The two words that strike fear in any women and increasing men too. But what are they? What can I do to avoid them? And what can be done to treat them?

With regard to stretch marks, there is both good news and bad news. The good news is that traditionally there has been very little that could be done to effectively treat stretch marks, but this has radically changed over the last few years. The bad news is that they remain almost impossible to avoid.

Before working through your avoidance and treatment options in detail, lets discuss the causes of stretch marks, and what makes them so difficult to treat.

What causes stretch marks?

In a nutshell, stretch marks are caused by extensive stretching of the skin over a short period of time. This causes the dermis (middle layer) of the skin to tear allowing deeper skin layers (subcutaneous) to show through. This leaves linear scars below the surface that are visible at the surface.

Medically stretch marks present no medical problems but they can cause much distress for those affected in terms of self-confidence. Hence the continued advances in aesthetic medicine to improve them.

Stretch marks affect women more than men and affect all ages and races equally.

Pregnancy is a leading cause of stretch marks, which presents itself on both the belly and breasts. In men the most common place for stretch marks is the upper body in men who participate in sports or gym extensively.

Genetics does play a significant role in the formation of stretch marks, so too rapid weight gain. So the best advice to avoid stretch marks is to remain at a regular body weight and hope your genetics favour you.

What can be done to prevent stretch marks?

Recent studies on pregnant women suggest that no preventative topical treatments will prevent the onset of stretch marks. This group is most affected by stretch marks and we can assume that if topical treatments for prevention show no preventative qualities in pregnant women then this should translate. The study does suggest however that more rigorous studies need to be performed.

The best advice to avoid the development of stretch marks is simple. avoid rapid weight loss or gain especially in high-risk groups such as teenagers and expecting mothers.

Treatment of stretch marks

As mentioned before there have been traditionally very few predictable treatment options available, but latest research suggests that the sooner the treatment begins the more likely you will have success. Adolescents who develop stretch marks due to puberty are also believed to see improvement as they age.

Stretch marks most commonly respond to clinical treatment in their early stages, but once they become white only a few treatment options exist that offer any improvement and the treatment thereof becomes very difficult in terms of result and patient expectation management.
Clinical papers support a combination homecare and physician care to provide best results in early formed stretch marks. This protocol includes intense moisturisation and vitamin C applications, plus chemical peels and retinols.

The problem does exist when treating pregnant or breast feeding women with early forming stretch marks in that you are limited by infant/foetal development concerns.

What are your clinical options?

A patient dedicated to the treatment of their stretch marks will continue a topical treatment at home, this element serves as an adjunct to clinical treatments and here are you options:

Non-ablative fractional laser

A study on 47 patients who developed stretch marks from undergoing breast augmentation surgery showed that non-ablative fractional laser offers encouraging results with less risk of pigmentation than other treatment options.

The results were assessed by two plastic surgeons based on clinical and photographic evidence from before and four weeks post treatment, and the patient satisfaction was recorded too.

Non-ablative fractional laser is a recognised gold-standard stretch mark treatment option, but due to the expense is seldom utilised. The treatment plan is based upon the FDA approved “collagen remodelling” theory that increased collagen to the stretch mark site will improve the visibility of the scar.

There are various non-ablative manufactures on the market today but most prominent platforms we as South Africans will come across include:

Palomar StarLux and Fraxel non-ablative.

The stretch mark reduction process involves precision beams coagulating columns in the dermis and epidermis. This action triggers the healing process that creates new healthy tissue and the formation of new collagen.

A treatment schedule will vary from 5-10 treatments spaced 4 weeks apart.

IPL (Intense Pulsed Light)

Intense pulsed light, that emits a broadband visible light, has been reported to yield clinical and microscopic improvement in stretch marks. IPL is a positive treatment option with minimal adverse effects and little-to-no down time, plus the treatment is cost effective. Its worth in the treatment of photo damaged facial skin has been widely reported and it promotes the production of collagen and elastic fibers, hence the positivity toward the treatment of stretch marks.

