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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘stretch marks’

Case Study – Tummy Tuck in Severely Damaged Abdomen

Sunday, May 1st, 2016


Background: Tummy tuck surgery is one of the most common of all body contouring procedures and can create some dramatic waistline changes. The operation is designed to reverse some of the tissue expanding effects caused by pregnancies and/or weight loss. While it can be tremendously effective at this purpose, its main effects are largely limited to the area of tissue excision. What lies beyond this zone is less significantly changed as it is pulled closer to the location of the suture line.

While the severe stretching effects of pregnancy affect women’s abdominal areas differently, some women develop a tremendous amount of stretch marks and loose skin. Large amounts of weight gain, small body frames and thin skin all lends themselves to the development of such abdominal skin damage. In these cases stretch mark radiate outward from the belly button like the rays of the sun. The redundant skin can be so significant that the loose and thinned out tissues can be stretched and pulled out like a piece of taffy.

Case Study: This very petite 36 year-old Hispanic female had two children that left here with a ‘wrecked’ abdominal area. She was very thin and had little subcutaneous fat but the loose skin on her abdomen was considerable. She had stretch marks from the pubic region all the way up to just below her lower ribcage.

MR Tummyb Tuck result front viewUnder general anesthesia,  a full tummy tuck was performed from hip to hip removing a large abdominal skin segment that measured 18 inches in the midline. The skin was so loose that no skin undermining was needed of the upper abdominal skin flap other than to free up the tissues around the umbilicus. With such little tissue undermining, no drains were used due to the small dead space at closure. She was so thin than no liposuction was needed around the perimeter of the tummy tuck zone to reduce tissue fullness.

MR Tummy Tuck result oblique viewMR Tummy Tuck result side viewWith extensive abdominal tissue damage as exemplified by a large number of stretch marks, only those stretch marks within the outline of the excised tissues will be removed. Stretch marks will remain with many mid- to upper abdominal marks being pulled down lower closer to the incision line.


1) The extent of tummy tuck surgery due to stretched out abdominal tissues depends on how large the zone of damaged tissues emanates out from the belly button area.

2) Large amounts of loose and damaged abdominal skin can often be removed during tummy tuck surgery with limited tissue undermining.

3) The quality of a tummy tuck result is influenced by the scar’s location, amount of pubic hairline distortion, appearance of the new umbilicus and whether dog ears are present at either end of the horizontal scar.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Stretch Marks and Breast Augmentation Surgery

Monday, May 25th, 2015


Background: Breast implant surgery works by the simple principle of placing a device under the breast tissues that pushes outward and creates a larger breast mound. Regardless of whether the implant is placed under the glandular tissue (subglandular) or partially or completely submuscular the outward result of a larger breast remains the same. Since the implant merely pushes the overlying breast tissue whatever outward breast characteristics that exist (e.g., nipple-areolar size/asymmetry, skin features) will remain the same or may get bigger as the breast mound enlarges.

breast stretch marksOne of the undesired features of breast skin is that of stretch marks. These skin deformities represent a dermal injury where the skin has thinned in a linear fashion due to expansion of the tissues. Breast stretch marks always appear in a radiating pattern extending outward from the central nipple-areolar complex and running directly perpendicular to the relaxed skin tension lines of the breast mound. (which are circular or concentric) They develop most commonly from pregnancy due to the skin stretch created by breast tissue engorgement. The collagen fibers in the skin’s dermis may also be weakened by the change in hormonal levels. Large amounts of weight gain or naturally very large breasts may also challenge the integrity of the dermis.

Since breast augmentation causes an immediate and large increase of the breast mound, through the placement of an implant and the resultant development of swelling, breast skin may theoretically develop stretch marks. In breasts that already have stretch marks could breast implants make them worse either by appearance or even making them bigger. These would be understandable concerns from any women considering breast augmentation.

Case Study: This 34 year-old female wanted breast augmentation as she had lost some of her breast volume after multiple pregnancies and they had lost any perkiness they once had. She had existing white-colored stretch marks on both breasts that radiated outward from the nipples.

Stretch Marks in Breast Augmentation Results front view Dr Barry Eppley IndianapolisStretch Marks in Breast Augmentation Results oblique view Dr Barry Eppley IndianapolisUnder general anesthesia, she had 375cc silicone gel implants placed in a partial submuscular position (dual plane) through lower breast fold incisions. With the immediate enlargement of her breasts her stretch marks did get wider but never turned pink or red. Looking at her six weeks after surgery, when all swelling was gone, the appearance of her stretch marks was not proportionally bigger or looked worse.

