-section) Scars

Best for: Severe keloid or tethered scars, which are disfiguring

In some cases, surgical scar revision is the most appropriate option, especially when the scar causes physical discomfort, restricts movement, or affects self-esteem significantly.

Surgical Options:

• Scar excision and re-suturing: The old scar is surgically removed, and the skin is closed meticulously in layers to reduce tension and improve healing.
• Z-plasty or W-plasty: Surgical techniques that reorient the scar to make it less noticeable or release tension.

Surgery comes with risks of recurrence of keloid scars, particularly in those prone to keloid formation. Scar revision surgery needs to be followed by laser and steroid treatment to maintain the results and prevent scar recurrence.

Conclusion

C-section scars are a natural part of many women’s postpartum journey, but that doesn’t mean they have to be permanent reminders of trauma or discomfort. Thanks to advances in dermatology and aesthetics, there are now safe and effective treatments that can improve the appearance, texture, and feel of these scars.

From topical silicone gels and laser resurfacing to injectable therapies like Rejuran or steroids and surgical revision, the right treatment depends on your scar type, skin tone, healing history, and personal goals.

For the best results, it's essential to consult an experienced doctor who can assess your scar and recommend a tailored treatment plan. With the right approach, your scar can fade into the background, allowing your confidence and skin to shine.

At Bay Aesthetics Clinic, Medical Director Dr Hoe Ying Min has helped hundreds of women with their postpartum issues. As a working mother herself, she deeply understands her patients and provides dedicated and personalised care.

Contact us to begin your postpartum journey of restoration and healing.