Stretch marks or striae distensae are visible linear scars which develop as a result of excessive stretching of the skin associated with rapid growth or rapid weight changes, such as during puberty or pregnancy. Stretch marks occur in the dermis, the resilient middle tissue layer that helps the skin retain its shape.
Stretch marks often cause cosmetic concern and psychological distress in affected individuals. With increasing preference for outdoor activities and increasing incidence of revealing apparel, treatment of striae has become a necessity in many patients.
Fractional laser resurfacing involves the deposition of a pixelated pattern of microscopic laser wounds surrounded by healthy tissue resulting in both greater efficacy and shorter downtime compared to non-fractionated treatments. It can be further subdivided into ablative and non-ablative. Ablative fractional lasers have longer wavelengths (e.g. CO2 10600nm) and lead to full-thickness destruction of skin, whereas non-ablative fractional lasers have shorter wavelengths (e.g. Erbium Glass 1550nm) and leave an intact skin surface. CO2 has greater efficacy compared with Erbium Glass but longer recovery time and a higher risk of complications.
Fractional Infrared Lasers have a good body of research evidence demonstrating safety and efficacy. They are the gold standard treatment for scarring against which other treatments are compared.
Discovery Pico Plus is a second-generation triple wavelength picosecond laser that generates the highest peak power in the world. A special microlens array further focusses the energy into numerous micro-beams 2mm under the skin. The highly concentrated energy produces laser-induced optical breakdown (LIOB) stimulating scar remodelling with almost no downtime.
Fractional Radiofrequency creates a pyramidal thermal injury zone (a relatively large coagulation zone deep in the skin with minimal surface damage) as opposed to the columnar shape of ablative lasers. Hence Fractional Radiofrequency has a favourable side-effect profile (such as downtime, post-inflammatory hyperpigmentation) in comparison to fractional lasers.
Scar remodelling requires heat delivery to the deep part of the skin. However, in most machine-based treatments for scarring such as lasers, much of the energy is dissipated at the skin surface and little reaches the deep layers. Fractional microneedle radiofrequency overcomes this using insulated microneedles to spare the upper part of the skin and deliver radiofrequency energy precisely up to 4mm deep in the skin, resulting in faster recovery, higher efficacy and increased safety.
Vascular lasers (such as pulsed dye lasers, yellow lasers, long-pulsed diode or NdYAG) target haemoglobin in blood vessels destroying them. They are useful for hypertrophic / keloid scars and fresh stretch marks. Intense Pulsed Light used together with special vascular filters can be used for similar purposes as well but is generally less powerful
Stretch marks or striae distensae represent dermal scars with epidermal atrophy. They commonly appear after weight loss or pregnancy. Many patients regard them as unsightly and feel less confident because of their stretch marks. They may even be reluctant to participate in social occasions such as going to the pool or beach as they are self-conscious about their stretch marks.
Topical treatments such as vitamin A and chemical peels can help, however, they don't really produce very obvious results. They should be used as an adjunct to energy-based treatments.
Fresh stretch marks are reddish (striae distensae rubra) while old stretch marks are white (striae distensae alba). Early treatment of stretch marks generally yields better results.
Fractional resurfacing devices (such as Fractional Radiofrequency, Fractional Lasers, Fractional Microneedling Radiofrequency) can produce visible clinical improvements in the length, width, depth and colour of stretch marks, with good patient satisfaction. Vascular lasers can also help with the red discoloration of fresh stretch marks.
Dr Wan has a wide arsenal of fractional energy devices and lasers to treat stretch marks. The choice of approach would be guided by the patient's budget, tolerance of downtime and severity and configuration of stretch marks.
As stretch marks are not uniform, it would not make any sense to treat the entire area indiscriminately. Rather, Dr Wan utilizes a more nuanced approach to accurately and intensively target only the stretch marks. This ensures adequate treatment while reducing the chance of complications such as post-inflammatory hyperpigmentation.
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