Stretch mark removal
Above: Photos of a client before and after treatment for abdominal skin laxity at Dr Bob Clinic. Consent obtained for use of image. Photos are for reference only, individual results may vary.
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What are stretch marks
Stretch marks are fine lines that become apparent on the body when there is tearing of tissues under your skin from rapid growth or over-stretching. It is a common condition that does not result in significant medical problems but can be a matter of cosmetic concern. Clinical names for stretch marks are striae rubrae (which are red) and striae albae (white) striae atrophicans (thinned skin), striae gravidarum (following pregnancy), striae distensae (stretched skin), striae nigrae (black) and striae caerulea (dark blue).
What do stretch marks looks like
An early sign of stretch marks developing is when an area of skin becomes flattened and thin with a pink colour. This may also occasionally be itchy. Soon reddish or purplish slightly swollen lines develop perpendicular to the direction of skin tension (striae rubrae). The terms striae caerulae (blue) and striae nigrae (black) have been used to describe striae distensae that appear darker than usual due to increased melanization. Subsequently, these lighten to become either hypopigmented or flesh-coloured and much less conspicuous (striae albae). Stretch marks are usually several centimetres long and 1–10 mm wide. The direction of the striae is determined by the mechanical forces responsible, but they are usually linear. Those caused by corticosteroid use or Cushing syndrome are often larger and wider and may involve other regions, including the face.
What causes stretch marks
The exact cause of stretch marks is still unclear. There are different hypotheses on the development of stretch marks in the literature
- Infection leading to the production of striatoxin that damage the tissues in a microbial toxic manner
- Mechanical effect of stretching, leading to rupture of the connective tissue framework (e.g., pregnancy, obesity, weight lifting)
- Normal growth as seen in adolescence and the pubertal spurt that leads to increase in sizes of certain body parts
- Increase in the levels of body steroid hormones; Cushing’s syndrome, local or systemic steroid therapy having an inhibitory effect on fibroblasts
- Genetic factors (As suggested by the absence of striae gravidarum in people with Ehlers‐Danlos syndrome and the presence of stretch marks as one of the minor diagnostic criteria for Marfan syndrome)
- Immunosuppression states associated with certain drugs, human immunodeficiency virus or diseases such as tuberculosis
- Chronic liver disease association
Who are affected by stretch marks
Stretch marks are very common, affecting up to 70% of adolescent girls and 40% of boys. They occur in certain regions of the body where the skin is subjected to continuous and progressive stretching. These include:
- Abdomen and breast in pregnant women
- Adolescents undergoing growth spurts (thighs, buttocks, breasts)
- Shoulders of body builders
- Obese or overweight people
Stretch marks can also occur from prolonged use of oral or topical corticosteroids and from anabolic steroids. They are also a feature of the disease Cushing syndrome, where there is excessive adrenal cortical activity. Stretch marks are seen more often in people with Marfan syndrome.
Pregnancy stretch marks (Striae Gravidarum)
Striae gravidarum occur in more than half (approximately 50% to 90%) of pregnant women because of the separation of underlying connective tissue as the uterus enlarges within the abdominal cavity. Dermal collagen is damaged and blood vessels dilate, resulting in the formation of reddish-purple early stretch marks. Collagen remodeling frequently leads to loss of melanocytes, which leads to the hypopigmented mature stretch marks. Pregnancy related stretch marks tend to occur primarily on the abdomen, thighs, and breasts. A woman’s skin type and genetic history play a significant role in the extent of the striae.
Apart from stretch marks, another common condition that many women suffer from after childbirth would be skin laxity over the abdominal area from overstretching by the expanding uterus. This can lead to unsightly sagging skin that appears wrinkly.
The treatment for skin laxity on the abdomen is similar to the treatment that is used for nonsurgical facelift. Fortunately, the treatments for stretch marks work just as well for skin laxity.
What are the treatments available for stretch marks in Malaysia
Throughout history, although many therapies for stretch marks has been tested, the results are often modest. This is possibly because the wound remodelling capacity of the skin is simply not resilient enough to overcome the extent of damage to collagen and elastic fibres when skin is stretched beyond its recoil capacity. This may be particularly so on the body where the vascular supply is limited and wound healing slower compared to facial areas. Despite these limitations, patients would often appreciate some degree of improvement where complete clearance is not possible.
Although numerous treatment methods have been attempted to improve the clinical appearance of stretch marks, most of them provide inconsistent and less than satisfactory outcomes.
