Laser and Skin

Stretch marks: red is treatable, white is hard

Stretch marks are tears in the connective tissue of the dermis, and treatment works best while they are still red or purple, usually the first 6 to 12 months, because the tissue is then well supplied with blood and still remodelling. Vascular lasers take the redness, fractional lasers and microneedling rebuild the structure over 3 to 6 sessions, and nothing removes a mark completely: once it has turned white it behaves like a mature scar, with complete clearance reported in only about 4 per cent of cases even after CO2 laser.

Red, then white

A stretch mark forms when the skin is pulled apart faster than its connective tissue can adapt. The epidermis stays intact, which is why the surface feels smooth, but in the dermis beneath it the collagen and elastic fibres tear, and the springy network is replaced by thin, scar-like bundles lying parallel to the surface. The result is a band a few millimetres to a centimetre wide and several centimetres long, running at right angles to the direction of stretch.

Fresh marks are pink, red or purple, in darker skin often reddish or dark brown, slightly raised and sometimes itchy, because the damaged dermis is inflamed and richly supplied with blood. Dermatologists call this phase striae rubrae. Over the following months the inflammation settles, the vessels retreat and the mark fades to white or silver, flat or slightly sunken, with a finely wrinkled surface: striae albae. The change usually takes 6 to 12 months, sometimes up to 2 years, and it does not reverse. From then on the mark is a mature scar, and everything said about scar treatment applies to it.

That is the logic of timing. In the red phase there is blood to target and tissue that is still remodelling, so a treatment can fade the colour and steer the repair. In the white phase there is neither, and every procedure has to provoke new collagen in tissue that finished healing long ago; the gains are smaller and the sessions more numerous.

Who gets them, and why speed matters more than size

Stretch marks are among the most common skin changes. Between 43 and 88 per cent of women develop them in pregnancy, mostly from the third trimester, on the abdomen, breasts and hips. In puberty the figures range from 6 to 86 per cent depending on the population studied, girls more often than boys, usually on thighs, buttocks and breasts. Around 43 per cent of people with obesity have them, and rapid muscle gain puts them on the shoulders and upper arms. What these situations share is not the amount of stretch but its speed: skin that grows over years copes, skin that grows over months tears.

Hormones set the stage. Cortisol weakens collagen, which is why long courses of corticosteroid tablets, potent steroid creams used for weeks and Cushing's syndrome all produce stretch marks, often wider and more numerous than the everyday kind. Marfan and Ehlers-Danlos syndromes bring them through weaker connective tissue, and a family history raises the risk. The consequence is uncomfortable but honest: two people can gain the same 15 kilograms in the same 9 months and only one of them will mark; neither cream nor discipline decides which.

If marks appear without an obvious cause, without pregnancy, a growth spurt or a change in weight, ask a doctor before a clinic: in rare cases they are the first visible sign of a hormone disorder.

What lasers and needles can do

Vascular lasers, above all the pulsed dye laser at 585 or 595 nanometres, are the tool for the red phase. They heat the haemoglobin in the small vessels beneath the mark, which reduces redness and swelling; 2 to 4 sessions at intervals of 4 to 8 weeks are usual. They do nothing for width or texture, and on white marks they have no target at all, so they are often combined early with a collagen-stimulating method.

Fractional lasers and microneedling work on the structure and are used in both phases. Each sets thousands of tiny injuries per square centimetre that the dermis answers with new collagen: non-ablative fractional systems at 1550 nanometres heat without opening the surface, ablative fractional CO2 lasers vaporise microscopic columns, and needles of 1.5 to 2.5 millimetres do it mechanically. Expect 3 to 6 sessions at intervals of 4 to 6 weeks. A 2025 meta-analysis of 6 randomised trials with 166 patients found that fractional CO2 laser and microneedling improved the appearance in over 70 per cent of patients, with no significant difference between them, but post-inflammatory hyperpigmentation was about 8 times more frequent after the laser. For skin types IV to VI this tips the choice towards needling.

For white marks the extra option is the 308 nanometre excimer laser, which stimulates pigment cells so that the pale band darkens towards the surrounding skin. The effect needs around 10 sessions and fades again within months without maintenance, so it is camouflage rather than repair. None of this erases a mark. A 2024 systematic review of 151 studies with 4,806 reported outcomes found complete clearance of white marks after CO2 laser in about 4 per cent of cases; the realistic goal is a mark that no longer catches the eye. Collagen remodelling is slow, so judge the result 3 to 6 months after the last session, and ask for photographs at 6 and 12 months.

Creams, oils and the evidence

The pharmacy shelf is long and the evidence short. The Cochrane review updated in 2022 pooled 6 trials with 800 pregnant women who used cocoa butter, olive oil or branded creams with vitamin E and hyaluronic acid, and found no high-quality evidence that any of them prevented stretch marks; 4 of the 6 trials had fewer than 100 women. The NHS says the same in fewer words: very little evidence that creams and lotions prevent or remove them. Massage and a daily emollient keep the skin supple and ease the itching of fresh marks, but they do not stop the dermis tearing.

Two ingredients have data on marks that already exist. Tretinoin 0.1 per cent, applied every night for 24 weeks, improved red marks in the original 1996 trial, shrinking their length by about 14 per cent and their width by 8 per cent; it does little for white marks and is off limits in pregnancy and breastfeeding. Hyaluronic acid creams have made early marks less noticeable in small studies; if you are pregnant, read skin in pregnancy: less is more before buying anything with a retinoid on the label.

