Quad Cities, IL/IA

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Cesarean (“Hangover” and “Front Butt”) Scar Correction


Submitted by Diamond Medical Spa and Vein

Statistically, except for when driving a car, the most dangerous time of a woman life is when she is pregnant. A major factor in the risk profile of pregnant woman is the additional risk of cesarean delivery. In the United States Cesarean sections (C/S) are performed for 30 percent or more of deliveries. In Malaysia and Singapore, the wealthy women elect to have scheduled cesarean section deliveries, and only the poor deliver vaginally. China and Viet Nam have 50 percent cesarean section rates, which the World Health Organization characterizes as being “epidemic proportions.” In Africa the cesarean section rate is 9 percent.

In the 1970s through 80s in this country there was a philosophy in Obstetrics that advocated, “once a cesarean, always a cesarean.” That is to say that many Obstetricians believed once a woman had a cesarean section, they should not be allowed to deliver vaginally with future pregnancies.” In those days, there were fewer protocols, policies, and standards for guidance. Vaginal delivery after a cesarean section (VBAC) was considered too dangerous due to the risk of uterine rupture during labor. Indeed, uterine rupture can result in catastrophic complications, including death of the pregnant mother and her baby.

In the Southern states, Cesarean rates (C/S) are high, almost 40 percent in Louisiana. Midwest C/S rates are 25 to 27 percent. There is a lot of variation regionally. Patients sometimes choose cesarean over vaginal delivery because they want to avoid urinary incontinence that may arise from trauma to the birth canal during vaginal delivery. A major factor in the increase in cesarean delivery is the national obesity epidemic affecting pregnant women. This causes the baby not to be able to fit through the birth canal. A C-section isn’t bad if it is necessary, but some of the scars can be quite horrible.

The sheer number of C-section deliveries per year in the U.S. is over 1,284,500. That’s a lot of C-section scars. The most common C/S incision is called Pfannenstiel (pronounced “fan-in-steal”). This is the sideways or transverse incision above the pubic bone. It is by far the most aesthetically pleasing and best healing when performed well. The transverse incisions tend to heal well because it occurs parallel instead of perpendicular to Langer’s Lines.

Unless the patient already has a pannus (fold of fat hanging over the belt line) these incisions may not look their best if the surgeon does not suture (sew) the deep layers of fat together before closing the skin. If the skin then heals close to the fascia (layer covering the rectus muscles) it causes the residual abdominal pregnancy fat to fold over (“hangover”) the incisional scar.

The worst healing C-section incision is the Vertical Midline Incision. This scar causes a major aesthetic distortion of the abdomen. Women have complained of having a “front butt” or “two butts.” The reason it occurs is that this incision cuts across Langer’s Lines, which causes more scaring, especially if the surgeon is not careful to suture the deep fat back together. If the skin heals directly to the fascia, the normal scar contraction will be accentuated if the woman is overweight. The resulting crease in the center of the lower abdomen gives the appearance of a buttock.

The next secret to having a fabulous C-section scar is a carefully planning and drawing the incision line with a sterile surgical marker immediately prior to cutting the skin. The drawing must be performed with the patient in a neutral position on the operating table without a tilt. The incision must follow Langer’s Lines. There can be no tension across the incision line. Dr. Yates leaves the steri-strip wound reinforcement tapes on for three to four weeks postoperatively. No woman wants to look at a bad Cesarean scar every time they undress or even worse — see the dreaded “hangover” or “front butt”.

Other poor aesthetic results may be a keloid scar, uneven fat distribution, or asymmetry. The majority of unhappy C-section scar results can be revised in the office setting using a mild sedative. Dr. Yates has a reputation for performing thousands of beautiful, amazing cesarean incisions. Many of them are nearly invisible and difficult to see after they fully heal. At Diamond Medical Spa and Vein, scar revision may require the use of Tickle Lipo body sculpting, scar excision, Mini-abdominoplasty (mini Tummy Tuck), ThermiTight radiofrequency therapy, Exilis skin tightening, or intra-lesional steroid injection.

Some scar revisions may be covered by insurance, though the majority of them are considered to be cosmetic and not medically necessary. A couple of days of antibiotics are usually prescribed to reduce the possibility of wound infection. Sterile technique and surgical scrub is performed after a preoperative shower at Diamond. During the procedure, clients watch movies on our big screen in the procedure room, listen to music, or play on social media. The majority of patients only need Ibuprofen for minor discomfort following scar revision. There is minimal or no downtime depending on the complexity of the treatment.

Everyone knows someone with a “bad belly.” Tell them about Diamond Medical Spa and Vein. Diamond has the “Minimally Invasive, Maximum Results” techniques to turn a C-section frown upside down. The type and amount of treatment is individual and a free consultation is available. Contact Diamond on the web at www.diamondmedicalspandvein.com, Facebook, Doctor.com, or call them at 563 275-4701.

Photo credit: Nobilior/AdobeStock