In short
- Timing is everything. Starting at one month or earlier improved the scar scales; starting after three months was indistinguishable from control.
- The centre’s protocol is sessions at the first, second and third month, which is exactly where the evidence places the effect.
- 🔑 The surgery does not have to have been ours: it can be applied to the scar of a caesarean done anywhere, with no operation beforehand.
- ⚠️ At first it looks as though it is getting worse. In the only trial carried out on caesarean scars, redness and pigmentation dominated the appearance between the first and third month; the benefit became visible at six.
- It can be done while breastfeeding. Laser introduces no substance into the body and no interference with breastfeeding has been observed.
- 🔑 And here it is done without topical anaesthetic, precisely so as not to expose a breastfeeding mother to any drug. It is a decision of caution, not an obligation.
- ⚠️ What does need bearing in mind is the risk of pigmentation, because the postpartum period is more prone to it.
Laser improves surgical scars, and when you start changes the result more than any other variable. In a meta-analysis of fourteen trials, starting at one month or earlier significantly improved the scar scales; starting after three months was indistinguishable from doing nothing.
That is the reason for the centre’s calendar — sessions at the first, second and third month — and also why this page exists: the protocol can be applied to a caesarean scar even with no surgery of ours beforehand, and the window in which it works best coincides exactly with the moment when many women do not even consider that anything can be done.
This page deals with the part about the appearance of the scar that the caesarean sequelae page mentions without going into.
Why the timing is everything
A meta-analysis of fourteen controlled trials with 492 participants or surgical scars looked specifically at the optimal moment to start with fractional CO₂ laser (Ji, 2025):
| Comparison | Mean difference on scar scales | |
|---|---|---|
| Starting at one month or earlier versus control | −1.66 (95% CI −2.31 to −1.01) | p < 0.001 |
| Starting at one month or earlier versus starting after 3 months | −1.93 (95% CI −2.24 to −1.62) | p < 0.001 |
| Starting after 3 months versus control | −0.17 (95% CI −0.56 to 0.21) | p = 0.37, not significant |
🔑 Read the third row, which is the one that changes the decision: starting late was indistinguishable from doing nothing. It is not that it works less well: it is that in that analysis it did not separate from control.
The centre’s protocol starts at one month, and that is where the effect is. The authors also note that, although a single session within the first month already produces significant results, most of the trials support two or three sessions or more — which is the calendar followed here.
⚠️ One framing caveat that has to be respected: that meta-analysis measures surgical scars in general, not caesarean scars in particular. The support for “at one month” comes from there, and saying otherwise would be overselling the source.
What is known specifically about caesarean scars
There is one trial, and it is worth telling in full because it changes what to expect.
A randomised trial with a split-scar design — each woman with half treated and half as control — in 12 patients with mature caesarean scars, with three sessions of ablative fractional laser (Karmisholt, 2017):
- At one month, the treated half was significantly better in pliability and in surface relief.
- Between the first and third month, the overall appearance was dominated by transient redness and hyperpigmentation, confirmed by measurement.
- At six months, blinded photographic assessment found the treated scars significantly better, and histology showed new collagen and elastic fibres.
- 64% of the patients asked for the control half to be treated as well.
🔑 The conclusion of the paper itself is the most useful information that can be given before starting: the remodelling begins at one month, but the improvement stays hidden until the colour changes the laser itself produces have resolved. Anyone who does not know that will think, at the second month, that it has got worse.
⚠️ And one difference from our protocol that should not be glossed over: that trial was done on mature scars, not recent ones. That is, it is not the proof that starting at one month is better in caesarean scars — that comes from the general meta-analysis — but the proof that laser works on this particular scar.
It can be done while breastfeeding
It is the doubt that holds most people back, and it has an answer.
Laser introduces no substance into the body. It acts on the skin with energy, not with a drug, and no interference with breastfeeding has been observed. That is the argument, and it is worth stating explicitly because that is the doubt the reader brings.
When the patient is breastfeeding, the procedure is done without topical anaesthetic, to eliminate any possible risk of absorption and passage into breast milk. It is not a peculiarity of this centre and it does not answer a demonstrated problem: the US National Library of Medicine’s lactation database records that concentrations of lidocaine in milk are low, that the infant absorbs it poorly, that no adverse effects are expected and that no special precautions are required (LactMed). It is dispensed with because it can be dispensed with.
⚠️ What does need bearing in mind is the risk of pigmentation. The postpartum period is a state prone to melasma, and on skin like that the risk of hyperpigmentation after an ablative laser is greater — the more so the higher the phototype. It is a warning and a matter for prior assessment, not a contraindication, and it fits with what the trial on caesarean scars documented: transient pigmentation peaking towards the third month.
🚨 And it is worth saying where the opposite idea comes from. The claim that “you cannot have laser while breastfeeding” circulates mainly on commercial pages, not in guidelines, and the reason given — “the hormonal changes” — points precisely to the above: to the risk of pigmentation, not to a risk to the baby.
What to expect, and what not to
It can improve the pliability, the relief, the texture and the colour of the scar, and the effect accumulates with the sessions.
It cannot make it disappear, or remove skin, or correct a bulge that comes from fat displaced out of plane. If what there is is a mechanical shelf, the laser improves the scar and leaves the shelf where it is — and knowing that beforehand avoids disappointment.