The one measure with a mechanism behind it is pace: the slower the skin stretches, the more time the fibres have to adapt, so a weight change of no more than 0.5 to 1 kilogram a week and a training plan that builds muscle over months rather than weeks do more than any oil; Body Metrics keeps that rate in view. A self-tanner darkens a pale mark along with the skin around it and hides it for about a week; sunbathing does the opposite, because scar tissue does not tan and the contrast grows.

Booking, cost and what to ask

Laser treatment of stretch marks belongs in a dermatology practice or a doctor-led laser centre. In most European countries ablative lasers are reserved for medical practitioners. Microneedling at shallow depths of 0.5 to 1 millimetre is offered by cosmetic institutes as well; the 1.5 to 2.5 millimetres that stretch marks need usually mean a medical setting. Ask which device and settings will be used, and how often the practitioner has treated your skin type.

The treatment counts as cosmetic everywhere, so public systems such as the NHS do not cover it and private insurers rarely do. As a rough guide, a pulsed dye laser session costs 150 to 400 euros, a fractional laser session 300 to 800 euros per area and a microneedling session 150 to 400 euros. Multiply by the number of sessions before you compare offers, and insist on a written quote for the whole series, not for one visit.

Between sessions the rules are those of any laser: no sun or sunbed for 2 weeks before, SPF 30 or higher on the treated area for at least 4 weeks after, no retinoids for 3 to 5 days either side of an appointment, no swimming or sauna for 48 hours. If you take or have recently taken isotretinoin for acne, wait longer still: dermatologists advise against ablative laser and mechanical resurfacing for 6 months after the last dose, because the skin then heals less predictably and scars more easily. Redness and swelling usually settle within hours to 3 days. If you are pregnant or breastfeeding, the whole plan waits: the marks are still forming and nobody can judge the result.

Before you book the first session

Frequently asked

Do stretch marks go away completely?

No. They can be made paler, narrower and flatter, above all while they are still red. White marks behave like mature scars; complete clearance is reported in only about 4 per cent of cases even after CO2 laser, so the realistic goal is a mark that no longer catches the eye.

When is the best time to treat them?

As early as possible, within the first 6 to 12 months while the marks are still red or purple. In that phase vascular lasers can fade the colour and the tissue is still remodelling. Once the marks have turned white, every method achieves less.

Do oils and creams help?

Not for prevention: a Cochrane review of 6 trials with 800 pregnant women found no high-quality evidence that cocoa butter, olive oil or vitamin E creams stop marks forming. Tretinoin 0.1 per cent over 24 weeks can improve existing red marks, but it must not be used in pregnancy or while breastfeeding.

How many sessions are usual?

For fractional laser and microneedling, mostly 3 to 6 sessions at intervals of 4 to 6 weeks. A pulsed dye laser for the redness typically needs 2 to 4. Judge the result 3 to 6 months after the last session, because collagen rebuilds slowly.

Does health insurance pay?

No. Stretch mark treatment counts as cosmetic everywhere, so public systems such as the NHS do not offer it and private insurers rarely cover it. Ask for a written quote that states the number of sessions before the first appointment.

Why do some people never get stretch marks?

Because the resilience of connective tissue is largely inherited, and because speed matters more than extent. Skin that is stretched over years adapts; skin stretched over months tears. Two people can gain the same weight in the same time and only one of them will mark.

Sources

• NHS: Stretch marks · causes and risk factors, retinoid and hyaluronic acid creams for new marks, laser and microdermabrasion, retinoids not in pregnancy, not available on the NHS; reviewed 30 April 2024
• Brennan M, Young G, Devane D. Topical preparations for preventing stretch marks in pregnancy. Cochrane Database of Systematic Reviews, plain language summary · 6 trials, 800 women, 50 to 90 per cent of pregnancies affected, cocoa butter, olive oil and vitamin E creams tested, no high-quality evidence for any preparation, 4 of 6 trials under 100 women; 2022
• Mikes BA, Oakley AM, Patel BC. Striae Distensae. StatPearls, NCBI Bookshelf · prevalence 43 to 88 per cent in pregnancy, 6 to 86 per cent in puberty, 43 per cent in obesity; histology of striae albae; pulsed dye laser for redness; tretinoin over 6 months; hyperpigmentation risk in darker skin; photographs at 6 and 12 months; updated 19 May 2025
• Mustafa A et al. Evaluating CO2 laser and micro-needling therapies for striae distensae: a comprehensive meta-analysis and systematic review. Lasers in Medical Science 2025 · 6 randomised trials, 166 patients; improvement in over 70 per cent with either method, no significant difference; post-inflammatory hyperpigmentation relative risk 8.37 after CO2 laser
• Zhu CK, Mija LA, Koulmi K, Barankin B, Mukovozov I. A systematic review on treatment outcomes of striae. Dermatologic Surgery 2024 · 151 studies, 4,806 reported treatment outcomes; complete clearance of striae alba after CO2 laser in about 4 per cent of outcomes (12 of 341); page blocks automated requests (403), verified via PubMed abstract

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This guide is for general information. It does not replace medical or professional cosmetic advice or an examination.