PRP treatment

Platelet Rich Plasma in combination with microneedling is proving to be a stretch mark treatment phenomenon at the moment. PRP treatment is based on the “Healing Cascade”

When tissue is injured, the body signals itself to increase production of “signal proteins” to be used at the site of trauma. These signal proteins include platelets, white blood cells, and mesenchymal or “adult” stem cells. The growth factors contained in the signal proteins concentrated in PRP create the production of new collagen and elastin. You will see this theory applied throughout all the below treatment options.

Based on the healing cascade, the injected plasma increases the amount of collagen and growth factors being produced. This helps the skin to thicken and rejuvenate and in doing so reduce the visibility of the stretch mark. After the PRP is injected into the area, more PRP should be used as a topical covering.

Carboxytherapy treatment

Carboxytherapy is another treatment aimed at repairing collagen within the skin and with results thought to visibly improve stretch marks. By injecting CO2 into the area and using the body’s natural response to flood the area with oxygen we improve the visibility of stretch marks simply by the resulting collagen synthesis.

It is estimated that 8-12 treatments would be necessary for best results, and the treatments would be two weeks apart for the duration.

Microneedling

Microneedling takes the treatment stance that the stretch mark is a scar and sets about thickening skin to improve the visibility of deep scars. Microneedling would restore the skin contours of the epidermal surface to lessen the visibility of the stretch mark.

Based on similar principles to Fraxel microneedling relies on tiny injuries to the skin and the collagen synthesis as a natural reaction to improve the scar or in this case stretch mark.
There is no clinical evidence to prove that microneedling works as no significant studies have been completed.

Velashape

Velashape uses radiofrequency to open the collagen fibres and stimulates lymphatic circulation. This treatment option does not rely on the injured body response to treat the area and it is suggested that Velashape will have very little effect on stretch marks.This treatment may work well as a preventative treatment but it still remains a patient favourite, probably due to the painless treatment cycle.

Conclusions

Being that stretch marks are known to offer significant self-confidence stress it is not wonder that more and more men and women are searching for treatment options. So much in the treatment of stretch marks relies on the patient and the quality of their skin that it takes an experienced hand to offer any form of result expectation. That said more and more studies are being presented to offer a glimmer of hope to those suffering from the condition and take it from a so-so treatment to a protocol of predictability and success.

You are more than welcome to subscribe to our newsletter &/ follow us via Facebook  !

References:

Lasers and lights for the treatment of striaedistensae.

Savas JA, Ledon JA, Franca K, Nouri K.

Topical preparations for preventing stretch marks in pregnancy.

Brennan M, Young G, Devane D.

SamerAlaiti, MD, RVT, RPVI, FACP  Clinical Associate Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California; Medical Director, Miracle Mile Medical Center for Dermatology and Cosmetic Surgery, Inc

PlastReconstr Surg. 2013 Mar;131(3):636-42. doi: 10.1097/PRS.0b013e31827c7010.

Striaedistensae after breast augmentation: treatment using the nonablative fractionated 1550-nm erbium glass laser.

Guimarães PA, Haddad A, SabinoNeto M, Lage FC, Ferreira LM.

J Cosmet Laser Ther. 2013 Jun;15(3):120-5. doi: 10.3109/14764172.2012.748200. Epub 2013 Feb 5.

A comparative study of the effectiveness of intense pulsed light wavelengths (650 nm vs 590 nm) in the treatmentof striaedistensae.

Al-Dhalimi MA, Abo Nasyria AA.

Fractional Nonablative 1540-nm Laser Treatment of StriaeDistensae in Fitzpatrick Skin Types II to IV. Clinical and Histological Results

Francesca de Angelis, MD, Larissa Kolesnikova, MD, Franco Renato, MD, GiuseppinaLiguori, PhD