Striae distensea, or stretch marks, result from pregnancy, weight loss or gain, weightlifting, or other extreme pulling of the dermis. Rapid expansion of the dermis causes splits and ruptures, resulting in the telltale depressed scarring of stretch marks. They are traditionally treated with varying efficacy with topical creams, dermabrasion, or peels, but patients and physicians continue to seek better performing stretch mark removal modalities.

Combination Approach

New combination treatments using fractional laser and radio frequency (RF) therapies with topical creams are able to achieve 25 to 50 percent lessening in the appearance of stretch marks.(Reference data on file). To reduce the appearance of deeply embedded stretch marks, procedures need to ignite the production of new collagen while also encouraging a skin tightening and contraction.

The Pixel CO2 fractional laser (Alma Lasers) is utilized in order to produce ablative results without the typical discomfort and inconvenience of traditional ablative solutions. The Pixel enables fast treatment times with the added benefit of significantly reduced downtime in comparison to more traditional resurfacing techniques.

The Pixel CO2 uses pulses of light over areas of the stretch mark scars, penetrating the skin with 10.6um thermal micro channels, causing tiny wounds. New collagen bonds and strengthening are formed three to six months after each treatment, promoting the appearance of new, smoother skin, and significantly diminishing the appearance of the stretch marks.

The Accent XL RF device (Alma Lasers) is a thermotherapy platform that promotes connective tissue contraction for body contouring applications. It combines two RF modules in a single device: a BiPolar module for superficial treatments and UniPolar to enable deeper dermal and subdermal RF heating. Operating at 300 watts, the powerful non-ablative device is virtually pain-free for patients.

Collagen contractions occur immediately after RF treatments with the Accent XL, promoting new collagen formation within a three to six month timeframe to fill the vacant collagen area caused by the stretch mark. (Reference data on file). The laser features two handpieces to custom tailor treatments to the specific patient. Using the UniPolar handpiece for stretch marks, deep penetration to 2cm is achieved, which results in significant oscillation of water molecules contained in the tissue.

Treatments with the Accent XL are typically completed once a month, and then the 70-watt power Pixel CO2 is used to vaporize the surface of the stretch marks. New epidermis results from the combination therapy and resulting skin tightening, with 25 to 50 percent reductions in the appearance of stretch marks.

Topical hydroquinone and tretinoin (Retin-A, Ortho Dermatologics) are both used post-operatively to further reduce the appearance of the stretch marks. Hydroquinone effectively “turns off” the color in the melanocytes, restricting the body's ability to produce new melanocytes. It also restricts post inflammatory hyperpigmentation and the corresponding darkening of the skin. Application of Retin-A once a day for six months further encourages cell growth, boosting collagen production in the dermis.

Patient Example

A 27-year-old Hispanic woman who was six months post-partum at the time of treatment presented significant red colored stretch marks, with some different stage brown marks. The patient first received laser liposuction, which was performed utilizing the Accent 980 (Alma Lasers), a diode laser for minimally invasive laser-assisted lipolysis procedures. After the patient's laser liposuction procedure, treatment was completed using first the Accent XL and then Pixel CO2 devices. The patient also received hydroquinone and Retin-A treatments to further promote collagen production and limit the darker appearance of the stretch marks. After treatment, both the darkness of coloration and the visible size of the patient's stretch marks were reduced by 50 percent.

Conclusion

Measurably significant reductions in stretch mark appearance are possible with a combination laser therapy utilizing non-ablative CO2 skin resurfacing and RF devices. Both treatments combine to encourage collagen production to effectively fill in stretch mark scarring. Complementary use of hydroquinone and tretinoin inhibits melanin production post-inflammation and encourages collagen production, respectively.

While surgery will remain the only method for complete stretch mark removal, further advances in laser therapy should enable 75 percent reductions in stretch mark color and size over time.

Dr. Hamel is a Luminary for Alma Lasers, where he is involved in writing protocols, coordinating studies, and training.

John Hamel, MD has completed a fellowship in Aesthetic Medicine and is boarded in Anti-Aging Medicine by the ABAARM and Emergency Medicine by the ABMS. He is the founder and Medical Director of Complete Laser Clinic since it's opening in 2003.