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Archive for the ‘stretch marks’ Category

The Current Futility of Stretch Mark Therapies

Sunday, May 4th, 2014


Stretch marks Dr Barry Eppley IndianapolisStretch marks are an aesthetic bane for many people, particularly women. Often occurring after puberty, pregnancy and weight gain/loss, the development of white or red depressed lines is distressing and they will be present forever as they never improve on their own. Many treatments allege to improve or remove stretch marks but the sheer number of treatments available over the years indicates the few if any are effective at doing so.

But what makes stretch marks such a difficult aesthetic problem to improve? To understand the why, it is important to look at the histology of stretch marks which are anatomically described as Striae Distensae. Technically there are two distinct forms of striae distensae, striae rubrae and striae albae. By histologic assessment, normal skin has haphazardly arranged small collagen fibers and thin elastin fibers in the papillary dermis, surrounded by ground substance; coarse elastic fibers and thick bundles of collagen parallel to the direction on the skin in the reticular dermis.

In contrast, striae rubae (red stretch marks) are tense, red and erythematous and they histologically show fine elastic fibers in the dermis with thicker tortuous fibers in the periphery. There is a reduction and reorganization of elastin fibers and structural changes in collagen are seen. Striae albae (white or pale stretch marks)  appear pale, depressed and wrinkled. Their histology demonstrates epidermal atrophy and loss of the rete ridges and densely packed thin collagen bundles are arranged horizontally, parallel to the surface of the skin in a similar way to in a scar.

These histologic findings show that stretch marks are distinctly different from normal skin. Their collagen infrastructure is drastically changed to thinner less oriented collagen layers with fewer elastic fibers. This is well known by their depressed and indented external surface lines. Trying to change this weakened and thinner collagen by any type of topical cream or treatment, while theoretically appealing and makes for robust retail product sales, is fundamentally flawed and not possible. You simply can’t thicken the damaged collagen structure of the skin. No clinical study has ever been published that supports any sustained effectiveness for topical therapies for stretch marks.

Can more invasive treatments, like laser resurfacing, laser collagen stimulation or an internal approach like Cellulaze, be effective? At the least they can have a more profound effect on the skin’s collagen infrastructure. Other than reducing redness from striae rubae, external or internal laser efforts not been shown to be effective either.

Stretch mark therapy today remains largely ineffective. The changes to the skin’s structure remains permanently changed and irreversible…at least by today’s technology.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Breast Augmentation and Its Effects On Stretch Marks

Friday, January 13th, 2012

Background:Breast augmentation works because it is a synthetic implant that makes the breasts bigger. While it is true that the role of the plastic surgeon is critical to get good implant placement in the proper position and as symmetrically as possible, but in the end the implant itself plays a major role in the final breast appearance. To a large degree, and often not appreciated by patients, is that implants merely magnify what the breasts initially looked like.

Stretch marks are usually the result of rapid stretching of the skin. They occur because the underside of the skin, known as the dermis, can not take the pressure from the rapid stretching and it tears. Stretch marks are, therefore, a form of scarring in the skin. But because they are located on the underside of the skin, they are generally resistant to improvement by any form of known treatment. While initially appearing as red or purple, they often fade in color to white.

When stretch marks occur on the breasts, usually from pregnancy, they occur in a radiating pattern from the areolas. This is reflective of the circular expansion of the breast mound against the natural lines of skin tension (Langer’s lines) of the breast skin. How fast the breast mound expands and the natural thickness of the skin will determine whether and how severe stretch marks may develop.

Because pregnancy causes some degree of loss of breast tissue, many women after they are finished having children desire breast augmentation. Pregnancies have left them with smaller deflated breast mounds that often have stretch marks as well. A very relevant question from them is what will happen to their stretch marks after getting breast implants. Will the stretch marks look worse?

Case Study: This 23 year-old female from Columbus Indiana wanted breast implants to improve the size and shape of her breasts. She had been through two pregnancies in the past four years and had lost most of her natural breast tissue. She also had very severe stretch marks that radiated widely out from her nipple-areolar complexes, were wide and many in number and were white in color. While she wanted larger breasts regardless of how the stretch marks would appear afterward, her question about what would happen to them after surgery was common.

Under general anesthesia, she had saline breast implants placed through a transaxillary approach. She was very small in size (5’ 1”, 102 lbs) and the implants were inflated to 375cc which stayed within the dimensions of her natural breast base diameter. During surgery it could be seen that her breast stretch marks did get wider from the expansion of the implants but they did not look worse in appearance.

When seen at one month after surgery, her breast implants were symmetrically placed and of acceptable size to her. Her stretch marks were still very apparent and actually a bit more red than before surgery. When comparing before and after photos, it could be stated her breast augmentation neither improved or made worse her pre-existing stretch marks.

This breast augmentation case shows a woman with very significant stretch marks on her breasts. Few women will present with a more severe case of breast stretch marks. While breast augmentation did not improve their appearance, nor would it be expected to, the procedure did not make them look worse. For some women whose breast stretch marks are relatively new (in the past few years) the rapid expansion of the breast skin from implants may make them initially more red. But this red color will fade as the breast skin relaxes after surgery. So while augmentation does make the stretch marks somewhat bigger, it does not necessarily make them look worse in the long run.

Case Highlights:

1) Stretch marks from pregnancy are common findings on many women considering breast augmentation. There is usually the concern that their appearance may be worse after surgery.

2) The expansion of the breast skin from implants does widen stretch marks but does not usually make them look worse in appearance.

