Correcting the Bulge above a C-section Scar with Tummy Tuck, Liposuction, and other Options

One of the most common problems that patients come to see me about is a bulge or fullness just above a C-section scar.  These bulges are notoriously resistant to diet and exercise and can impose limitations in the choice of clothes and swimsuits.  Even in a trim and otherwise athletic woman, this bulge may be quite noticeable, especially on side view.

As with all other aspects of plastic surgery, proper treatment comes from making a proper diagnosis.  There are three factors which contribute to the bulge: a tight band of scar tissue underneath the original C-section scar, excess fat in the lower abdomen, and loose skin.  The relative contribution of each of these factors will determine the best treatment.

In almost all cases one of the key factors is a tethering of the C-section scar to deeper tissue underneath.  This means that when a woman stands, the skin below the scar is anchored to a high position, so that the tissues above the scar tend to bulge over it.

For some women the only problem is the tethering of the scar.  Usually the best treatment involves surgical removal of the scar and release of the tethering beneath it, so that the skin will glide in a normal manner.  Sometimes if the scar at the skin surface itself is fine and the only problem is the band of deeper scar tissue, this can be released by means of a trick known as a Rigotomy, after the surgeon who developed the technique.  A needle is passed through the skin, and the sharp tip of the needle is used to break the bands of scar tissue that tether the surface scar to the deeper tissue.

Perhaps the most common pattern is a tethered scar, loose skin of the lower abdomen, and a concentration of fat in the lower abdomen.  If there is reasonably good tone of the deep muscles and fascia, a combination of lower abdominal liposuction with removal of the scar and some of the skin above it will restore a nice balance to the abdomen.

If the deep tone is good and there is a significant amount of loose skin both below and above the umbilicus and a tethered C-section scar, then a superficial abdominoplasty, usually combined with liposuction, will be helpful.  This will remove the scar and excess skin above it move the umbilicus to a better position and sculpt the excess fat that may be present in the central abdomen.

For some patients there is a significant loss of deep structural support in addition to the loose skin, excess fat, and tethered scar that we have already discussed.  These patients will usually get the best results with a full abdominoplasty  by one of several versions of the high lateral tension technique.  This involves tightening of the deep muscles and fascia that play a key role in supporting the abdominal wall.

We would be happy to analyze your particular situation and explain the options that will be best for you.  Please contact us at 312-751-2112 or to further information or an appointment for a consultation at our Chicago or Winnetka office.

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