Stretch marks, a common skin concern, can be treated effectively with ablative co2 fractional lasers. However, achieving the best results requires a deep understanding of key treatment parameters, including energy levels, pulse width, and spot size. These factors can significantly impact the effectiveness of the treatment while minimizing potential side effects. In this blog, we’ll explore the clinical classification of stretch marks, how different lasers work for their treatment, and the optimal settings to ensure the best results.
1. Two Types of Stretch Marks
Initially, stretch marks are red or purplish in color, known as red stretch marks. They may appear sunken or raised, with symptoms like itching or burning. Under a microscope, you may see the rupture of elastin fibers in the dermis, collagen degeneration, and thickening and dilation of small blood vessels. Over time, red stretch marks mature and turn white, known as white stretch marks. Histologically, white stretch marks show epidermal thinning, reduced dermal papillae, and collagen thickening, which becomes parallel to the skin surface. These marks can become narrower or less pronounced but do not disappear on their own. Stretch marks cause both aesthetic and psychological pressure for patients, leading to high treatment demand.
2. Mechanism, Classification, and Manifestation of Stretch Marks
Stretch marks are a unique type of skin scarring that can develop under various conditions, including pregnancy, rapid growth during puberty, or prolonged use of corticosteroids.
White stretch marks, which occur as the skin matures, show varying degrees of indentation and width but do not resolve on their own. They require more advanced treatments to improve their appearance.
Initially, red stretch marks are caused by over-expansion of capillaries beneath the skin. These marks tend to be raised and may be accompanied by itching or discomfort. Over time, as the skin heals and collagen is reduced, the marks turn into white stretch marks.
3. Prevention and Treatment
Prevention
Clinical studies reveal that commonly used products like olive oil, pregnancy oils, and lotions offer limited efficacy in preventing stretch marks, including pregnancy-related ones. Effective prevention strategies include:
- Weight management to reduce cortisol levels.
- Regular exercise to maintain skin tension.
- Proper dietary habits.
Skin Care Products Treatments
While many over-the-counter products, such as olive oil, pregnancy oils, and lotions, claim to prevent stretch marks, clinical studies show their efficacy is quite limited. The most effective prevention strategies focus on controlling the physiological factors that lead to stretch marks:
- Weight management to reduce fluctuations in cortisol levels, which can contribute to skin stretching.
- Regular exercise to maintain skin elasticity and strength.
- Balanced diet to support skin health.
Co2 Fractional Laser Treatments:
Once stretch marks have formed, there are a variety of laser treatments and therapies that can improve their appearance and reduce symptoms. According to the Guidelines for the Diagnosis and Treatment of Common Laser Cosmetic Conditions (2024 Edition), treatments based on physical energy sources, like lasers, have been shown to improve stretch marks with success rates ranging from 27% to 100%. However, no treatment has been identified that can completely cure stretch marks.
- For Mature White Stretch Marks: CO2 fractional lasers, intense pulsed light (IPL), and radiofrequency (RF) are more effective in promoting collagen remodeling. These technologies help break down scar tissue and stimulate the skin to create new, healthy collagen fibers.
- For Early-Stage Red Stretch Marks: Lasers like 1064nm Nd:YAG and 585nm pulsed dye lasers (PDL) are effective for targeting the blood vessels that cause redness. These lasers stimulate collagen production, helping to reduce the visibility of red stretch marks.
4. CO2 Fractional Laser Treatment Parameters for Stretch Marks
CO2 fractional lasers are considered one of the most effective treatments for stretch marks, particularly mature white stretch marks. They are preferred over non-ablative lasers due to their ability to deeply stimulate collagen production and improve skin texture.
When describing the intensity and severity of stretch marks (also known as striae distensae), they are typically assessed based on several factors, including the number, distribution, color, depth, and skin damage. Here’s how to classify them:
1. Intensity (Density)
The intensity of stretch marks refers to their number and coverage area. It can be described in the following categories:
- Mild Intensity: Stretch marks are few in number, scattered sparsely in localized areas (e.g., abdomen, thighs, or hips). The marks are not overlapping and are often confined to specific areas.
