Stretch Marks

Interview of plastic surgeon Mr Anastasios Tsekouras in the ‘Art of life and health’ magazine.

WHAT YOU NEED TO KNOW ABOUT STRETCH MARKS AND HOW TO TACKLE THEM

Stretch marks are a cosmetic problem that is particularly annoying this time of year as our apparel becomes more … revealing.

It is useful to know the structure of the skin to understand the mechanism responsible for their creation.

The skin consists of the epidermis and the main skin or dermis. The epidermis is a thin layer of cells on the surface of the skin, which represents a small percentage of its total thickness. The dermis or main skin is situated between the epidermis and the subcutaneous fat and is much thicker than the epidermis. It contains the blood vessels of the skin and consists mainly of collagen and elastic fibers, which are organized in a grid-like structure closely resembling the structure of fabric.

How are they created

If a fabric is stretched abruptly, you'll notice that at some parts of the fabric the fibers have parted and formed gaps between them, without, however, the fabric being torn. It is this phenomenon that occurs in stretch marks. They are essentially a form of an atrophic scar that is generated as a result of the strong stretching of the skin.

The stretch marks may therefore be due to either a rapid increase in height during puberty, or sudden weight gain due to obesity or the use of corticosteroids, either during pregnancy due to the increased size of the uterus. 85% of pregnant women develop stretch marks mainly on the breast and abdomen areas during the third trimester of their pregnancy.

In rarer cases, certain medicines or endocrine disorders can cause the appearance of intense stretch marks (long term administration of cortisone, Cushing's disease, etc.). Finally, the quality of the skin (inheritance) and gender (men develop stretch marks at a much smaller rate) play a crucial role. However, the intensity and extent of the problem that will occur vary from person to person.

They usually appear on the buttocks, thighs, knees, calves, arms and chest.

The fibers of collagen and elastin in the dermis are separated, forming streaks on the skin’s surface. These lines are at first of a red-violet color due to hyperemia and form an imprint (i.e. their surface is located underneath the skin’s surface). Gradually they decolorize until they turn into a lighter shade to that of normal skin. They are a permanent skin damage which is shiny in appearance but feels as if the skin is thinning when touched (feeling of vacuum pressure) and the skin wrinkles easily.

How to prevent them

There are no treatments proven to prevent the appearance of stretch marks. However, it is of benefit:

• To avoid changes in your weight.
• To properly hydrate your body. Drink at least 8 glasses of water a day.
• To use a daily body moisturizer. If your skin is extremely dehydrated, choose a product with a rich texture.

How to tackle them

As a fault detected in the network of collagen fibers, the goal of intervention is to increase the density of collagen fibers in areas where stretch marks appeared. To achieve this, we should stimulate the fibroblasts, cells that produce collagen in our skin. This can be done:

• Conservatively, with dressings that contain substances that "nourish" and "mobilize" the fibroblasts. Some of these are vitamin C, vitamin E, flavonoids and other pharmaceuticals, which are widely used in the medical cosmetics industry.
• Invasively, which gives better results when combined with conservative treatment.

To stimulate the production of collagen by fibroblasts, we exploit the mechanism of healing of the skin in which the fibroblasts are required to repair an injury. What remains, therefore, is to provoke a "controlled" damage to the area we want to heal, to 'cheat' the skin and cause it to produce collagen at a local level. This can be done in two ways:

• On the surface of the skin: for the creation of the damage, we use microdermabrasion and superficial peeling.
  In both methods some superficial layers of the skin are being removed, stimulating it to regenerate. Caution is advised, as the skin near the stretch marks is very delicate and can easily be pigmented after treatment. The use of A-retinol in combination with glycolic acid is the common protocol for the superficial peeling of the body.
• At the deeper layers: in this case we take advantage of laser technology, which allows us to channel energy into the depth of the skin without causing surface damage. This is done using specialized equipment such as:
• IPL laser (intense pulsed light devices) aimed at the skin’s collagen in order to re-establish its regeneration both qualitatively and quantitatively. They work without affecting the skin and injure 'selectively' the deeper layers of the skin, stimulating fibroblasts, cells that produce collagen and elastin and result in the tightening of the skin, improved texture and tone and reduction of deep stretch marks .
• radio frequency (RF) caused by thermal stimulation of collagen, thereby tightening the skin and the improvement of stretch marks while managing mild lipolysis and improvement of cellulite.
• pulse dye lasers’ (595nm) energy is absorbed perfectly by the red color of the stretch mark thus activating physiological regeneration mechanisms that lead to major improvement.
• Lately a new technology, technology Fractional («fractional» photoanaplasis) seems to bring a real breakthrough especially in addressing mature stretch marks (white) which had the poorer treatment outcomes. With this technique, the laser beam is split into separate beams depending on the depth of penetration we want to achieve, thus being capable of acting throughout the depth of the skin by channeling the necessary power to achieve full skin regeneration.

The choice of laser will depend on the nature of the problem considering various parameters such as age, mechanism of creation, time elapsed since their formation, etc.

Results

It should be noted that:

• It takes several laser sessions at intervals of 30-45 days. The end result, however, can be assessed much later - up to 6 months after the end of such a course of treatment.
• The improvements in red stretch marks reach a rate of 80% -90% in contrast the white stretch marks improvement rates are lower.
• We must remember that stretch marks are a type of scarring of the skin. This means that our main goal is always to improve their appearance and not their elimination necessarily.