Stretch Marks in Breast Augmentation results side view Dr Barry Eppley IndianapolisThere is little question that breast implants can potentially cause stretch marks or make existing ones bigger. The chance of developing stretch marks from the skin stretch caused by the implants is, however, extremely low and should be considered a rare occurrence. Even if they do occur they will not be severe and will fade within a few months after surgery. The risk factors for these occurring are in large breast augmentations, in implants that are placed above the muscle and in women that already have some amount of stretch marks. In the vast majority of women that already have stretch marks, the appearance of them does not worsen even though they make become wider as the breast mound size increases. (stretch of the stretch marks)


  1. Pregnancy and extreme weight gain/loss are the most common causes of stretch marks on the breasts.
  2. Breast augmentation surgery does not cause stretch marks on the breasts if they are not already present.
  3. Breast augmentation surgery does not usually make the appearance of existing stretch marks worse. (other than temporary redness)

Dr. Barry Eppley

Indianapolis, Indiana

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

Scar Types and their Descriptions

Sunday, August 8th, 2010

Any interruption of the skin, whether from a fall on the ground, an accident on the job, or from the surgeon’s knife, prompts the complicated and not yet fully understood process of healing, the end result of which is a scar. However, the word “scar” often invokes the image of an unwanted deviation of the healing process, that which is a physical derangement from the smooth and non-discolored appearance of skin that it replaces.

As do the injuries from which they result, the appearance of scars can vary tremendously. Differing scar appearances are because the scars are different from each other. Different scar types are treated differently! Like all of medicine, successful treatment is based on establishing the diagnosis first. The wrong treatment method on a scar results in not only no beneficial effect but a waste of your time and money.

Hypertrophic scars appear as raised, wide,firm,and red to purple-colored scars that

remain within the physical boundaries of the original skin injury. They are more likely to

occur in wounds that cross natural lines of skin tension or an original open wound that

healed on its own. These can cause some itching and discomfort to the touch but may

improve with time.

Keloids are also raised, reddish-purple, nodular scars that are usually firmer than hypertrophic scars.Keloids are the result of uncontrolled scar healing that the body does not stop once the wound is healed. The difference between keloids and hypertrophic scars is that keloids extend beyond the boundaries of the original injury site, encroaching upon surrounding uninvolved healthy tissue. Keloids can result from seemingly innocuous activities such as ear piercing and tattoos and unlike hypertrophic scars, keloids do not regress over time. While keloids can occur in all skin types, they are generally more common in darker skin.

Stretch Marks are linear bands of wrinkled skin that most frequently result from rapid weight loss or weight gain, for example following pregnancy, and tend to appear in areas like the abdomen, breasts, thighs, and hips. Initially, they tend to be red or purple, but often fade to white over time. They are essentially ‘partial tears’ on the underside of the skin from overextension.

Depressed Scars (atrophy) are due to the irreversible damage of the skin from the injury where the amount of scar formed is less thick than that of the surrounding normal skin. The level of the scar (thickness) is less than that of the surrounding skin. They can occur from a multitude of inciting events such as acne lesions, burns, or skin avulsive injuries from trauma. Trying to apply makeup to conceal depressed scars actually worsens their appearance as makeup enhances the textural variations.

Acne scars are a variety of depressed scars that have occurred due to loss of skin thickness from the body’s inflammatory response to a plugged sebaceous follicle. The inflammatory reaction (infection) results in thinning of the skin even though scar tissue has formed. Acne scars appear in a variety of shapes, which are important to distinguish, as they are often treated differently.

Icepick scars are usually narrow, sharply demarcated tracts that are wider at the surface and taper as they extend through the skin. Rolling scars are more superficial, wider, and produce an uneven appearance in the skin. Boxcar scars are round- to oval-shaped skin dimples with sharp margins and are wider than icepick scars.Most tend to have diameters from 2.0 – 4.0 mm.

Burn Scars are unique in that they have a very thin and atrophic underlying dermis. They are quite stiff and inflexible and do not heal well when cut and sutured. The fat layer underneath them is frequently gone or thinned due to the initial heat of the original injury. The burn scar can appear smooth and almost ‘glass-like’.

Scar diagnosis is critical to selecting the proper scar revision approach. These simple descriptions may help one better describe and identify their scar problem.

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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