The most common C-section scar is a horizontal line just above your pubic hair.  The only part of the scar you can see is a line on the surface, but remember that the scar tissue is at every level from the skin to the uterus where the baby came out.  Sometimes, the scar tissue under the skin (in the fat, fascia, and muscle layers) can pull the skin scar inward and create a "tethered scar."  The tethered scar makes the whole scar line tuck in and can cause your belly skin to hang over the top like a shelf.  If it's a small amount of overhang, the excess skin can be cut out and the deep scar tissue can be released, allowing the scar to lay flat instead of being pulled inward.  This improves the appearance of the scar and the surrounding belly skin.  

Some women form very thick, rope-like scars at their C-section site.  This is usually caused by genetics, meaning that if a woman's body naturally forms thick scars, it will do so in this location as well.  There are two kinds of thick scars: 

1. Hypertrophic Scars.  This is the more common type of thick scar, and is formed because your body has an aggressive healing response to the trauma of being cut open.  This kind of thick scar is usually related to the way the injury happened, how it was closed, and your body's wound healing response.  For example, if you had an emergency c-section because your baby was in distress, your Ob/Gyn would have been appropriately focused on your baby and not your scar.    Hypertrophic scars can be revised and made to look better with reasonable success by cutting out the bad scar and lining up the edges again.  After surgery, we can use aggressive scar management including scar massage, silicone sheets, steroid injections as needed. 

2. Keloid Scars.  This is caused by a genetic condition that makes your body heal wounds by developing scar tissue all around the area of the wound.  True keloid scars are harder to manage, because the underlying condition (your body's natural wound healing process) can't be changed.  Attempts can be made at scar improvement; however, there is no guarantee that your keloid scar wont do the same thing again after revision.  To try to prevent re-formation of keloid scars, we typically cut the scar out and then treat the area with 3 doses of low-level radiation administered by a radiation oncologist.  The radiation seems to halt the abnormal scar formation and help you prevent keloid scarring.

Sometimes a C-section scar is vertical, extending from your belly button to your pubic hairline.  This is an incision that doctors use when the baby is in major distress, so obviously the focus is not on the scar. Unfortunately, if this scar becomes tethered to the underlying tissue, you get a '"front butt" that looks exactly as it sounds! 

Scar revision techniques are not as helpful for vertical scars, but a standard abdominoplasty (tummy tuck) removes this scar completely and replaces it with a low transverse scar near your pubic hairline.  (It also gets rid of the front butt.)