What are striae and why do they occur?
The skin consists of a thin outer layer, the epidermis, and the underlying dermis - a dense framework of collagen and elastin fibers, which provides elasticity. When the skin stretches faster than this frame can rebuild itself, the fibers break. The body closes the defect in the same way as it closes any wound inside the tissue - with connective tissue laid randomly and parallel to the surface. The epidermis over this area becomes thinner, so the stretch mark looks like a depressed strip with a slightly shiny, slightly wrinkled surface.
However, mechanical stretching alone is not enough, and this is fundamentally important to understand. People gain weight at the same rate, but not everyone gets stretch marks. It's all about hormones: excess cortisol and hormonal changes during pregnancy and puberty suppress the cells that produce collagen and make the fibers less strong. The frame becomes fragile and breaks under the load that healthy skin would withstand. This is why stretch marks are so closely associated with hormonal periods of life and with the use of steroid drugs, and not just with kilograms. Heredity also plays a big role: if the mother had severe stretch marks during pregnancy, the daughter’s likelihood is significantly higher.
- Pregnancy - most often the belly and chest, mainly in the last trimester
- Adolescent growth spurt - hips, lower back, chest, in young men there are often transverse stripes on the back
- Fast weight gain and fast weight loss
- Intensive gain of muscle mass, especially on the shoulders and chest
- Long-term use of hormonal ointments on the same area, taking systemic steroid drugs
- Endocrine diseases, especially excess cortisol
- Hereditary predisposition and structural features of connective tissue
Red and white: why timing is everything
Stria goes through two stages, and they are so different in terms of treatment options that they should be considered different conditions. In the first stage, the stretch marks are red, pink or purple. This color is given by blood in dilated vessels, which in a fresh scar are still abundant. The tissue here is alive and active: fibroblasts work in it, inflammation and restructuring occur. It is at this stage that you can influence the process - push the production of normal collagen, influence blood vessels, limit the formation of a rough scar.
After a few months, usually from six months to a year and a half, the vessels become empty, the inflammation subsides, and the striae fades. At the same time, melanocytes—the pigment-producing cells—disappear, so the old stretch mark does not tan and becomes even more noticeable on tanned skin. A white atrophic scar is formed: the skin over it is thinner than the surrounding one, there is almost no elastin, the surface is slightly depressed. No amount of impact will completely return this zone to its original state - you can only thicken the tissue, level out the relief and make the border less noticeable.
- Red and violet stretch marks are fresh, usually up to 6-12 months old, respond best to treatment
- White striae are a mature atrophic scar; the realistic goal here is to reduce visibility rather than disappear.
- Fresh stretch marks are often itchy and slightly protruding, white ones are usually depressed and do not bother
- White striae do not tan, so after the sun the contrast increases - in summer they seem more noticeable
- Some fresh stretch marks turn pale and decrease on their own in the first year, especially after childbirth
When and to whom do they appear?
Understanding typical scenarios helps both to anticipate the problem and to notice in time an atypical situation behind which the disease lies.
- Pregnancy: stretch marks appear in a significant proportion of women, most often in the last two to three months, when the stomach grows fastest; localization - abdomen, chest, thighs
- Adolescents: Striae occur in both sexes during a period of rapid growth; for girls - hips, buttocks, chest, for boys - lower back and back in the form of transverse stripes
- Strength Athletes: Rapidly increasing muscle volume in the shoulders, chest and arms stretches the skin
- Sudden weight fluctuations in any direction, including the period after bariatric surgery
- Long-term topical use of hormonal ointments, especially on thin skin and under a bandage
- Taking systemic steroid drugs for chronic diseases
Separately, it is necessary to say about the situation in which stretch marks are not a cosmetic problem, but a symptom. If wide purple stretch marks appear quickly, while a person does not become pregnant, does not grow and does not gain weight sharply, and at the same time the face becomes rounded, fat is deposited on the torso while arms and legs are losing weight, blood pressure rises, muscle weakness and light bruises appear - we may be talking about excess cortisol. This condition requires examination by an endocrinologist, and cosmetic procedures are secondary here: until the cause is eliminated, new stretch marks will appear. The same applies to a teenager with striae without a corresponding jump in height and weight.