Nor does it act on adhesion, which is another problem and is worked on differently: it is covered in the conservative route.
What each session is like
It is applied to the scar and the area immediately around it, as an outpatient session. Afterwards there is redness and a sensation of heat, and over the following days a fine flaking.
The aftercare — strict sun protection included, which is what most influences the risk of pigmentation — is set out at the assessment. The detail of the procedure is on the fractional CO₂ laser page and the full calendar in the scar protocol.
The protocol, and what it costs
On a recent scar the protocol is six sessions: three of intense pulsed light and three of CO₂ laser, at one month, two months and three months. €800, with the prior assessment consultation included. It can be booked through the centre’s shop, in the scar treatment protocol package.
⚠️ On an old scar the regimen is different, and it cannot be given in advance: it depends on the type of scar — how old it is, whether it is raised, retracted, widened or only pigmented — and a doctor has to assess it before setting sessions or a price. What is known is that the result to be expected is smaller than on a young scar, and that is said in the consultation.
Book an appointment
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Frequently asked questions
Is laser any use if my caesarean was years ago?
It works on mature scars — the trial specific to caesarean scars was carried out precisely on those — but it works considerably less well than starting early: in the meta-analysis, starting after three months was indistinguishable from control. If the scar is old, an assessment is worth having to calibrate the expectation.
Can I have it while breastfeeding?
Yes. Laser introduces no substance into the body and no interference with breastfeeding has been observed. Here it is also done without topical anaesthetic, so as not to expose you to any drug.
Why does it look worse a month after the session?
Because the laser itself produces transient redness and pigmentation, which dominate the appearance between the first and third month. The benefit stays underneath until that colour resolves: in the trial specific to caesarean scars, it became visible at six months.
How many sessions do you need?
The centre’s protocol is three, at the first, second and third month. The meta-analysis notes that a single session within the first month already produces significant results, but that most trials support two or three or more.
Will it get rid of the shelf?
No. Laser works on the scar, not on the contour. If the bulge comes from fat displaced out of plane, it will improve the scar and the shelf will still be there.
Is there a risk of pigmentation?
Yes, and it is the effect worth knowing about: the postpartum period is prone to melasma and on that skin the risk of hyperpigmentation after an ablative laser is greater, the more so the higher the phototype. It is assessed beforehand and the sun protection afterwards is part of the treatment.
Do I have to have had my surgery with you?
No. The protocol can be applied to the scar of a caesarean done at any centre, with no surgery beforehand.
Sources
- Ji Q, Luo L, Ni J, Pu X, Qiu H, Wu D. Fractional CO₂ laser to treat surgical scars: a systematic review and meta-analysis on optimal timing. Journal of Cosmetic Dermatology. 2025;24(1):e16708. PMID 39780524 — Fourteen controlled trials with 492 participants or surgical scars. Starting at one month or earlier improved the scales compared with control (MD −1.66; 95% CI −2.31 to −1.01) and compared with starting after 3 months (MD −1.93; 95% CI −2.24 to −1.62); starting after 3 months was indistinguishable from control (MD −0.17; 95% CI −0.56 to 0.21; p = 0.37). It notes that one session within the first month already produces significant results and that most trials support 2-3 sessions or more. Surgical scars in general, not caesarean scars. Verified on 29-08-2026.
- Karmisholt KE, Taudorf EH, Wulff CB, Wenande E, Philipsen PA, Haedersdal M. Fractional CO₂ laser treatment of caesarean section scars — a randomized controlled split-scar trial with long term follow-up assessment. Lasers in Surgery and Medicine. 2017;49(2):189-197. PMID 27862066 — Randomised within-patient split-scar trial in 12 patients (11 completed) with mature caesarean scars and three sessions. At one month, significant improvement in pliability and relief; between 1 and 3 months, predominance of transient erythema and hyperpigmentation; at 6 months, significant improvement on blinded photographic assessment and histology with new collagen and elastic fibres. 64% asked for the control half to be treated as well. Verified on 29-08-2026.
- Drugs and Lactation Database (LactMed). Lidocaine. National Institute of Child Health and Human Development / National Library of Medicine, Bethesda. Entry on NCBI Bookshelf — “Lidocaine concentrations in milk […] are low and lidocaine is poorly absorbed by the infant. Lidocaine is not expected to cause adverse effects in breastfed infants. No special precautions are required.” It supports the point that avoiding topical anaesthetic here is a decision of caution and not a necessity. Verified on 29-08-2026.
- Pelosi MA 2nd, Pelosi MA 3rd, Romero R. The cesarean apron: description, proposed pathophysiology, classification, and prevention through Scarpa fascia closure at cesarean delivery. American Journal of Obstetrics and Gynecology. 2026;233(6S):S118-S128. PMID 41485815 — It describes the mechanism of the contour bulge, which laser does not correct. It supports the limit this page publishes: the scar is treated, not the shelf. Verified on 29-08-2026.
Book your consultation
If your caesarean is recent, this is the moment when the treatment works best, and it is worth an assessment before the window passes. And if it is an old one, it can be assessed too: the scar is looked at and you are told frankly what can be expected, which will be less than starting early.
Clinical confirmation by the surgeon
Registration no. 46/4624077
Registration no. 46/4624503
Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
