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To best understand what a stretch mark is one first needs to better understand the anatomy of skin. Skin is composed of a thicker deeper layer called the dermis. The dermis is essentially a complex weave of collagen fibers somewhat similar to a woven fabric. Overlying this deeper foundation layer is thin veneer of living cells called the epidermis. A stretch mark is a tear in the collagen fabric of the dermis that occurs whenever the skin is stretched beyond its tensile limits. The tear in the collagen fabric is analogous to a run in a stocking. Because the epidermis remains intact, what appears is an area of weakness in the skin underneath the intact epidermis layer. This is visible as a lighter appearing linear wrinkling under the skin, commonly known as a stretch mark.

Stretch marks can occur for different reasons. The most common cause is a rapid stretching of the skin as occurs in the abdominal region during pregnancy, or in the hips and leg region as occurs with rapid weight gain. It can occur, however, anywhere there is rapid stretching of the skin. Stretch mark also commonly occurs in adolescence due to the hormonal alteration in the skin to accommodate growth.

One way to prevent the formation of stretch marks is to use topical perparations that increase the elasticity of skin. This is why pregnant women often apply cocoa butter to their abdominal area to try and reduce stretch marks. The very best product, in my opinion, is a hyaluronic acid serum which can absorb and hold in the skin hundreds of times its weight in water, thereby greatly increasing the skins elastic tolerance. We offer this proprietary product through our office under the name Hy-Pep. In addition we have a very elegant product called Essential, which consists of environmentally friendly squalene oil which offers tremendous protection for the skin.

Since stretch marks are actually an area of the skin where the collagen is damaged, treatments to improve stretch marks are directed at rebuilding the integrity of the collagen in the area of the mark. Patients are placed on a skincare regimen that helps to support the rebuilding and restructuring of the dermis. At the same time, collagen building lasers such as the Palomar 1540 and Deep IR Lasers are employed to stimulate the dermal repair. Most recently, superficial treatment attachments for the Ulthera machine have become available to also treat at this depth. Several treatments are generally needed, but we have treated hundreds of stretch marks and have seen very significant improvement of their appearance using these modalities.

Originally published: 08/09/16

Scott Wells, MD

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