Stretch marks (striae distensae) are common dermal scars caused by the rapid stretching of skin, which ruptures the underlying support structure. This often occurs during pregnancy, puberty, or significant weight fluctuations. While no treatment guarantees total removal, laser technology significantly improves the texture, color, and overall appearance of these marks. Treatment success depends heavily on the stretch mark’s age and the specific laser used to target damage within the skin layers.
Understanding Stretch Marks (Striae)
Stretch marks are a type of scarring where the collagen and elastin fibers in the dermis have torn and disorganized. Their appearance changes over time, progressing through two distinct stages that dictate the most appropriate treatment. Initially, they present as striae rubrae, characterized by a reddish, pink, or purple color. This coloration is due to inflammation and dilated blood vessels (vascularity), often making them slightly raised or itchy.
Over time, these marks mature and lose their vascularity, becoming striae albae. These mature marks appear white, pale, or silver, becoming atrophic, depressed, and wrinkled as the dermal structure collapses. The distinction between these stages is crucial because it defines the primary target for laser treatment. Striae rubrae are highly vascularized, responding best to treatments that target blood components. Striae albae require an approach focused on dermal remodeling due to the loss of structural components like collagen and elastin.
The Science Behind Laser Removal
Laser therapy for stretch marks uses selective photothermolysis, where specific light energy wavelengths are absorbed by a targeted molecule (chromophore). Common chromophores in the skin include water, hemoglobin, and melanin. By targeting different chromophores, lasers can address both the vascular and structural components of the striae.
The heat generated by the absorbed light creates a controlled micro-injury within the dermis. This intentional damage triggers dermal remodeling by stimulating fibroblasts, the cells responsible for producing new structural proteins. This stimulation leads to neocollagenesis (new collagen) and neoelastogenesis (new elastin). By rebuilding the disorganized, damaged network, the treatment increases the skin’s thickness and elasticity in the scarred area. This ultimately smooths the texture and improves the visual blend with surrounding skin.
Specific Laser Technologies Used
The specific laser technology is selected based on the color and maturity of the stretch mark.
Striae Rubrae (Red Marks)
For early, red-hued striae rubrae, Pulsed Dye Lasers (PDL) are the preferred option. PDL typically operates around 585 nm or 595 nm, targeting the hemoglobin in the dilated blood vessels. This effectively reduces the redness and inflammation associated with new marks.
Striae Albae (White Marks)
For mature, white striae albae, which lack significant vascularity, the focus shifts to dermal remodeling and resurfacing using Fractional Lasers. These are split into two main types: ablative and non-ablative.
Ablative fractional lasers, such as the 10,600 nm CO2 laser, vaporize microscopic columns of tissue. This creates intense thermal damage that maximizes the stimulation of new collagen and elastin production. While offering strong results, these systems require a longer healing period.
Non-ablative fractional lasers, such as the 1550 nm Er:Glass laser, heat the dermal tissue deep beneath the surface without removing the top layer of skin. This gentler approach still induces neocollagenesis but involves less downtime. Both fractional methods encourage the skin to repair itself, improving the atrophic texture of older marks.
Practical Considerations and Expected Results
Achieving noticeable improvement requires a commitment to multiple treatment sessions. Most patients need three to six treatments for optimal results, spaced four to six weeks apart to allow for dermal healing and remodeling. The exact number depends on the severity of the striae and the individual response.
Discomfort during the procedure is generally managed with a topical anesthetic cream. Expected downtime varies significantly based on the laser type. Non-ablative fractional treatments may involve only one to two days of mild redness and swelling. Ablative fractional lasers cause a more aggressive injury, resulting in several days of redness, swelling, and temporary scabbing or peeling, potentially requiring up to a week of recovery.
The cost of laser treatment is influenced by the size of the area, the laser type, and the clinic’s location. A single session can range from a few hundred dollars to several thousand dollars for a larger area or more aggressive ablative laser. Since this is a cosmetic procedure, it is not typically covered by medical insurance.
Patients should maintain realistic expectations; the goal is significant improvement, not total erasure. Clinical studies consistently show that laser treatments can reduce the visibility of stretch marks by 50% to 75%. The best outcomes are seen when marks are treated early, while they are still in the striae rubrae (red) phase, but mature marks can still achieve substantial textural improvement.