When Stephanie Shalit gave birth to her second child in 2009, she was thrilled to have a healthy little girl…and pissed about what she considered to be an "ugly, muffin top-esque" C-section scar.
"I have a tattoo of flowers that starts on the side of my torso and winds down to below my navel," the Chicago yoga and Crossfit instructor, now 50, describes," and my doctor cut right through one of the vines but didn't match them up afterwards. It also doesn't feel like he took enough time sewing it. I have a big flap of skin hanging over the top, almost like a shelf." Even now, nearly nine years after her delivery, she says she is hyper-aware of it, "especially when I'm wearing a bikini or leggings."
Closing a C-section incision involves reuniting multiple layers of muscle and fascia (a web-like layer of connective tissue that surrounds all of the body's organs) with sutures, then reapproximating, or matching up, the skin as exactly as possible before closing with more sutures, or staples. Appearance-wise, the goal is to avoid unnecessary dimpling and puckering. "We generally make the incision as low as possible and into the pubic hairline so that it is not visible when wearing bikinis or low-riding clothes," says Leena Nathan, MD, an OB/GYN at UCLA Health in Westlake Village, California. Once healed, most scars are four to six inches in length but may vary in color and texture; "they can be flat, thin, and barely perceptible or thickened, dark, and raised," Dr. Nathan says. "The scar can appear red or white, it can feel soft or hard—these are all normal."
While a C-section scar's appearance should act as a reminder of what freaking badass warriors women are, many moms prefer they disappear. Maybe that's why more women are hiring plastic surgeons to join them in the surgical suite for their planned section. In October of last year, following the birth of son Lazlo, actress and Live Fast Die Hot author Jenny Mollen revealed her perfectly symmetrical cesarean section scar in an Instagram post, praising her doctor for his "artistry.
One plastic surgeon, David Cangello, MD, who's in private practice in New York City and an attending plastic surgeon at Lenox Hill Hospital and NewYork-Presbyterian Hospital, says he has attended hundreds of C-sections for just this purpose.
He performs the initial incision, then the OB delivers the baby and closes up the uterus and deepest layers of muscle. Dr. Cangello then returns to bring the fascia, fat, and skin back together in as picture-perfect a manner as possible. Subtle difference in technique, such as inserting the scalpel perpendicular to the skin and using sutures made of materials known to minimize inflammation, can make all the difference to an image-conscious mother. Plastic surgeons, he adds, may be more skillful at closing the incision in a way that minimizes the chances of invagination, medical speak for the common phenomenon of a c-section scar looking as if it's tethered to the muscle beneath it.
"I'm not at all saying that OBs don't know how to close [a wound] properly," Dr. Cangello emphasizes. "But an OB's concern is delivering a healthy baby—that's their expertise. In this case, our expertise is making things look beautiful." Insurance does not cover a plastic surgeon's involvement; Dr. Cangello charges $3,000 and says that fee is on par with other surgeons'.
Dr. Nathan says she personally would not feel insulted if a patient chose to have a plastic surgeon open and close the skin. "My expertise is in pelvic surgery and delivery of the baby," she says. "However, given the number of C-sections we do as obstetricians, we are very experienced in making skin incisions and closing them." She adds that women undergoing a crash C-section or emergency surgery to deliver their baby may end up with an incision that's "a little crooked or higher than it would be otherwise, [but] that does not always mean a worse scar, and it's a small price to pay for a chance at the healthiest baby possible. Scars can always be revised but [a baby's health] cannot."
If the appearance of your C-section scar is upsetting you, there are possible ways to change its look—and not all require surgery. A scar revision, which takes place under local anesthetic or sedation, involves opening the scar (but not the underlying muscle) and re-closing it. Recovery time is about three to four weeks, Dr. Cangello says.
For a less invasive option, you can apply a silicone sheet to the scar, starting two weeks post C-section. It may prevent long term redness or bumpiness by hydrating the scar, Dr. Cangello says, "but you need to wear it 24/7."
You can also massage your scar, to reduce scar tissue formation and can help ensure a smooth, flat, pain-free, and supple scar, says Leslie Lo, DPT, a women's health physical therapist at Northwestern Memorial Physicians Group in Chicago. Beginning four to six weeks post-surgery (get your doctor's clearance first), massage the scar, working it with a rubbing motion—first side to side, then up and down; then diagonal. "You can also lift and roll the scar between your thumb and forefinger," Lo says. Doing this two to three times a day for five to 10 minutes at a time can keep the scar pliable, soft, and cosmetically appealing.
Appearance concerns aside, Lo says scar massages can help prevent chronic pelvic pain. "If the scar is thick and deep, it can limit the mobility of muscles and connective tissue, contributing to pain and immobility," Lo says.
Having a plastic surgeon come in as The Closer has been going on for decades, mostly with celebs, and has finally trickled down to the everyday mom, explains Nancy Redd, author of Pregnancy, OMG!: The First Ever Photographic Guide for Modern Mamas-to-Be and a mother of two young kids. ("Like weaves and extensions," she quips.) But not all moms are concerned about the look of their C-section scar—some choose to appreciate what it symbolizes, instead.
"Parenting comes with a lot of scars, emotional and physical," Redd says. "I'm of the belief that embracing, rather than erasing, scars leads to higher levels of long-term satisfaction because it symbolizes the lack of control that comes with this new stage of life called parenting."