Stretch marks are dermal scars, not surface marks. Whether they are red or white tells you a great deal about what will and will not work — and the two stages respond to different approaches.
Stretch marks pass through two stages, and they are not the same problem.
Striae rubra are the early red or purple phase. Vascular activity is present and the tissue is still actively remodelling. That ongoing biological activity is something treatment can work with.
Striae alba are mature. The redness has resolved, leaving tissue that is atrophic, thinned and short of pigment. The scarring process has completed, which makes this the more difficult of the two.
Honest expectation-setting begins here. Mature white striae are a challenging presentation for any modality, and any account of them that suggests otherwise should be treated with caution.
The change that produces a stretch mark sits in the dermis — disrupted collagen and elastin from tissue stretching faster than the matrix could accommodate.
This is why topical products so often disappoint. A cream applied to the epidermis does not reach the layer where the problem is.
Approaches that do reach it work by creating a controlled healing response in the dermis. Fractional laser at 1540 nm and 1927 nm combines dermal collagen work with more superficial action, and fractional CO2 resurfacing creates columns of controlled injury so the tissue reorganises as it heals.
Which applies, and what is realistic, is established at assessment rather than assumed.
“Stretch marks are scars in the dermis. That is why creams applied to the surface do not reach the problem.”
Dr Sin YongOn why topical treatment disappoints
Treatment is planned individually, so the cost follows the plan rather than a fixed list. Four things shape it:
A figure quoted before assessment would not reflect your presentation. Cost is set out clearly at consultation, before anything is agreed.
Stretch marks, or striae distensae, are a form of dermal scarring. Rapid stretching of tissue disrupts the collagen and elastin matrix in the dermis, producing a linear change in the skin. Because the change sits in the dermis rather than on the surface, topical products generally do not reach it.
Red or purple striae, called striae rubra, are the early stage: vascular activity is present and the tissue is still remodelling. White striae, or striae alba, are mature, with the vascular phase resolved and the tissue atrophic. The two stages behave differently and respond differently to treatment.
Stretch marks are established scarring, and treatment aims at improving their appearance rather than erasing them. Early red striae generally have more scope for change than mature white striae. What is realistic in an individual case is discussed honestly at assessment.
The change that produces a stretch mark sits in the dermis, below the layer a topical product reaches. This is the usual reason patients find creams disappointing. Approaches that create a controlled healing response within the dermis address the correct layer.
Cost depends on the area treated, the stage and extent of the striae, and how the plan is staged. Since surface area and presentation vary considerably between patients, a figure given before assessment would not be meaningful. Pricing is discussed at consultation.
Timing is assessed individually. Treatment is generally not planned during pregnancy, and post-partum timing depends on the individual situation, including whether breastfeeding is ongoing. This is discussed at consultation.
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