3) Some stretch marks may initially get more red right after breast augmentation but this fades with time and skin relaxation.

Dr. Barry Eppley

Indianapolis, Indiana

Stretch Marks – Difficult Problem, A Few Hopeful Treatments

Saturday, October 23rd, 2010

Stretch marks remain one of the few cosmetic skin deformities in plastic surgery that defies a really convincing treatment. Known medically as striae, stretch marks often appear after rapid weight gain and loss and most commonly as the result of pregnancy. They frequently appear in the teen years when growth spurts and increased levels of steroid hormones cause significant changes throughout the body and can occur in males as well as females. Pregnancy remains the most reason women get them because of obvious weight gain and fluid retention.

But why stretch marks develop is largely unknown. If you look at the cross-sectional anatomy of a stretch mark you will see that it has a thinned dermal layer to the skin. I often refer to this as an incomplete tear of the skin. The stretching has almost torn its way through the skin so to speak. Herein lies the important thing to known about a stretch mark…it is missing part of the layer of the skin…it is a volume deficiency problem. (like a stretched out rubber band or speaking from a physics perspective, it has gone beyond its elastic deformation limit)

Stretch marks affect the vast majority of women, it usually is only a matter of degree. Once they initially appear, when they are red or purple, they are the most likely to be improved. Once in the later or mature stage, where they have become white or silver with deep indentations, they are virtually impossible to get much improvement.

When a problem is difficult to treatment, prevention therefore is the key. Avoiding rapid weight gain is important. For those who are pregnant or experiencing the hormone changes of the teen years, it is crucial to moisturize. Skin becomes more pliant, more plasticized and better able to stretch when it’s well hydrated. One should moisturize three or four times a day with products that contain cocoa butter or shea butter as a prime ingredient. They are very inexpensive and no other topical ingredients have been proven to be scientifically better. Massage the moisturizer deep into breasts, belly, hips, and buttocks.

The appearance of stretch marks depends on the color of your skin. They can start out pink, reddish brown, brown, or dark brown, and fade over time to a more silvery color. Once stretch marks have appeared, it’s essential to treat them as early as possible. Research has focused exclusively on the early stages of stretch marks, when they are still red or purple and numerous treatment strategies have been shown to be beneficial at this point.

While pharmacies and innumerable internet sites tout hundreds of topical stretchmark products, very few of these provide any benefit at all…at least to the patient. It would also be fair to say that home remedies for stretch marks, such as wheat germ oil, are not much help either.

Chemical peels of medical grade variety, however, can be useful. Glycolic acid, a sugar cane derivative and a member of the alpha hydroxy acid (AHA) family, works on stretch marks by increasing collagen production. Widely used for its exfoliative and skin rejuvenation effects, it also helps with collagen production which is a missing element in the skin of the stretch mark. Treatments are inexpensive and it may require three or four peels before results will be visible. When combined with the daily use of retinoids (vitamin A, Retin-A) in between the peels, more collagen formation and elastic production may be induced. The best topical ‘combo’ therapy may be when both chemical peels, Retin-A and Vitamin C (collagen producer) are all combined in a comprehensive topical treatment strategy.

Peptide-containing products, such as Relastin or Strivectin as examples, are widely touted as having skin repair properties. Despite the appeal of these high-tech skin products, there is little evidence at present that they really work as claimed even on facial wrinkles. The activity and the effectiveness of peptides on the skin is more theoretical than fact at present, When it comes to stretch marks, I would be even more skeptical and would save my money until better scientific studies are forthcoming.

The most popular treatment option are differing laser modalities to treat both red/purple and white stretch marks. They appear to work by promoting synthesis of healthy, new collagen, which has been lost in the stretch mark creation process. Several lasers are now FDA-approved for stretch marks which supports some level of effectiveness. Just remember that early treatments in colored stretch marks will be better than in mature white ones.

Dr. Barry Eppley

Indianapolis, Indiana

Stretch Marks – Does Anything Really Work?

Wednesday, November 7th, 2007

Stretch Marks – Magical Solutions??

Stretch marks are scars that occur, usually as a result of pregnancy, when the skin stretches enough to cause tearing within the deepest layers of skin. New stretch marks are usually pink or red before they fade to white, though they never completely disappear. But some women are more prone, expecially those that gain weight rapidly and carry multiple or big babies.


Many women attribute a lack of post-pregnancy stretch marks to body cream. Whether used to ease the itching associated with stretching or in an effort to keep stretch marks at bay, moisturizers certainly feel good. But, medically speaking, there is no topical cream or anti-stretch mark product that has been proven to have any benefit, despite claims to effectiveness that are often wildly exaggerated and not substantiated by any scientific evidence. Despite unproven benefits, there is certainly no harm to using moisturizing as prevention. Balms that are blends of oils and butters keep skin supple as it stretches. Since it is being used in pregnant women, the topical agent should be composed of natural products that are unscented. 

Once present, repairing stretch marks likewise remains an enigma. Many laser and light therapies are currently being investigated but none yet have been shown to be an effective treatment. One topical ointment, Retin-A, has been found to help reduce the appearance of stretch marks. Just like it does for facial wrinkles, it boosts collagen production and increases skin turnover to aid the creation of new skin. Since it contains a Vitamin A derivative (a proven cause of fetal birth defects), it should not be used until after delivery. But it is not a miracle stretch mark treatment and results should be expected to take time and be a modest improvement at best. There are a variety of laser treatments being used, including fractional laser resurfacing, and these appear to be the most promising at the present time.

Dr Barry Eppley
Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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