Caesarian Section Scar Revision

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About C section Scar

Some women may do to emergency or elect to have their birth surgically. This is called a Caesarian Section or most often referred to as a C-section. In this surgical procedure one or more incisions are made through a mother’s abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. This will leave a surgical scar that many woman wish to have revised after the decision not to have any more children. In emergencies often the scar is longitudinal running from just below the naval to the lower abdomen. In elective C section more often the scar is latitudinal just above the pubic bone on the lower abdomen.

The Video Below is a medical procedure and contains graphic images that may be unsuitable for children and some adults.

About C section Scars

  • This Cesarean section scar involves a midline longitudinal incision which allows a larger space to deliver the baby. It is not often performed today.
  • The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair.
  • An emergency Cesarean section is a Cesarean performed once labour has commenced.
  • A crash Cesarean section is a Cesarean performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, the child or both.
  • A Cesarean hysterectomy consists of a Cesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
  • A repeat Cesarean section is done when a patient had a previous Cesarean section. Typically it is performed through the old scar.

    • Regardless of the type of C section performed and the resulting scar they can be treated in a similar way. Tummy tucks are often used to revise or obscure a C-section scar.

Risk of Scar Revision

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Pre & Post Operative Risk of Scar Revision

Cosmetic procedures involve the placement of scars in inconspicuous areas heal with minimal scarring. Any time an incision is made, a scar will result. Unfortunately, the thickness and the texture of the scar is only partially related to the skill of the surgeon and the procedure itself. In no case will scar revision surgery eliminate a scar completely. In nearly all cases, it will minimize the scar. In very rare cases, the scar could be made worse. This is a risk that a patient needs to accept. The doctor’s knowledge of your healing history is critical to making the most educated decision for the benefit of the patient.
In developed countries risk in surgery has greatly been diminished. However, a person considering elective scar revision surgery as with any surgery should discuss risks with their surgeon. Here is a partial list a person can ask their doctor about.

Scar Revision Surgery Risk

• Allergies (tape, suture materials,blood products, topicals, injected agents etc…
• Anesthesia Options & risks
• Changes in skin sensation post-surgery
• Excessive Bleeding (hematoma)
• Delayed or Slower healing
• Deeper Tissue damage e.g. nerves, blood vessels, muscles and lung
• Pain tolerance or changes to pain sensitivity
• Possibility of revisional surgery or staged procedures
• Post-Surgery Infection
• Skin contour irregularities
• Skin discoloration and swelling
• Temporary or permanent damage possibilities

Take the time to ask questions!. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress.

Facial Scars

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Facial Scar Duress

The impact of scarring and the disfigurement from it has a tremendous emotional impact on a person. It can be even greater for children who may lack the cognitive and language skills to communicate there distress. Males of all ages are often ingrained socially not to communicate distress over scarring even if it is impacting them in a negative way. Many people undergo unnecessary deformity because either they or their families have failed to deal with their concern over the effects of facial scarring or have failed to seek advice on what can be done to improve the appearance of facial scars.

Advancement in today’s cosmetic surgery provides more options. The treatment of facial scarring can be the most gratifying thing that a cosmetic surgeon does. Unlike other cosmetic procedures, incisions for revision cannot be hidden. The location of the scar determines the incision but it is the techniques in restructuring the scar that can greatly reduce its appearance and advance a patients self-image and emotional wellbeing.

Importance of Timing Scar Revision

Children and young adults are the disproportionately the victims of injury. Their skin tends to heal with more scarring because they heal more rapidly. Although these scars tend to fade with time, it still makes the treatment program more difficult. Furthermore, it makes it much more important to wait before initiating treatment since a scar that looks poor a month or so after injury may continue to greatly improve in appearance for many months. Ultimately, it may be so unnoticeable as to not require treatment.