- Moderate Intensity: Stretch marks are more numerous and cover a larger area, such as the abdomen, thighs, hips, and arms. They may overlap slightly but are not widespread across the entire region.
- High Intensity: Stretch marks are dense and widespread, covering most or all of the affected area. They may overlap significantly and extend over a large portion of the body, including the abdomen, thighs, hips, arms, and even the back.
2. Severity
The severity of stretch marks refers to the color, depth, and the extent of skin damage. It can be described as:
- Mild Severity: The stretch marks are light in color (often pink or purple), relatively shallow, and the skin retains some elasticity. There may be little to no indentation or noticeable texture changes.
- Moderate Severity: The stretch marks are darker (red or purple) and may appear deeper, with some skin indentation or slight hardening. It may be accompanied by mild itching or discomfort, and skin elasticity may be somewhat reduced.
- Severe Severity: The stretch marks have faded to a whitish or silver color, and they appear deeply indented, with noticeable skin laxity and a hardened texture. Skin elasticity is significantly reduced, and scar tissue may be present, affecting the overall appearance.
Here’s a table summarizing the treatment parameters for fractional laser on stretch marks based on intensity and severity:
| Parameter | Severe Intensity (High Density) | Moderate Intensity (Medium Density) | Mild Intensity (Low Density) |
|---|---|---|---|
| Power | 18-20W | 15-20W | 12-18W |
| Pulse Duration | 1 ms | 1 ms | 1 ms |
| Interval Time | 1 ms | 1 ms | 1 ms |
| Spot Spacing | ~0.6mm | ~0.8mm | ~0.8mm |
| Scan Mode | Random or Customizable | Random or Customizable | Random or Customizable |
| Scan Time | Twice (Once within the lesion, once over the entire affected area) | Twice (Once within the lesion, once over the entire affected area) | Single pass |
| Treatment Intervals | 3 months intervals, 3-5 treatments recommended | 3 months intervals, 3-5 treatments recommended | Over 3 months intervals, 2–3 treatments recommended |
| Coverage Rate | 5%-10% | 5%-10% | 5%-8% |
Notes:
- Energy Settings: Energy settings for fractional laser treatment should be adjusted based on the patient’s skin type and treatment area thickness. For thinner or sensitive skin, lower energy settings are recommended to minimize side effects and discomfort. For thicker skin or deeper treatment areas, higher energy levels can be used to achieve better results by penetrating deeper layers of the skin and promoting more significant collagen remodeling.
- Treatment Intervals: Typically range from 4 to 6 months, depending on the type of laser used and the patient’s skin reaction.
- Treatment Endpoints: Common endpoints include erythema (redness) or mild edema (swelling), though in some cases, pinpoint scabs or small pinpoint bleeding may occur.
These laser parameters help ensure deep penetration into the skin layers, effectively targeting the blood vessels and collagen structures responsible for the appearance of stretch marks.
Pain and Side Effects: While CO2 fractional lasers are the gold standard for skin resurfacing, they can cause redness, pain, and prolonged hyperpigmentation, leading to lower patient satisfaction. This is especially noticeable on the trunk and limbs, where the skin is thicker. Pre-treatment communication with patients is key.
Tailored Approaches: Factors such as energy density, pulse width, spot size, treatment intervals, and the number of sessions will all affect the treatment outcomes. Even slight differences between similar devices can impact the results, so it’s important to adjust the settings based on the specific brand and the individual’s needs.
By understanding and adjusting these parameters, practitioners can maximize the benefits of ablative fractional lasers, ensuring effective treatment for both red and white stretch marks while minimizing side effects and maximizing patient satisfaction.
5. Comparison of Ablative Fractional Lasers with Different Wavelengths for Treating Stretch Marks
Ablative Fractional Laser Effectiveness
- Ablative Fractional Lasers vaporize the superficial layers of the skin, effectively removing part of the epidermis and even reaching the dermis to promote skin remodeling.
