INTRODUCTION: To determine which of the two most common methods of cesarean skin closure resulted in greater patient satisfaction and better cosmetic outcome. METHODS: We conducted a prospective, multicenter, randomized clinical trial in which women undergoing cesarean delivery via low transverse skin incisions were allocated to skin closure with suture or staples. Patients were asked to rate their satisfaction with closure method and with skin cosmesis using a Likert scale. We used a validated scar assessment tool (the Patient and Observer Scar Assessment Scale with subjective and objective components) to evaluate cosmetic outcome. To minimize interobserver variability, we limited cosmetic outcome assessments to the primary research site. Standardized assessments were performed by one of seven trained clinicians who were blinded to the skin-closure technique. RESULTS: A total of 746 women were randomized from 2010–2012: satisfaction data were available for 606 (81%). Overall satisfaction with closure method and satisfaction with skin cosmesis were significantly higher in women who received suture closure (Table 1). There was a positive correlation between cosmetic satisfaction and overall satisfaction. Both the subjective and objective components of the Patient and Observer Scar Assessment Scale favored suture.CONCLUSION: Suture closure was associated with greater patient satisfaction and improved patient and physician cosmetic assessments as compared with staple closure of the skin incision at cesarean delivery.