Although the repair carried out at the time of injury does influence the amount of scarring that exists after healing, even the most careful repair may not provide a totally acceptable result. When treating the initial injury, one is never sure how tissues will heal. Lost tissue may have to be replaced with grafts. Wounds may have to be closed under tension. These are only some of the factors that tend to promote increased scarring.

The Nature of Scars

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Scars are the result of our natural biological process of wound healing. This repairing takes place in the skin and in other body tissues. The external scars of the skin most often comes to mind even though injured internal parts of the body can heal with scar tissue. Often a doctor can diagnose a condition based on some internal scarring of an organ such as the liver, lungs or kidneys.

Regenrative Animals do not scar

What Are Scars?

Scars are areas of fibrous tissue (fibrosis) that replaces normal skin or organ tissue after injury. This is why it is said that scarring is a normal part of the healing process. Every wound (e.g. after accident, disease, or surgery) has some degree of scarring. There are some exceptions to this in the animal world. These animals undergo regeneration, which do not form scars and the tissue will grow back exactly as before. Some examples are:

• Lizards who lose all or part of their tails can grow new ones. Most
lizards can regrow a tail within nine months.

• Planarians are flat worms. If cut into pieces, each piece can grow
into a new worm.

• Sea cucumbers have bodies that can grow to be three feet long. If
cut into pieces, each one can become a new sea cucumber.

• Sharks continually replace lost teeth. They can grow as many as
24,000 teeth in a lifetime.

• Spiders can regrow missing legs or parts of legs.

• Sponges can be divided. In that case, the cells of the sponge will
regrow and combine exactly as before.

• Starfish that lose arms can grow new ones; sometimes an entire
animal can grow from a single lost arm.

As mammals, humans just aren’t that fortunate. Scars are part of our existence for better or worse.

Variant Formation of Scars

• Scar tissue is the same protein (collagen) as the tissue that it
replaces, but the fiber composition of the protein is different;
instead of a random basket weave formation of the collagen fibers
found in normal tissue
• Scar tissue is fibrosis and the collagen cross-links forms a
pronounced alignment in a single direction.

Scar Tissue has inferior functionality

• Scars in the skin are less resistant to ultraviolet radiation
• Sweat glands and hair follicles do not grow back within scar tissue
• A heart attack causes scar formation in the heart muscle, which
leads to loss of muscular power and possibly heart failure.
• Bones can be an exception they can heal without any structural or
functional deterioration.

Special Report: Addressing the Challenge of Scalp Scars

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Scarring is an inevitable part of hair restoration and physicians performing hair transplants are always challenged to reduce scarring as much as they are able. The strip method which is the most popular form of hair restoration surgery requires a donor strip to be taken from the permanent zone which requires the doctor to pay close attention to wound closure and scar reduction. Some patients have suffered trauma that may have left unwanted scar. Hair, can naturally cover scars in most cases. However, when it happens to be close to the hairline or depending on the patients hair style it can be harder to cover up.

Since the advent of hair transplant surgery, hair transplant surgeons have been challenged to address the scarring that is inevitable from the donor wound in strip hair transplants. Other types of scalp surgeries such as neurological surgeries can also leave linear type scars in the scalp. In addition trauma to the head can leave a person with unwanted scar. A patient’s natural hair coverage can obscure the visibility of a scar in most cases. However, proximity to a patient’s hairline and or wearing the hair too short can make a scar more obvious.

Surgeons can repair or disguise most scars. The differences of shape as well as the placement and size of the scars will determine the technique that is used by the surgeon. The goal is to revise the scar so that it may be almost invisible. This scar revisioning is far more than a cosmetic need. Scars can affect the person’s self-esteem. Surgeons are in the forefront of minimal scarring.

Addressing scalp scarring from trauma and scalp surgeries.