- Better for Smoothing: These lasers are more effective in improving the texture of stretch marks, including pregnancy-related stretch marks (striae distensae). Typically, only 1–3 treatments are needed for noticeable improvements.
- Post-Treatment Side Effects: Ablative lasers may cause erythema (redness) or pigmentation changes post-treatment. However, their depth makes them more suitable for treating more severe stretch marks.
Non-Ablative Fractional Laser Effectiveness
- Minimal Skin Damage: Non-ablative fractional lasers cause less damage to the skin and have a shorter recovery time with a lower risk of pigmentation changes.
- Limited Depth: These lasers typically penetrate only the superficial layers of the skin, making them more suitable for treating mild to moderate stretch marks.
- Less Effective for Severe Marks: Non-ablative lasers are less effective for improving the texture of deep stretch marks but may help in the overall appearance of mild cases.
Different Wavelengths of Fractional Lasers
| Laser Type | Wavelength | Effectiveness | Best For | Side Effects to Consider |
|---|---|---|---|---|
| 1550nm & 1650nm Fractional Laser | 1550nm / 1650nm | Similar effectiveness for treating atrophic stretch marks | Effective for moderate to severe stretch marks | Risk of post-treatment erythema and pigmentation in darker skin tones |
| 2940nm Fractional Laser | 2940nm | Used for facial rejuvenation, concave scars, and hypertrophic scars | Ideal for mild stretch marks, facial and superficial treatments | Minimal skin damage, but suitable only for lighter marks |
Other Treatments
- Microneedling with RF (Radiofrequency) Combination Therapy
- Best for Dermal Remodeling: Microneedling with RF may be a better option for deeper dermal remodeling and skin rejuvenation.
- Less Risk of Pigmentation: The pigmentation risk is much lower compared to fractional lasers, making it a more ideal choice for patients with darker skin.
- Pulsed Dye Lasers (e.g., 585nm or 595nm)
- Best for Red/Purple Stretch Marks: Pulsed dye lasers are particularly effective for treating red or purple stretch marks in their early stages, offering significant improvements in vascularity and color.
Treatment Recommendations and Considerations
- Ablative Fractional Lasers (e.g., 1550nm, 1650nm) are generally more effective for treating severe stretch marks but require careful management of potential side effects, such as redness and pigmentation changes, particularly in individuals with darker skin tones.
- Non-Ablative Fractional Lasers (e.g., 2940nm) are more suitable for treating milder stretch marks, with less skin damage and quicker recovery, but their efficacy is limited for deeper scars.
- Microneedling with RF might be a better alternative for treating deeper stretch marks while minimizing the risk of pigmentation issues.
- Pulsed Dye Lasers can be beneficial in the early stages of stretch marks where the redness and vascularity are more pronounced.
6. Aftercare Tips to Reduce the Risk of Pigmentation
However, laser treatments can sometimes lead to temporary pigmentation changes, particularly during the healing process. Fortunately, by using precise treatment parameters, appropriate aftercare, and repair skincare products, the risk of pigmentation can be significantly reduced, and skin recovery can be enhanced.
1. How Fractional Lasers Reduce the Risk of Pigmentation
Adjusting Laser Parameters
- Lowering Energy Density: High energy settings may overstimulate the skin, increasing the risk of pigmentation. By adjusting the energy density and pulse width, excessive damage to the epidermis can be avoided, thus reducing the chances of pigmentation.
- Optimizing Pulse Duration: Shorter pulse durations (such as 150-700μs for CO2 fractional lasers) can minimize heat buildup, reducing the likelihood of pigmentation.
- Appropriate Spot Spacing and Scanning Mode: By adjusting the spot spacing (e.g., 0.6mm for severe cases, 0.8mm for moderate cases) and scanning mode (such as random scanning), laser energy can be evenly distributed across the skin, avoiding over-treatment in specific areas, thus preventing localized pigmentation.
