Lasers for Stretch Marks
Dr Reichel, I am interested in treatment for white stretch marks. I heard that a CO2 laser is the gold standard for treatment. What is the difference between the Fraxel Repair, Fraxel Restore, and the Total FX lasers? Also, I understand that the dermis is made of 70% collagen, what is the other 30% made of?
Both the Fraxel Repair and the Total FX lasers are ablative fractional CO2 lasers. Fraxel Restore is a non-ablative fractional Erbium laser.
Sadly, once they turn white, stretch marks are very hard to treat (with anything). They are best treated when they are new, and are still red. I have very good luck treating red stretch marks with the Vbeam Perfecta laser (pulsed dye laser). It takes a series of treatments, but can basically make the stretch marks 80% better.
For white stretch marks, what I always recommend, is doing a “test patch”. We choose an area that is a couple of inches in size, and do either one or maybe two fractional CO2 treatments. I use the Lumenis Total FX CO2 laser. For me, I consider this laser to be the gold standard for CO2 lasers. CO2 lasers are more risky when you are treating areas that are off of the face (the face has a lot of sebaceous glands – which makes healing much easier). Since stretch marks are off of the face, you have to turn the energy down. That is why we often need to treat them more than once. The other option is to use the Fraxel Restore laser. I do a series of 4 treatments on the test patch. I would say that about 30% of patients feel that there is enough improvement to treat larger areas. So, as I said, it is hard to treat white stretch marks. I make the test treatments very affordable, and I will bundle the payment into the cost of the whole treatment if a patient decides to go on to treat a larger area. I have had very good luck with treating other types of scars with the Fraxel Restore (surgical, injury, acne).
About the dermis: The dermis is the 2nd layer of skin. It provides pliability and elasticity. The main cell type in the dermis is called a fibroblast. Fibroblasts make the matrix of the dermis. Collagen accounts for 75% of the dermis. Elastin, 5%. The rest is Hyaluronic acid, cells, vessels, nerves and hair follicles.
About the lasers: Fraxel Restore and Fraxel Repair. Fraxel Repair and Total FX are fractional CO2 lasers. Fraxel Restore is a fractional Erbium laser. Both Fraxels are made by Solta (originally made by Reliant). Ablative lasers (CO2) completely destroy the tissue that is treated (the skin literally goes "up in smoke"). However, since they are "fractionated", they only treat a percentage of the area. This is done by laying down columns of laser light, rather than a "sheet" of laser light.
Fraxel Restore causes coagulation, rather than ablation. So, while it also knocks out tiny columns of skin, the top layer is left intact. If you were to look at a biopsy of skin after treatment with the Fraxel Restore, you would see columns of dead tissue surrounded by areas of live tissue. The live tissue begins to regenerate the dead tissue columns - making new collagen, elastin, and new cells. This regeneration process is what causes visible improvement in texture, lines, and pigment.
Director, Pacific Dermatology & Cosmetic Center
Seattle WA 98133