A hair transplant surgeon can easily repair or camouflage most scalp scars. The variations in a scar shape, location and size are key factors affecting the techniques that a surgeon will use in the revisioning of the scar. The singular and most important purpose of the scar revisioning is to obscure or minimize its appearance to the naked eye. Scar revisioning is not merely cosmetic. Disfigurement from scarring often affects a person’s sense of well being and self worth. Do to the inherent nature of the work they do cosmetic surgeons are at the forefront of minimizing the appearance of scars. We have developed an algorithm utilized in hair restoration and other surgical cosmetic practices that effectively meets the challenge of scarring from these procedures. Many of the same techniques are also employed in addressing scalp scarring from trauma and scalp surgical procedures.

A wider scar can come to be as the result of stretching. Stretched skin can have a variation in color, different from the skin surrounding the scar. Bringing hair into the scarred area can meld this difference. Blending the contrast is the key to success. Follicular unit grafts with FUE and trichophytic closure on one or both edges of the scar is the best technique. Many people need various transplants into the scalp to better disguise the scar.

A scar that is wider than expected gives evidence that some level of stretching has occurred. Skin that is stretched typically has a contrasting color to neighboring skin. Minimizing this contrast is one of the key approaches to reducing this type of scar. Hair transplant surgeon can reduce the contrast by bringing hair inside the scar by a variety of techniques to minimize the contrast between the hair bearing scalp and non-hair bearing scar. That is done through placing follicular unit grafts with FUE procedure or by performing trichophytic closure on one or both edges of a scalp scar. Many people may need more than one hair transplant into their scalp to improve the reduction in visibility of the scar.

If you are suffering from a scalp scar, you need to find a good hair transplant surgeon with plenty of experience with treatment of scalp scars. A simple consultation would make the overall plan clear. The plan may include a surgical procedure, using cosmetics for hair and scalp and hair style changes.

Parsa Mohebi, MD
US Hair Restoration, Los Angeles, CA, USA.

Hair Transplant Scar Revision

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Hair Transplant Scar Revision Options

Hair transplant surgery can sometimes lead to unanticipated and esthetically displeasing linear scars at the donor sites. A creative medical approach combining scar revision and/FUE Hair Transplant can mitigate the appearance of a hair transplant scar. Permanent tattooing in a small degree can also obscure the scar bringing a level of satisfaction to the patient when wearing a short hair style exposing your natural scalp.

Hair Transplant Scalp Scar

Trichophytic Closure

This method allows hair to grow inside the scar and minimize the contrast between scar and surrounding areas of the scalp. Trichophytic closure is performed by preparing one side of the surgical wound to allow the hair follicles on the margin of the incision to produce hair that will grow through the scar. There are various ways hair restoration surgeons prepare the incision. The end result is to allow for hair to grow through the margins of the scar as healing takes place. The hair growing through the scar borders camouflages the typical straight linear appearance of a hair transplant scar. The scar is present but as in all successful scar revision it is rendered less visible.

FUE Hair Transplant Procedure

Follicular Unit Extraction (FUE) is a method of extracting individual hair follicles which leave little to no scarring at all. In revisioning a scar a hair transplant surgeon can harvest a modest number of grafts from the various areas on the back of the head in a manner that is virtually unnoticeable. Those grafts can then be transplanted into the scar area strategically. Upon healing and the regrowth process the scar is hidden more because of the hair growing from its margins. This procedure combined with Trichophytic Closure is one of the most effective ways of hair transplant scar revision.

Evolution of Scars – Part 2

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Why Do We Have Scars?

“Human wound healing appears to have been optimized for quick healing in dirty conditions,” Mark W. J. Ferguson, Ph.D., University of Manchester.

Part II
Before and After Facial Scar Revision of Young Woman
Anthropologists and science have yet to explain why humans develop larger and thicker scars than other animals. Our response to scars reaches back through the eons of human evolution. A physically weaker structure than most mammals; humans live longer than any other mammal it perhaps is our species wound healing that allows us to thrive. When we’re injured; cut or burned, the immune system is immediately activated to close the wound and heal it.

