There's a number of good reasons and also bad reasons for the appearance of incisions. Crooked incision: flank incisions rarely end up perfectly straight and I

There's a number of good reasons and also bad reasons for the appearance of incisions. Crooked incision: flank incisions rarely end up perfectly straight and I understand the cesarian in the conscious patient is not optimal from a surgical positioning standpoint, though good for the patient and baby. Odd spacing: in live tissue, even when you measure 6mm or whatever the tissue seems to move. In addition, there is often a bit of subcutaneous tissue that is hidden better with one placement over another. Half hitches: these are bad knots, and one of the failure modes of the square knot. If surgeons are leaving lots of these they might be careless. However, monofilament suture has more likelihood to form them and it's preferred on the skin. Loose ends: monofilament suture is a little unforgiving and the last throw often does not stay in place. This is why 4 throws of the square knot is preferred. Speed: how long do you want your patient to wait for you to finish the cosmetic portion of the incision? A model might have a plastic surgeon on hand to finish the job. The layers you cannot see are the important ones from the standpoint of no hernia or infection. Hopefully they are all done flawlessly, but there cosmesis is not the goal.