Q&A: Scars

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Q After my first c-section, I was closed up with staples that were removed after 10 days or so, if memory serves me correctly. I didn’t use anything on the scar. On my skin itself the line faded quickly, but underneath I had a big bump running along the length of it. It looked a bit like a fat roll, but I am slim with a flat tummy. It was only really visible in a bathing costume. Then, after my second c-section three years later with a different doctor, I actually ended up with a much nicer scar. Apparently all the old scar tissue was cut out, and now I don’t have that lump. The line has also faded. So, just asking for friends: what made the difference? Ideally, how should one treat a c-section scar, and is there any way to avoid the forming of scar tissue? Are some doctors just better than others at avoiding scars?

A DR JUDEY ANSWERS

After a c-section, the incision on the uterus is always closed with dissolvable stitches, but there are three ways doctors close your skin:

■ STAPLES. Your doctor uses a skin stapler to close the incision with metal staples

– a popular choice because it’s the easiest and quickest option.

■ STITCHES. Using needle and thread, your doctor sews the incision together. While this method takes a little more time, some experts believe it could be a better option. Some research suggests that women whose c-section incisions are closed with stitches may be significantly less likely to develop wound complications than those whose incisions are closed with staples.

■ GLUE. Surgical glue, also known as fibrin, seals the skin, which is then topped with a transparent dressing. Some experts say that glue heals fastest and leaves the finest, least visible scar. But it’s not always an option, as this particular glue is very expensive. Doctors can use glue depending on several factors, including how the c-section went, whether you had a horizontal incision, and the consistency of your abdominal skin and fat.

Most times, c-section scars heal properly, but sometimes your body’s healing process can be influenced by various factors and stressors, which can lead to scarring – especially if you’re younger and have darker skin. This may include the formation of keloid or hypertrophic scars. ■ KELOID. A keloid scar occurs when scar tissue extends beyond the original boundaries of the wound, possibly resulting in lumps of scar tissue around the cut.

■ HYPERTROPHIC SCARS. A hypertrophic scar is a thickened, wide, often raised scar that develops where skin is injured, such as a caesarean scar. Scars are common during the wound healing process, but a hypertrophic scar is a result of an abnormal response to a trauma or injury. In certain people, body cells called myofibroblasts produce too much collagen during healing.

This can happen simply because of a person’s skin type and healing tendencies. More commonly, overproduction of collagen occurs when a wound is infected or inflamed, under a great deal of tension or motion (such as in injuries over a joint) or left to heal without stitches.

These scars aren’t dangerous or lifethreatening. They can be itchy and painful, but more often are simply a cosmetic issue. Some people seek treatment to minimise the appearance of the scar.

Following these tips will help your c-section scar to heal better:

■ KEEP IT CLEAN. For the first while, a c-section scar will be treated by your doctor and nursing staff at the hospital. It’s important that both a primary dressing such as an ointment or a cream, as well as a secondary dressing, such as a silicone covering, be used to ensure aesthetic healing. Typically, after wound closure, your dressing will be changed after 48 to 72 hours.

■ ONCE YOU ARE RELEASED FROM HOSPITAL, when you shower, let soapy water drip down your wound. There is no need to waterproof it, and you should avoid vigorous scrubbing or cleaning the wound with harsh compounds such as chlorhexidine. When you’re done, gently pat the area dry with a clean towel.

■ IT MIGHT BE POSSIBLE TO USE OINTMENT and cover your scar. Some doctors may advise to apply a topical antibiotic or honey-based ointment and cover the wound lightly with a bandage depending on the inflammatory response of your wound.

■ AIR IT OUT. Air promotes healing in skin injuries, so whenever possible, expose your scar to air. That doesn’t mean you have to walk around without any clothing – wearing a loose gown at night is enough to get the air circulating.

■ KEEP YOUR APPOINTMENTS. If your incision was closed with stitches that don’t dissolve, be sure to go to your follow-up postnatal appointments, so your doctor can remove them. Leaving the stitches in for longer than recommended can lead to a scar with disproportionate formation and a lack of aesthetic healing.

■ HOLD OFF ON EXERCISE. You need to take it easy to allow the scars on your uterus and your abdomen to heal. Avoid bending or twisting your body or making sudden movements as much as possible, and don’t pick up anything heavier than your baby. Do not resume exercise until approved by your medical practitioner.

■ LIGHT “MOVING AND MASSAGING”. Increased blood flow, in fact, helps healing and decreases your chances of developing deep vein thrombosis.

Once you feel up to it, take your baby for a stroll. Gentle massaging of the wound with a wound care ointment or a tissue oil also encourages vascularisation to the wound and will facilitate new collagen contraction and aesthetic healing.

By two weeks, your scar should look and feel much better.

That said, it can take anywhere from eight weeks to three months before you’re fully healed.

Though the c-section scar will fade in its own over time, a few simple tricks can help improve its appearance:

■ SILICONE SHEETING. You can buy these small sheets over the counter; they generally cost around R200 for a 12-week supply. Silicone sheeting assists by holding the skin together and preventing stretching of the skin, which inherently softens and flattens scars, especially if you have a tendency to form keloids or hypertrophic scars.

■ OINTMENTS AND CREAMS. Certain ointments and creams, such as a honeybased wound occlusive, could help to maintain the skin’s natural pH levels, prevent infection, and ensure that the skin cell turnover rate takes place in an aesthetic fashion. This is a preventative measure for keloid and hypertrophic scar formation.

■ LIMIT SUN EXPOSURE. Sunlight can cause a scar to be more noticeable by making it darker or lighter than the surrounding skin, so try to keep it out of direct sunlight for the first year, and apply sunscreen thereafter.

Itching is very common, since the nerves in the area have been disrupted. Avoid scratching. To calm itchy skin, you can apply a serum with a little tea tree oil. On the other hand, many women experience numbness or a tingling sensation in the area, which usually goes away with time. ●