Surgeon N. Scott Adzick, M.D., researches and studies scarring at the Center for Fetal Diagnosis and Treatment at the Children’s Institute for Surgical Science in Philadelphia, he notes:

“If you’re a caveman or cave-woman running around, and you get bitten by a saber-toothed tiger, it makes sense to patch that wound together as quickly as possible in order to survive, as opposed to devoting the body’s energy and resources to healing perfectly”

The result is that our bodies’ rapid immune response to inflammation leads to the larger and thicker scabbing and scarring. Some social anthropologists theorize that scars served as sexual attractors. Heavily scarred early men would be more attractive because it indicated there bravery and strength in survival.

No matter the theory or culture scars are part of human life; if you know someone who is experiencing anxiety from scars. Today’s cosmetic medicine may have the answers.

Evolution & Psychology of Scars

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Part 1

How Scars Make Us Feel

Man with extensive facial scar
There is unlikely an adult human on the planet without a scar. Most scars are not of consequence to cause severe emotional or physiological issues. Wound research has proven that the age of the person, gender and location of the scar are factors on how it will affect a person. In addition how the scar occurred can make it more of a problem. Facial scars cause more duress and scars that may be disfiguring or near around intimate areas of the body. Society premium appearance contributes to the anxiety associated with scarring. Stereotypes in moving show scarred people to be unpleasant, sadistic and mean.

However in some cultures consider scars desirable and are intentional and deliberate. Some tribes identify their clan and families by scar markings this was very common in Nigeria though the custom is no fading. Traumatic scarring is often very different. I greatly distress the person suffering from the scar and detract from their quality of life. Some anthropological studies indicate that facial symmetry seems to be innate attraction within humans; clearly facial scarring moves a person further away from what maybe a pre-programmed ideal. People who have adverse reaction to the scars can experience embarrassment and loss of self-image. Over long term this can lead to isolation, anger and self-loathing. In worse case scenarios psychological conditions that need to be treated can develop.

Today’s modern surgical techniques in the field of cosmetic surgery now provides many options in scar revision. Birth Marks, skin anomalies as well as scars can be treated with much success.

Read Part II of the Evolution of Scars

Scarring and Breast Cancer

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Scarring and Breast Cancer

Healing and Coping with Physical and Emotional Scars

Breast cancer is often treated by minor or major surgical intervention; from a lumpectomy to radical mastectomy life changing surgery takes place. This means that the treatment of breast cancer surgery that unavoidably leaves scarring as part of the process. The concern for loss of life is for many women often underscore by the fear of disfigurement and loss of feminine ideal and beauty. However this is not inevitable.

Breast Cancer Scarring Is Not Only To The Body

The journey to healing from breast cancer surgery always leaves the challenge of mitigation scarring from the minor to major depending upon the surgical treatment required to restore the patient’s health. Even radiation therapy can leave lasting marks. These scars can range from localized, temporary burns that resemble sunburn or a hardened, rigid-type known as radiation fibrosis. Chemotherapy can potentially leave some scarring. The chemotherapeutic medicine is often delivered through an intravenous line or catheter, and since these catheters are inserted during minor surgical procedures that pierce the skin. In some cases a patient’s ability to heal has seriously been compromised; these minor procedures can cause scarring at the site. In extreme instances sites may have to be rotated because of the patient’s inability to heal well and the subsequent scarring.

Factors that Affect Scarring

The breadth and or amount of scarring from breast cancer treatments depends on several factors:
• the type of surgery performed
• each patient’s individual capacity to form scar tissue.
•
Lumpectomy & Mastectomy Scarring
Sixty percent of patients prefer for lumpectomies, surgery that spares the breast and much of the surrounding tissue while removing the cancerous tumor or cells. Still scarring can be a problem. These surgeries range from the removal of a very small amount of breast tissue for testing; to having a full quarter of the breast taken to eradicate the cancer. The result is quite often an asymmetry in the shape of the breast that is emotionally disconcerting to the patient. This feeling is part of the emotional despair experienced by the forty percent of patients who undergo a modified radical mastectomy or the radical surgical removal of the entire breast. These invasive surgical procedures result in a long, slit-like scar that runs from the breastbone to up under the pit of the arm.

