Stretch marks: Can they be removed?

Stretch marks are white, pink or bluish streak like marks on skin commonly noticed during pregnancy and when body is growing rapidly during adolescence.


Pregnant women notice the stretch marks on their growing belly after 4th or 5th month. Stretch marks in adolescents and men are usually seen on a variety of body parts parts like abdomen, hips, thighs, chest ,breasts , shoulders and arms. People who are on a muscle building exercise program , and those who take supplements containing steroids , also tend to develop stretch marks.

Stretch marks are medically called’Striae”.The term stretch mark is misleading. Stretching of skin is not the real cause of these marks . Stretch marks are seen is thin individuals as well . When plastic surgeons actually stretch the skin 2-3 times its size during some surgeries like tissue expansion, stretch marks do not appear. When someone is suffers from Cushings disease ( excess steroid hormones) the body develops stretch marks. Stretch marks happen due to excess circulating steroid hormones in the body- like during pregnancy, vigorous exercise etc and also due to increased sensitivity of skin to those hormones. Indian women are more prone to develop stretch marks during pregnancy than their white skinned counterparts.

All stretch marks are not the same. Mild stretch marks are like faint scratches whereas severe stretch marks are as wide as half a centimeter and also deep. You can feel the thin papery skin at the bottom of a wide stretch mark. All stretch marks look pink initially but gradually turn pale white over next few months. Deep and wide stretch marks tend to look bluish due to visibility of blood vessels through the thinned out skin.

Variety of stretch mark creams containing cocoa butter, Vit E etc sell like hotcake because people are desperate to treat stretch marks. These creams provide moisture but do not really do much for stretch marks. So what is the alternative? How do some actresses continue to wear skimpy clothes even after pregnancies without a sign of stretch mark?

Certain vascular lasers like Pulse dye laser can lighten bright pink stretch marks to pale white. If the stretch marks are already pale vascular laser will not be of any use. Other treatments like chemical peels, microdermabrasion can slightly improve certain superficial stretch marks only. A lot of sittings over many months are needed and the results are unpredictable. Recently fractional laser has been used for treatment of stretch marks. Light stretch marks can be improved upto 50 percent . Like with most lasers 6-10 sitting are required at one month intervals. Cost of laser treatment of marks on lower abdomen can be 1-2 lakh(2000-4000USD) rupees.

The fact remains that the most common type of deep stretch marks on the abdomen , post pregnancy can not be treated by any of the above methods. Tummy tuck or abdominoplasty is a surgical option. Apart from stretch marks there is also loose skin and bulging abdomen after pregnancies, which is resistant to proper diet and exercise. All these issues can be tackled with tummy tuck, which involves removal of fat, tightening of muscles and removal of all the skin below naval . Abdomen ends up looking pretty much same as it did before pregnancies. Even if the marks are extensive and going above the naval, they can be shifted very low down. Downside of tummy tuck is a long scar. Fortunately this scar is placed very low near pubic hair and it can be cleverly hidden in bikinis and low waist jeans. Cost of tummy tuck in India is Rs and 75000-1.5 lakhs( USD 1600-3000) upwards depending on gepgraphical location and surgeon.

Liposuction for weight reduction

I am a plastic surgeon. A lot of people who are overweight approach me everyday for getting a good body shape by liposuction. Those who are within 10 percent of their ideal body weight( for example if ideal weight for someone is 60 kilos and he weighs 66 kilos or less) are ideal candidates . Thats because their fat is usually localized in one or two body parts, like belly, thighs hips or arms .By removing a limited quantity of fat- say 5-6 kilos from those specific parts I can give them nearly perfect figure ,without compromising their safety . But quite often patients are really obese and want to reduce 10-20 or even 30 kilos by liposuction. This is a different scenario altogeather.

Lets first briefly consider few facts about liposuction. Liposuction is a plastic surgery procedure wherein fat from any body part can be extracted in liquid form through multiple tiny( 4 mm) cuts. Since procedure takes 1-4 hours to perform depending on the amount of fat and number of body parts treated- it is performed under some kind of anaesthesia inside a fully equipped operation theatre. There are no stitches but in every other way it is a major surgery with risks of surgery and anaesthesia. There is a healing time and period of rest involved.

People often ask if liposuction is safe? My answer is- yes it is , if done within safe limits. Liposuction involves removal of fat but invariably some amount of blood is mixed in the fat. By using tumescent technique blood loss can be minimized but can not be completely eliminated. Just like in case of blood donation where 300 ml blood can be safely donated by a healthy person , liposuction if done under strict quality conditions fat equivalent to 5-7 percent of person's body weight( 7 kilos for person weighing 100 kg) can be removed safely in one sitting.

People who are fat all over and 30-40 kgs overweight sometimes ask for liposuction , to reduce weight primarily. There are several problems in this scenario.First of all reducing a lot of fat like 10 kgs or more is risky, involves blood transfusions, long operating time and more dose of anaesthesia drugs. This risk though small is not justified just for losing weight which can be done in healthier and safer weighs. Results of liposuction are also inferior in large volume liposuctions due to surgeon working hastily and getting tired instead of doing a fine sculpting job. Irregularities and asymmetries are common after large volume liposuctions .

Then there is the question of long term maintenance of results. If patient says he is obese because he can not diet and has no time for exercise , I ask him how he is going to maintain the results? Fat gain is related to more calorie consumption relative to calorie burning. Weight can be regained if same lifestyle is faulty.

In a moderately overweight person removal of fat from one or 2 areas of body 5-7 kilos in a sitting can result in a great figure with safety. One can opt for another sitting after 2-3 months gap if more fat from another are needs to be removed. Very obese people( BMI 35 and above ),for example a person of height 5'3" weighing 100 kilos do not get appreciable improvement in one sitting unless they accept higher risk of high volume liposuction.

For such people I first of all want to know if their weight has been stable in last 6 months. There is no point wasting efforts on person who is still gaining weight because liposuction is not going to stop further weight gain. For obese people who have started healthy diet and moderate regular exercise and who have stopped gaining weight- liposuction can sometimes serve as a kickstart for weight loss . After removal of 5-7 kilos of fat from tummy or thighs often person feels more comfortable exercising and feels motivated to lose weight by further efforts of his/her own.The psychological barrier is broken . After some weight loss on his own person can then reward himself with another sitting of liposuction if needed. This approach takes care of weight loss safely with higher chances of long term maintenance, that the shortcut, quickfix method of large volume liposuctions .