Stretch marks (striae distensae) are common dermal scars resulting from the rapid stretching or shrinking of the skin. This abrupt change causes collagen and elastin fibers in the dermis to rupture and tear. The lesions initially appear as reddish or purplish lines (striae rubrae) and eventually mature into white, depressed streaks (striae albae). While not a health threat, these marks often cause cosmetic concern, leading many people to explore options offered by plastic surgery.
When Plastic Surgery Directly Removes Stretch Marks (Excisional Methods)
True surgical removal of stretch marks occurs only when the section of skin containing the scars is physically excised from the body. This is typically achieved as a secondary benefit during major body contouring procedures, not as the primary goal of the operation.
The most common example is an abdominoplasty, or tummy tuck, which is primarily performed to remove excess skin and tighten abdominal wall muscles, often following weight loss or pregnancy. During this procedure, the skin and fat between the belly button and the pubic area are surgically removed. Since most abdominal stretch marks are concentrated in this lower quadrant, any striae in that excised tissue are permanently eliminated. Marks located higher on the abdomen are not removed but are pulled downward and repositioned closer to the resulting incision line.
Procedures like a body lift, thigh lift, or arm lift may also remove stretch marks if the marks are present on the skin targeted for excision. These are extensive surgeries with prolonged recovery periods and are not justifiable solely for the purpose of removing stretch marks. The removal of the striae is a welcome side effect for patients who already require these operations to address significant skin laxity and excess tissue.
Advanced Cosmetic Procedures for Improvement (Non-Surgical Alternatives)
For individuals who do not require or desire major excisional surgery, the most common approach involves non-surgical cosmetic procedures aimed at improving the texture and color of the stretch marks. These methods work by creating controlled injury to the skin to stimulate the body’s natural wound-healing response and promote the production of new collagen and elastin fibers. Non-surgical treatments reduce the visibility of the striae, but they do not physically remove them.
Fractional laser resurfacing is a highly effective option, using a device to deliver microscopic columns of heat into the dermis while sparing the surrounding tissue. Ablative fractional lasers, such as CO2 lasers, vaporize tiny zones of tissue to encourage collagen remodeling, often used for older, white stretch marks (striae albae). Non-ablative fractional lasers penetrate the skin without removing the top layer, offering a milder treatment with less downtime.
Radiofrequency (RF) microneedling combines the physical stimulation of tiny needles with the heat energy of radiofrequency waves delivered deep into the skin. Devices like Morpheus8 or Scarlet stimulate collagen contraction and synthesis, which helps to plump the depressed texture of the stretch marks. This combination therapy is useful because the thermal energy from the RF can penetrate deeper than microneedling alone.
For newer, reddish stretch marks (striae rubrae), a pulsed dye laser (PDL) is often the preferred treatment. This vascular laser targets the hemoglobin in the blood vessels that give the marks their red color, causing them to collapse and fade. Treating the vascular component early can prevent the marks from maturing into prominent white scars.
Determining Candidacy and Setting Realistic Outcomes
The selection of the appropriate treatment depends on several patient-specific variables, including the age of the stretch mark and the patient’s skin type. Newer, red-hued striae rubrae respond better to treatment overall because of their active blood supply, making them ideal targets for vascular lasers. Older, white striae albae require more aggressive treatments, such as fractional lasers or RF microneedling, to induce collagen remodeling.
Skin type, specifically the level of pigmentation, is an important consideration, especially with energy-based devices. Individuals with darker skin tones face a higher risk of post-inflammatory hyperpigmentation following laser treatments, meaning the treated area could darken temporarily. For these patients, non-ablative lasers or RF microneedling systems are considered safer options than fully ablative lasers.
Overall skin elasticity, the location of the marks, and the patient’s general health also influence whether a surgical or non-surgical route is advised. A professional consultation is necessary to assess these factors and to manage expectations regarding the final result. Complete eradication of stretch marks is rare with any method, and the goal of most treatments is significant improvement and blending of the scars with the surrounding skin.
Patients must be prepared for the differing recovery timelines and costs associated with each approach. Excisional surgery involves a significant recovery, while non-surgical treatments require less downtime but necessitate multiple sessions, each incurring a separate cost.