Post-Treatment Cooling and Repair
- Rapid Cooling: Cooling treatments help reduce inflammation and heat-induced damage, significantly decreasing the chances of pigmentation. Many modern fractional laser devices are equipped with built-in cooling systems or cooling gloves to ensure the skin does not overheat.
- Sun Protection: UV exposure is a major factor in pigmentation. Since skin is typically more sensitive after laser treatments, it is essential to protect it from UV damage. Using high SPF sunscreen (SPF 30 or above) is crucial, particularly during the first 1-2 months after treatment, to reduce pigmentation risk.
2. Using Repair Skincare Products Post-Treatment
Using the right repair skincare products can accelerate skin recovery and prevent pigmentation. Below are common types of repair products and their roles:
A. Anti-Inflammatory Repair Products
- Repair Serums: Products containing anti-inflammatory ingredients like Centella Asiatica, Witch Hazel, or Aloe Vera help reduce redness, swelling, and irritation after laser treatment.
- Vitamin C Serums: Vitamin C is a powerful antioxidant that inhibits melanin production, helping to reduce pigmentation. It also promotes skin repair and boosts collagen production.
B. Skin Repairing Products
- Hyaluronic Acid: Hyaluronic acid provides intense hydration, which helps restore the skin’s moisture balance, support barrier repair, and promote healing. Keeping the skin hydrated helps prevent excessive dryness, which could lead to pigmentation.
- Repair Creams: Products containing Vitamin E, Beta-glucan, or allantoin are excellent for healing and strengthening the skin’s barrier, preventing dryness or irritation that could trigger pigmentation.
C. Brightening Ingredients
- Niacinamide (Vitamin B3): Niacinamide is well-known for its ability to inhibit melanin transfer, helping to reduce pigmentation and improve overall skin tone. It can be used post-treatment to prevent new pigment spots from forming.
- Arbutin: Arbutin is a popular skin-brightening agent that can effectively inhibit melanin production, helping to reduce post-laser pigmentation.
- Tranexamic Acid: Tranexamic acid has been shown to reduce pigmentation by blocking pathways that lead to melanin formation. It is particularly useful in treating pigmentation that arises after laser treatments.
3. Daily Skincare and Precautions
Post-Treatment Care:
- Avoid touching the treated area immediately after treatment to prevent bacterial infection.
- Mild redness and a slight burning sensation are normal; apply a cold compress to reduce swelling and pain.
- For facial treatments, avoid hot water for washing your face for 5 days, and refrain from using makeup, steaming, saunas, intense facial massages, or vigorous exercise for 2 weeks.
Crusting Care:
- Around the third day post-treatment, small crusts will form on the treated area, and they should naturally fall off after 7-10 days.
- Do not pick or scratch the crusts; allow them to fall off on their own.
Moisturizing and Sun Protection:
- Use moisturizing products with glycerin, hyaluronic acid, or other hydrating ingredients to enhance skin moisture and reduce inflammation.
- Apply products with ceramides, vitamin E, or other reparative ingredients to help rebuild the damaged skin barrier and support healing.
- Pay extra attention to moisturizing and protecting the skin from direct sunlight.
Diet and Lifestyle:
- Follow a light diet and avoid spicy or irritating foods. Increase intake of vitamin C, E, and zinc-rich foods.
- Minimize activities that induce sweating, and keep the treated area dry and clean.
Medications:
- Consider using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or corticosteroids (e.g., hydrocortisone) to reduce post-treatment redness, swelling, and discomfort.
- Use epidermal growth factors like basic fibroblast growth factor (bFGF) to promote skin cell regeneration and wound healing.
Other Considerations:
- Avoid makeup for at least two weeks after the procedure to prevent secondary irritation or infection.
By combining appropriate laser treatment settings, proper post-treatment care, and effective repair skincare products, the risk of pigmentation after fractional laser treatments can be greatly reduced.
Any problem you have when used the Mico Aes fractional co2 laser machine, just contact us to get the professional advice.
