Stretch mark treatment: which procedures work and what to expect

Stretch marks are one of the most commonly asked-about skin concerns at med spas — and one of the most frustrating to treat. Understanding what they are structurally helps set realistic expectations about what treatments can achieve.

What stretch marks are

Stretch marks (striae) form when skin is rapidly stretched beyond its elastic capacity. The dermis tears, disrupting collagen and elastin fibers. The result is a permanent structural change in the dermis — a type of scar.

Striae rubrae (red/purple stretch marks): Recent marks with active inflammation and new blood vessels. Easier to treat — more responsive to most modalities.

Striae albae (white/silver stretch marks): Mature marks where the inflammation has resolved and the tissue is atrophic, flat, and hypopigmented. Harder to treat — the vascularity that makes red marks responsive is absent.

Common locations: abdomen, hips, breasts, upper arms, thighs, and buttocks. Causes include growth spurts, pregnancy, rapid weight gain or loss, and bodybuilding.

The fundamental challenge

Stretch marks are scars. No treatment fully eliminates them. What treatments can do:
Improve texture so marks are less palpable
Improve color (reduce redness or improve pigmentation match)
Increase collagen density in the thinned area
Make marks less visually distinct overall

Realistic improvement = less visible, not invisible. Patients who understand this are more satisfied with treatment.

Treatments that work

RF Microneedling (Morpheus8, Potenza, Genius RF)

RF microneedling is currently among the best-supported treatments for stretch marks. The micro-injuries stimulate collagen remodeling, and the thermal energy from RF further amplifies the fibroblast response.

Evidence: Studies show measurable improvement in texture, depth, and color after 3 sessions. A 2020 study in the Journal of Clinical and Aesthetic Dermatology showed significant improvement in striae albae after 4 RF microneedling sessions.

Best for: Both red and white stretch marks; body areas including abdomen, thighs, and hips.

Sessions: 3–4, spaced 4–6 weeks apart.

Downtime: 3–5 days of redness and swelling at treatment sites.

Cost: $800–$2,500 per session depending on area size; $2,400–$10,000 for a full course.

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Fractional Laser (CO2 or Erbium)

Fractional ablative laser creates controlled micro-injury columns in the skin, triggering repair and collagen production. CO2 fractional has strong evidence for stretch mark improvement — particularly for texture reduction.

Evidence: Multiple RCTs support fractional CO2 for striae. The thermal and ablative injury stimulates significant collagen remodeling over 3–6 months.

Best for: Abdominal stretch marks, particularly striae albae; patients who want significant improvement and can tolerate downtime.

Sessions: 1–3 sessions; each session is more intense than RF microneedling sessions.

Downtime: 5–10 days of significant redness, swelling, and skin shedding.

Skin tone caution: Fractional ablative laser has a higher risk of post-inflammatory hyperpigmentation on darker skin tones (Fitzpatrick IV–VI). Non-ablative fractional or RF microneedling is safer for these patients.

Cost: $1,500–$4,000 per session.

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PRP (Platelet-Rich Plasma)

PRP growth factors stimulate fibroblasts and improve collagen synthesis. PRP applied topically immediately after RF microneedling (using the micro-channels for penetration) may enhance results. PRP injected directly into stretch marks is also practiced.

Evidence: Small studies suggest PRP improves the texture and color of striae when combined with microneedling. As a standalone, evidence is more limited.

Best used: As an adjunct to RF microneedling or fractional laser, not as a primary standalone treatment.

Cost: $400–$800 per session when added to another procedure.

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Non-ablative fractional laser (Fraxel 1550, MOXI)

Non-ablative fractional delivers heat in columns without removing the surface skin. Less downtime than ablative CO2, requires more sessions, appropriate for patients who want improvement with minimal recovery.

Sessions: 3–5.

Downtime: 2–4 days.

Cost: $800–$2,000 per session.

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Chemical peels

Superficial to medium chemical peels (glycolic acid, TCA) improve the superficial skin texture over stretch marks but do not meaningfully affect the deeper dermal change. Useful as a maintenance treatment or adjunct, but not a primary modality for stretch marks.

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What doesn't work for stretch marks

Topical treatments (oils, creams, serums): Vitamin E, cocoa butter, and most over-the-counter products have no credible evidence for treating established stretch marks. They may reduce itch or improve skin hydration but don't change the dermal structure.

Tretinoin (retinoic acid): There is some evidence that tretinoin applied to early red stretch marks may slightly improve collagen production, but effects on established white stretch marks are minimal. Tretinoin is absolutely contraindicated during pregnancy.

Prevention: Keeping skin hydrated and maintaining healthy weight during growth phases may reduce severity. But stretch marks cannot be fully prevented if there's significant rapid stretching — genetics plays a major role.

Timing matters — treat early

Red stretch marks (striae rubrae) respond significantly better than white ones. If stretch marks are recent (still red or purple), starting treatment earlier yields better results. The vascularity and active remodeling state of new marks makes them more responsive to laser energy and growth factors.

What to expect from treatment

For striae albae (white/silver):
Texture improvement: Likely significant
Color match improvement: Possible but unpredictable
Complete elimination: Not achievable

For striae rubrae (red/purple):
Color reduction: Good
Texture improvement: Good
Overall improvement: Better than for mature marks

Most patients complete a series and see meaningful improvement — enough that marks are no longer their primary concern in photos or daily life. "Invisible" remains unlikely.

Questions to ask your provider

What type of stretch marks do I have (red vs. white), and how does that affect treatment choice?
For my body area and skin tone, do you recommend RF microneedling or laser, and why?
How many sessions do you estimate I'll need for my pattern?
Will you be adding PRP to enhance results?
What realistic improvement should I expect after a full course of treatment?

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