Stretch marks, or striae, are basically a type of atrophic scars. They are being formed for various reasons: pregnancy, sudden weight loss, continuous hormonal therapy, rapid growth during pubertal growth stage. Reasons are abundant, yet possess one common feature – rapture of collagen fibres or sudden decrease of collagen synthesis. Collagen fibres form the framing of our skin and are responsible for its endurance and elasticity. Currently over 20 different collagen types are identified, with only two types being instrumental in the skin structure: type I and type III. They form the framing of our skin. Type III collagen fibres can significantly stretch as well as contract. Type I fibres stretch insignificantly and break thereafter. Prevalence of type I collagen fibres signifies the skin predisposition to the formation of stretch marks (Fig.1). The percentage ratio of the two collagen types is genetically inherited.
Fig.1. Relation of stretch mark formation to collagen types
The processes of old collagen degradation and the synthesis of new collagen are constantly taking place in the deeper layers of the skin. Multiple factors influence the formation of new collagen: balanced nutrition (lack of protein in nutrition causes decreased collagen synthesis), environmental influence (climate, UV radiation), social habits (alcohol, smoking), lack of vitamin C. These, among other numerous factors, lead to decreased collagen synthesis, with collagen degradation staying on the same level. Therefore, old collagen degrades while new collagen is not synthesized in the necessary amount which leads to decreased skin tone and stretch mark formation (Fig.2).
Fig.2. Stretch marks and atony of abdominal skin
People liable to stretch mark formation:
- obese persons;
- pregnant women;
- adolescents in pubertal growth stage;
- persons on high-calorie diet;
- patients prescribed to hormones;
- persons with frequent weight fluctuations;
- genetically liable persons;
- women in menopause period
Methods of stretch mark removal (treatment and correction)
It is impossible to inject molecular collagen through undamaged skin into the points of rupture as its molecular mass is too big against the distance between the cells. Therefore, animal collagen injections into the problem zone are applied. The procedure is painful, often causing allergic reactions and produces a temporary effect (3-6 months).
Surgical methods of removing stretch marks. Surgical excision of stretch marks with intradermal suture leads to scarring. It is a costly surgery in view of subtle and meticulous work of the plastic surgeon. Abdominoplasty for stretch marks is not the procedure of choice, as it does not solve the stretch mark issue (Fig.3).
Fig.3. Stretch marks after abdominoplasty and TCA-peel in the stretch mark area
Mesotherapy stretch marks does not yield tangible results either. Patients tend to refuse from the method after 3-4 procedures in view of its pain level and non-availability of results (Fig.4).
Fig.4. Mesotherapy stretch marks before and after. Unsatisfactory result
Microdermabrasion for stretch marks with aluminum oxide microcrystals is a lasting (each stretch mark is polished along the full length), moderately painful and is to be repeated 4-8 times at 3-4 week interval (Fig.5).
Fig.5. Microdermabrasion of stretch marks on the hips
Mechanical deep rotational dermabrasion causes bleeding with long-term slow recovery and skin depigmentation risks.
Chemical peels for stretch marks. Glycolic acid peel for stretch marks after standard month-long preparation with tretinoin and application glycolic acid as cream produce zero result. Stretch marks – is the break of collagen fibers! Treatment of stretch marks with superficial chemical peels and scrubs can not give a significant result, since they do not penetrate so deep to the level of collagen fibers. Reduce stretch marks can only applications of medium and deep chemical peels.
Laser for stretch marks treatment. Ablative (ablation – removal, thawing) laser systems suggest vaporization of epidermis and, water from dermis to improve general appearance of the skin. Such laser efficacy is insignificant whereas side effects are way more serious than the expected result. Non-ablative lasers effectively remove redness in fresh stretch marks. Skin sagging, however, remains unaffected (Fig.6).
Fig.6. Vascular lasers for red stretch marks before and after
We tend to use 2 major methods of stretch mark treatment and correction:
- Combined method of sandabrasion, TCA-peel and variable occlusion. This method is simple, fast (the procedure takes from 30 to 60 min) and practically painless. It is not limited to a specific number of procedures, as the result is assessed after each procedure and upon reaching the satisfactory effect (usually 1-2 procedures at 2-3 month interval), the treatment is discontinued.
- Collagen Induction Therapy, or micro needling for stretch marks. Multiple perforations 0.08 mm in diameter are formed in the skin by means of dermaroller. The depth of microneedle penetration is down to 2.5mm depending on the stretch mark localization. Cells in punctured areas start to intensely divide and produce collagen to patch the micropunctures. The more perforations are made per 1 cm2, the more collagen islets will be synthesized. 150 perforations may be performer per 1 cm2. Therefore, an elastic supporting block is formed out of fresh collagen tissue, on the one hand, while the size of atrophic scars and stretch marks reduces due to their constriction and retraction of bottom to the skin surface, on the other hand.
Fig.7. Microneedling with derma roller for stretch marks
Stretch marks removal before and after
Fig.8. Old stretch marks on stomach before and after TCA – peel
Fig.9. Old stretch marks before and after TCA peel. Epidermis has not fully recovered
Fig.10. Old stretch marks on the hips before and after treatment with Dermaroller
Fig.11. Red stretch marks on the breast before and after sandabrasion and TCA peel