Stretch Marks: What Works (and What Doesn't)
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What Are Stretch Marks?
Stretch marks are one of the most frustrating skin care concerns, especially as so many deal with them at some point! It's estimated that 90% of women who are or have been pregnant, 70% of adolescent females, and 40% of adolescent males have stretch marks. There does not seem to be any link to ethnicity: all races can be affected. As it is a widely afflicting condition, there is no shortage of demand for products to treat them—but what really works?
Stretch marks occur when skin is abnormally stretched and expanded for a period of time. Typically, this occurs during pregnancy, weight gain, weight loss, or during periods of rapid growth (think puberty). The abnormal stretching causes the skin's support structure of collagen and elastin to break down or rupture. The visible curled ends of stretch marks beneath the skin are actually bands of elastinthat have broken—think of elastin as rubber bands beneath the skin that give it spring and its ability to snap back into place.
Essentially, stretch marks are scars that have formed from the inside out, rather than scarring that occurs when skin is externally wounded. Unfortunately, stretch marks are among the toughest skin-care concerns to treat because there are no cosmetic ingredients or products that can make much of a difference in their appearance.
What About Vitamin E, Cocoa Butter, or Stretch Mark Creams?
Applying topical products such as plant oils or cocoa butter, Mederma (which didn't show results on scars beyond plain Vaseline,) or any skin-care product promising to prevent, reduce or eliminate stretch marks doesn't work, and there is no research showing otherwise. Massaging skin with rich emollients and creams may feel nice, but the purported benefits of such products only add up to myths and anecdotal accounts mixed with hope, because stretch marks are not caused by dry skin. The depth of stretch marks —far below the skin's surface—and the extreme strain, stress, and trauma needed to break down the skin's support structure, is damage beyond the reparative or preventative capability of any moisturizer or oil.
The above information applies to all the products which claim to prevent stretch marks during pregnancy, too. Stretch marks come from the inside out, and applying something topically to your skin won't prevent the breakage. We're either predisposed to developing stretch marks or not; women who've said they used "X cream" and didn't get stretch marks while pregnant probably wouldn't have gotten them anyway. It's frustrating, we know, but despite anecdotal statements by those who've used stretch mark creams, the research-backed evidence just isn't there.Still, other than the ding to your budget, for the most part there's no harm in trying such products (just don't expect them to stop stretch marks if you're predisposed to them).
The claims of massage therapy as a treatment for stretch marks are often from those doing the massaging. Unfortunately, no amount of massage will improve the torn, broken elastin under skin. It's just not the way the body works, and there is no clinical research (we've looked) demonstrating the improvement of stretch marks from massage therapy (Swedish or otherwise.) Also, massaging the abdominal area during pregnancy can have its own risks if too much pressure is used. If you're pregnant and considering massage, be sure to speak with your doctor about what type is most appropriate.
Dermal Rollers for Stretch Marks?
Dermal rollers are handheld devices outfitted with many small needles designed to lightly pierce the skin as you roll the device over it. The popular claim is that this controlled wounding of skin and its subsequent healing process is akin to dermatologic treatments (think laser treatments) which follow the same concept of a controlled wound to stimulate collagen growth and repair.
Thetruth is there's no research demonstrating dermal rollers improve stretch marks, or produce results better than (or comparable to) laser treatments. It's very difficult, if not impossible, to generate new elastin, and building collagen alone isn't going to make stretch marks look much better. Moreover, it's easy to overdo it with these roller devices, and that can damage skin. Don't believe the hype around dermal rollers as a solution to stretch marks.
What About Microdermabrasion?
One study that demonstrated microdermabrasion had improved the appearance of stretch marks but not so fast—closer examination of the research revealed a few sticking points. The first was that the treatment was aggressive: 5 sessions of microdermabrasion per week, for 12 weeks! Second, the measurement of "improvement" was never defined, and the study mentioned that the primary improvement was to the reddish-purple marks (striae rubra,) of which typically fade anyway with time (leaving you with white stretch marks).
To be fair, those who had stretch marks for longer periods of time also noted some level of improvement after the study. The question is, as you one of those who would be willing to commit to aggressive microdermabrasion in the hopes for non-specific improvement (and who also have deep purple/red stretch marks?)
Prescriptions and Procedures That May Help
Let's talk about the options of treatments that actually do have the potential to improve stretch marks! As mentioned above, there are no cosmetic ingredients or skin-care products that can improve or prevent stretch marks. It is impossible for any cosmetic to raise the indentations back to where the skin level used to be or repair snapped elastin fibers, but there are alternatives that may provide a small degree of improvement.
- Tretinoin: In the pharmaceutical realm, there is some research showing tretinoin (the active ingredient in Retin-A, Renova, or in generic form) can have a positive effect on stretch marks. Typical improvement is 20%, which isn't necessarily exciting, but may still be worth the effort and expense. The dilemma for expectant mothers is that tretinoin cannot be used during pregnancy, and is also contraindicated if the mother-to-be intends to breastfeed her baby.
- Laser Treatment: Studies have been conducted using Intense Pulsed Light (IPL) and Pulsed Dye Laser (PDL) treatments emitting 585 nanometers (nm) of light to improve stretch marks. Results after five sessions were labeled as a clinical improvement, with microscopic analysis showing improvement in the length, depth, and coloration of stretch marks. Studies also demonstrated improvement with a 1,064 nanometer Nd:YAG after 3-4 sessions.
- Peels: Beyond non-ablative lasers, you can also consider a series of chemical peels. Trichloroacetic acid (TCA) peels may be of some help for improving the appearance of stretch marks when used at the proper concentration (typically 20% TCA) and applied by a dermatologist or cosmetic surgeon skilled in the use of this type of peel. Because TCA peels penetrate further than AHA or BHA peels, they are believed to have a greater ability to stimulate collagen and elastin for the depth of damage seen in stretch marks.
Don't fall for the ad hype or false promises of stretch mark creams! Topical skin-care products can't raise the indentations back to where the skin level used to be or repair snapped elastin fibers, nor do preventative measures like massage or dermal rollers work to avoid stretch marks. Tretinoin, as a generic and as the active ingredient in Renova/Retin-A and other brands shows a small degree of benefit (but be realistic with your expectations.) Also, some medical procedures can improve their appearance, such as laser treatments and TCA peels, but again, it's important to keep your expectations realistic.
Additional sources: Burns, 2009, September 17; Aesthetic and Plastic Surgery, January 2008, pages 82-92; and Clinical Experimental Dermatology, August 2009, 688-693; Dermatological Surgery, August 2009, pages 215-210; Dermatologic Clinics, January 2002, pages 55–65.