A hysterectomy is a surgical procedure involving the removal of the uterus, and sometimes the cervix, ovaries, and fallopian tubes. Since any incision leaves a scar, the visibility of the resulting mark depends entirely on the specific surgical approach used. Modern surgical techniques offer a wide spectrum of outcomes, ranging from a large abdominal scar to no external marks at all. This allows patients and surgeons to consider cosmetic preferences alongside medical necessity.
Scarring from Abdominal Hysterectomies
The traditional method, known as an abdominal hysterectomy, requires a single, large incision in the lower abdomen for direct access to the pelvic organs. This open approach is typically reserved for cases involving a very large uterus, extensive internal scarring from prior surgeries, or certain complex cancer surgeries.
Surgeons use two primary types of incisions for this procedure, each with a different cosmetic outcome. The most common is the horizontal incision, often called the Pfannenstiel or “bikini cut,” which is typically made just above the pubic hairline. This incision is usually several inches long and follows the natural creases of the skin, allowing the resulting scar to be concealed by underwear or a bikini bottom.
The second type is the vertical or midline incision, which runs from the navel downward toward the pubic bone. This approach provides the surgeon with a greater field of view and more access to the upper abdomen, which may be needed in more complicated cases. While the vertical scar is generally more noticeable than the horizontal cut, the choice of incision is ultimately dictated by the size of the uterus and the extent of the disease being treated.
Scarring from Minimally Invasive Hysterectomies
Minimally invasive approaches have largely replaced the traditional open method, significantly reducing the size and visibility of external scarring. These techniques include laparoscopic, robotic-assisted, and vaginal hysterectomies.
A standard laparoscopic hysterectomy involves using a laparoscope and surgical tools inserted through small openings in the abdomen. This results in three or four small “keyhole” incisions, each typically about the size of a dime or a penny. These tiny scars are often placed near the belly button, where one incision is frequently hidden, and in the lower abdomen.
The robotic-assisted hysterectomy uses a similar technique, where the surgeon controls precise instruments through tiny ports inserted into the abdomen. The scarring profile is comparable to a standard laparoscopic procedure, resulting in several small, fine-lined incisions. Over time, these small laparoscopic and robotic scars tend to fade significantly.
The vaginal hysterectomy is the least invasive technique and results in no external abdominal scars. In this procedure, the uterus is removed entirely through an incision made around the cervix inside the vagina. This method is often preferred when possible, though it may not be an option if the uterus is too large or if there is a need to access other abdominal structures.
Post-Operative Scar Management
Regardless of the surgical method used, the incision site will go through a natural maturation process over several months. Initially, the forming scar will appear raised, firm, and reddish or pink due to the intense collagen production and blood vessel formation during the early healing phase. The scar will gradually soften, flatten, and fade to a color closer to the surrounding skin, though this process can take anywhere from 12 to 18 months, or even up to two years.
Long-term management strategies can help optimize the final appearance of the scar once the initial wound has fully closed. Scar massage should begin a few weeks after surgery, using firm, circular pressure to help break up developing scar tissue and improve flexibility. This technique is often performed twice daily for several minutes using a moisturizer or oil.
Silicone-based products are often recommended because there is evidence that they help flatten, soften, and fade scars by keeping the area moisturized and reducing collagen overgrowth. These products, available as adhesive sheets or topical gels, should be worn for at least 12 hours a day over a period of months for the best results.
Protecting the scar from the sun is also important, as early sun exposure can cause the developing scar to pigment and become permanently darker and more noticeable. Applying a broad-spectrum sunscreen with an SPF of 30 or higher and keeping the area covered with clothing are standard recommendations.