For both the lumpectomy and the mastectomy, breast reconstruction is optional, but one of the ways to achieve this actually results in at least one more scar. A flap of tissue can be taken from the women’s abdomen or other area of the body, depending on the amount needed to restore the form of the breast, this results in additional scarring at the site from where the tissue was taken from.

Scars, Body Image, and Intimacy

“Some women choose mastectomy with reconstruction, because they feel there will be a better cosmetic outcome,” says Debbie Saslow, PhD, director of breast and gynecologic cancer at the American Cancer Society in Atlanta. “Some women have a really strong reaction to the scarring – it affects their body image and their sex lives – and other women can almost ignore it.”

The overt presence of scars that are difficult to disguise when a mastectomy patients disrobe can be troublesome for the patient. Many patients who initially decide against breast reconstruction opt for it ater which makes for a more difficult surgery. Patients are not only self conscious about the scars; they fear having to explain them in intimate relationships. This underscores the importance of having a fully holistic team prior to surgery. A consult with counselors and plastic surgeons should be utilized to address the concerns and fears prior to surgery. Discussing with other breast cancer patients who have undergone the surgery is helpful. Those who have and have not opted for breast reconstruction is advisable.

Healing and Reducing Scars

Some of the best ways to limit scarring are:
• by preventing infection immediately after surgery
• lightly stretching and massing the scar area daily during the first year, when most healing occurs
• medical consult with surgeon specializing in scar revision
• ensuring proper surgical site drainage which is inevitable
• keeping the wound clean
• following physicians orders in bandaging the wound
• transverse friction massage by a therapist

The implications of scarring aren’t only in appearance. There can also be pain associated with tightness and pulling. This can be moderate to severe in patients. Various professional modalities and therapies can be used to guide and assist the patient in their wound healing. Some are deep and soft-tissue massage, physical therapy if the muscular structures of the chest and shoulders have been involved to any degree. Alternative therapies such as yoga, which involves deep breathing and full-body stretches, as well as, acupuncture can be used to assist in the recovery of patients who have undergone surgery from breast cancer.

Dermabrasion Scar Revision

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Before and After Dermabrasion Scar Revision
Dermabrasion Advances Scar Revision

The disfigurement of facial scarring is one of the most traumatic injuries that a person “literally” has to face the world. Long after the often excruciating pain and initial wound healing; a person endures social stigma and deep psychological wounds and depression. Modern advancement provides new hope and relief in the hands of today’s highly skilled cosmetic surgeons. The advances in Dermabrasion technique in adjunct with other dermatologic surgical procedures have put it at the forefront as a scar revision treatment.

Dermabrasion is non-surgical. It is a technique that is used to revise scars with abnormal skin texture or to reduce ones that are raised. It can also used in conjunction with other methods of scar revision to further blend the skin surface.

Dermabrasion Basics

Unlike micro-dermabrasion; dermabrasion creates a wound that can take a few days or a week to completely heal. The purpose is to give the skin a smoother and more refined appearance than prior to the procedure. The use in scar revision becomes obvious. Dermabrasion is analogous to a finishing carpenters sanding of fine woodworking. Micro-instruments with an abrasive rotary tip are used to refine the contour of the skin. This medical procedure also requires a delicate touch and a since of artistry. Scar revision is intended to improve the cosmetic appearance of skin irregularities and blemishes resulting from prior injury or unsatisfactory surgical repair. These include scars that are raised, discolored, depressed, poorly aligned and/or have mismatched texture. Often times scars that are quite obvious and unsightly can be revised to blend naturally into the surrounding skin, making them barely noticeable.

Dermabrasion has minimal complications when expertly performed. The simplicity of learning the procedure advanced its popularity in dermatology. Some applications formerly treated with Dermabrasion are now treated with lasers. Yet within specific medical indications it remains a bona fide modality with the best facial plastic surgeons.