Stretch marks, or striae distensae, are another common cosmetically-troubling problem for which ideal treatment is still unavailable. Like the American flag, stretch marks come in red, white and blue. Early on, they may be reddish and slightly elevated, later, dusky purple or bluish, and finally, ivory-colored or whitish flattened bands with a wrinkly, crinkly surface. Typically, they appear on the breasts, abdomen, thighs and arms and commonly appear after the skin is excessively stretched as a result of adolescent growth spurt, pregnancy, weight gain and weight lifting. They are estimated to affect seventy percent of adult women and forty percent of young men.
Although much remains to be learned about what causes them, current wisdom suggests that stretch marks result from an overproduction of adrenal glucocorticoid, which accompanies each of the above circumstances. They can also appear following prolonged use of high potency glucocorticoid creams and ointments. Whichever the case, the high level of steroids interferes with the production of collagen and elastin fibers, resulting in a loss of dermal support that leads to tearing when the skin is stretched.
The term stretch marks is actually a misnomer. Although stretching may determine where striae may appear and even in which the direction they run, it does not cause them. In fact, no matter how much you stretch or overstretch, they will not appear unless glucocorticoid steroid levels are increased. In general, the earlier that stretch marks are treated, the better.
Most of the current over the counter (OTC) creams and lotions that are purported to work for preventing or treating stretch marks serve little more than to simply moisturize the skin. By contrast, I have found that the daily topical application of high potency retinoids (vitamin A derivatives), such as Avage, along with alpha hydroxy acids, such as Amlactin, have been helpful for promoting new collagen and elastic fiber production and stimulating the turnover of epidermal cells.
Unfortunately, we currently do not have any gold standard method for entirely eliminating mature stretch marks. We do, however, have a number of very effective techniques for improving them. Although lasers and intense pulsed light therapy have their proponents, overall, I have not been particularly impressed with their efficacy. Microdermabrasion, as its name suggests, is simply too superficial a process to do anything and is, in my opinion, not worth the time, effort and expense.
My treatment of choice, and one that I have personally had great success and patient satisfaction with combines the use of medical microneedling with a Dermaroller followed by the use of a collagen-stimulating filler. Treatment typically entails two sessions of medical microneedling (occasionally three or four), performed under local anesthesia, spaced at a three month interval, followed by the injection of tiny amounts of a stimulatory filling material. such as Radiesse. Using these techniques, I have had gratifying results even for "mature" stretch marks that have been present for several years.