Stretchmarks are a kind of small fissures similar to soft scars formed on the skin, that are due to a reduction in the thickness of the skin secondary layer to a reduced production, at this level, of collagen and elastin by the fibroblasts, cells that make the skin.
They appear when the skin is subjected to an exaggerated distension, extension then following loss of volume.
Very frequently, they are seen amongst in more than 50% of the young population: 25% of girls and 10% of boys at puberty, and 50 to 70% of pregnant women.
Histologically, there is an inflammatory infiltrate at the level of recent stretch marks and a breakage of dermal collagen at the level of the older stretch marks with neocollagenesis and thickening of the elastic fibers.
The circumstances of onset are puberty, pregnancy, obesity, taking certain medications.
ANALYSIS
Evolution
Stretchmarks evolve in two stages :
– Inflammatory stage that lasts 12 to 24 months, with red, pink or purple stretch marks.
– Definitive stage where established stretch marks become atrophic, white, pearly scars.
Classification
- Stage 1: Recent stretch marks, inflamed, usually purplish-blue in appearance.
- Stage 2a: White, superficial stretch marks with no transverse streaks and no palpable depression on the surface of the skin.
- Stage 2b: White stretch marks, at the surface without long streak marks but with obvious depressions at the skin’s surface.
- Stage 3a: White stretch marks with atrophic base with long streak marks measuring less than 1cm wide, without a pearly appearance.
- Stage 3b: White stretch marks with atrophic base with long streak marks measuring more than 1cm wide, with a pearly appearance.
POSSIBLE TREATMENTS
Peel
For a visible result it is necessary to realize a medium peeling. Superficial peels are not relevant for the treatment of stretch marks. This is a fairly heavy act, skin scarring is long (more than for the face), there is a risk of lighter or darker spots.
I practice it only on the phototypes 1 or 2 because beyond the pigmentary disorders are too frequent.
One session is sufficant
Laser erbium or CO2 fractional
The ablative laser is the gold standard for the treatment of white stretch marks.
I prefer the erbium laser CO2 because after effects are lighter and pigmentary complications infrequent.
We can treat the 100% of the surface (continuous modality) or the 25% (fractional modality).
Fractional technique is the most used because it allows rapid healing (10-15 days) and minimizes complications.
At each session (we need 4), we remove micro-columns of skin which stimulates the fibroblasts (cells responsible for the synthesis of the skin) to create a denser skin, thus reducing the visibility of stretch marks.
Vascular lasers (pulsed dye laser and KTP) are used for the treatment of red stretch marks. 3 to 4 sessions are required to reduce the color.
Carboxytherapy
This technique has an action of stimulating synthesis of collagen; of capillary vasodilation with intensification of the local-regional blood circulation and increase of the oxygen pressure. Injections are performed all along the stretch mark and at the level of healthy skin between stretch marks.
It takes about 10 sessions, I do not utilize this too technique often due to the fact the results are modest and I only use it for dark skin.
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