Myths about creams, oils and wraps
The stretch mark treatment industry is huge, and the advertising promises directly contradict how stretch marks work. Let’s look at this calmly, because serious money is spent here, and disappointment then prevents you from turning to methods that actually work.
- Cosmetic cream acts mainly within the epidermis, and striae are a defect in the dermis; to affect the rumen, the substance must reach the deep layer in the effective concentration
- Oils, including olive, almond and coconut, moisturize and improve the appearance of the skin, but do not rebuild the collagen framework and do not remove stretch marks.
- Wraps, scrubs and massage brushes temporarily improve the appearance of the skin due to swelling and blood flow; the effect lasts for hours
- Products with hyaluronic acid and centella have some justification for prevention and at the earliest stages, but they do not eliminate the formed stretch mark
- No external remedy has proven the ability to completely remove white stretch marks - this statement is always an exaggeration
Retinoids—vitamin A derivatives in the form of creams—are worth a separate discussion. This is perhaps the only external group that has a clear rationale for fresh red stretch marks: they stimulate collagen production and skin renewal, and with prolonged use, stretch marks can become noticeably less pronounced. But they have a strict limitation: retinoids are absolutely contraindicated during pregnancy and are not used during breastfeeding. That is, it is precisely during the period when stretch marks are fresh that a woman often cannot use them, and this should be discussed with a doctor, and not decided on her own based on advice from the Internet. The purpose, concentration and regimen are determined by a dermatologist: retinoids irritate the skin and require sun protection.
What Really Works
All effective methods are united by one logic: in order to change the scar, you need to damage the dermis in a controlled manner and force the body to re-synthesize collagen and elastin. They differ in the method, depth and at what stage the stretch marks are designed for.
- Fractional laser - creates micro-zones of influence in the skin, around which tissue renewal is launched; works on both fresh and white stretch marks, usually requiring a course of 3-6 procedures at intervals of several weeks
- Vascular laser and systems based on intense pulsed light - used on red stretch marks, affecting dilated vessels and removing bright color
- Microneedling therapy - multiple micropunctures with sterile needles that stimulate collagen production; well tolerated and suitable for large areas
- Microneedle radiofrequency method - needles additionally deliver energy to the dermis, which enhances the effect on atrophic white striae
- Medium chemical peels - used on individual areas, often in combination with other methods
- Plasma therapy and biorevitalization - used as a supplement to improve the quality of the skin around
- Surgical excision - only possible for stretch marks on the lower abdomen and usually as part of abdominoplasty, when excess skin is removed entirely
What they honestly warn about at the initial consultation. Firstly, we are always talking about a course, and not about one procedure, and the result is assessed several months after its completion, because collagen is rebuilt slowly. Secondly, a realistic expectation for white stretch marks is a noticeable improvement in relief and color, in which the stretch marks are no longer noticeable, but remain visible upon close examination. Thirdly, on dark skin and skin prone to pigmentation, some aggressive techniques are used with caution, since persistent hyperpigmentation is possible; therefore, the choice of parameters and mandatory sun protection before and after the course is not a formality. And finally, it makes no sense to start treating stretch marks if you continue to gain or lose weight, during pregnancy and in the first months after childbirth - first the weight and hormonal levels stabilize, otherwise new stretch marks will appear next to the treated ones.
Prevention: what is really in our hands
- Плавный набор веса при беременности в пределах, которые рекомендует наблюдающий врач: скорость растяжения кожи — единственный фактор, на который можно повлиять напрямую.
- Избегать резких колебаний массы тела: быстрые диеты с последующим возвратом веса создают растяжки не хуже, чем сам набор.
- Наращивать мышечную массу постепенно, без резких скачков объёмов.
- Регулярное увлажнение кожи в зонах риска — оно не гарантирует отсутствия стрий, но улучшает эластичность и общее состояние кожи.
- Питание с достаточным количеством белка, а также цинка и витаминов, участвующих в синтезе коллагена.
- Не использовать гормональные мази дольше назначенного срока и не наносить их самостоятельно на обширные зоны и под повязку.
- Поддерживающее бельё в период беременности и при большой груди — снижает механическую нагрузку на кожу.
- При появлении первых красных полосок обращаться к дерматологу сразу, а не откладывать на потом.