The most common therapy is the application of topicals used both therapeutically and prophylactically. However, there is a distinct lack of evidence for topical formulations. In conclusion, there is no topical formulation, which is shown to be most effective in eradicating or improving stretch marks.
Studies have shown that vitamin A derivatives can been used successfully in the treatment of striae rubrae, but of limited value for striae albae. Treatment has to be administered for a duration of up to 6 months. The results showed a reduction in length and width of the stretch marks. Unwanted adverse effects include redness and scaling during the first few months.
Hyaluronic acid is an organic substance found in human skin and is the main constituent of Dr Bob Remedies Hydromax Essence. The hyaluronic content stimulates fibroblast activity and collagen production to restore any inhibition and collagen loss induced by hormonal fluctuations or mechanical stretch. The application of hyaluronic acid containing products can markedly lower the incidence of stretch mark development after pregnancy.
Microdermabrasion is a popular method of resurfacing that is effective in many skin conditions such as acne scars, dyspigmentation and rhytides. It has been established that microdermabrasion induces epidermal signal transduction pathways that are associated with remodelling and repair of the dermal matrix.
Studies have shown that microdermabrasion produced good to excellent response in more than half the of the stretch mark cases treated, with more marked improvement in striae rubrae.
Glycolic acid is an Alpha Hydroxy acid that has been shown to be efficacious in skin rejuvenation, peeling, and photoaging.
The precise mechanism of action of Glycolic acid is still unknown because the biological effects has not been fully studied, although glycolic acid is reported to stimulate collagen production by fibroblasts and to increase their proliferation. This mechanism can be useful for stretch mark treatments.
Of the many modalities to ameliorate and improve stretch marks, lasers have recently become a popular therapeutic alternative.
The histology of stretch marks is that of a scar, and the development of striae distensae has been likened to that of wound healing or scar formation. Theoretically, lasers with proven efficacy in the treatment of scars would have some role in the treatment of stretch marks.
Certain lasers such as fractional photothermolysis, long pulsed Nd:YAG laser, copper bromide laser as well as pulsed dye laser have been studied for stretch mark treatments. Fractional photothermolysis has been reported to be effective for both mature and immature striae with a demonstrated increase in the amount of collagen and elastin fibres.
The latest laser to be introduced for scars treatment is the picosecond laser. The use of picosecond lasers with a diffractive lens array results in light induced optical breakdown. Light induced optical breakdown is evident histologically as unique intra-epidermal cavities. This injury is most consistent with a localised plasma formation in the epidermis initiated by melanin absorption of the high energy picosecond light.
Treatments with picosecond lasers with diffractive lens array results in improvements in dyspigmentation and scars with new collagen, elastic and mucin.
Some studies have shown that Picosecond lasers with diffractive lens array are equally effective in the treatment of stretch marks when compared to fractional photothermolysis. The parameters measured include texture improvement, degree of atrophy, and subject assessment.
Picosecond lasers have the added benefit that it has been rated as less painful, and has a shorter healing time.
Microneedling Radiofrequency (Lutronic Genius) has recently emerged as a new method for treating stretch marks. Microneedling Radiofrequency devices emit high-frequency alternating electric current producing dermal heat. They are used to tighten the dermis, reduce wrinkles, and improve cellulite.
Microneedling RF treatment promotes neocollagenesis, neoelastogenesis, and increased ground substances (proteoglycans) and should theoretically improve the appearance of striae. One published study has reported treatment was well tolerated, and the patients were satisfied with the results.
In the skin Calcium Hydroxyapatite (CaHA) results in active physiologic remodelling of the extracellular matrix by stimulating a 2 step process, whereby collagen type I gradually replaces collagen type III. Increased elastin synthesis stimulated by CaHA also indicates active remodelling.
The injection of diluted CaHA into the buttocks and thighs has been shown to increase neocollagenesis, with the highest conversion of collagen type III into collagen type I occuring at 90 days.
CaHA is designed to be injected into deeper planes of the skin such as the subdermal layer. Injection of diluted CaHA more superficially can produce a yellowish discolouration of the skin, therefore in addition to increasing volume to atrophic striae, CaHA may also add color to provide a more natural appearance to white striae.
Profhilo is an injectable anti-aging treatment made up of hyaluronic acid used to treat loss of skin elasticity and firmness. It can be used to treat the face, neck, decolletage, arms, hands as well as knees, or any other part of the body where there are visible signs of aging.
Above: Before and after photos for abdominal skin laxity treated with Profhilo. Courtesy of Profhilo Body Protocols. Photos are for reference only, as individual results may vary.