Two people can have stretch marks that look similar in a photograph and get very different outcomes from the same treatment. The reason is almost always timing. A stretch mark that is still red or purple behaves differently from one that has turned silvery white, and the gap between those two states is the single biggest factor in what any treatment can achieve.
This explains what stretch marks physically are, how the early and late stages differ, and why the honest word for what treatment does is reduce rather than remove.
What is a stretch mark?
A scar in the deeper layer of the skin, formed when it stretches faster than it can adapt. The dermis contains collagen and elastin fibres that give skin its structure and stretch. When growth outpaces them, those fibres tear, and the skin heals across the tear with scar tissue rather than rebuilding what was there.
That is why creams alone have limited effect. The damage sits below the surface, and anything that does not reach the dermis is not reaching the problem.
Why do they appear where they do?
Wherever skin has been stretched quickly. Pregnancy, growth spurts in adolescence, rapid weight change and rapid muscle gain are the common causes, which is why they turn up on the abdomen, breasts, hips, thighs, upper arms and lower back. Hormonal factors and genetics both influence how prone someone is, which is why two people can go through the same pregnancy and end up in different places.
What is the difference between red and white stretch marks?
Age, and it changes everything about the treatment plan. Early stretch marks are red, pink or purple because the tear is recent and blood vessels are visible through thinned skin. Mature ones have faded to silvery white because those vessels have receded and the pigment-producing cells in the area have become less active.
The clinical terms are striae rubrae for the red stage and striae albae for the white, and the distinction is not cosmetic.
Why does the red stage respond better?
Because there is still an active healing process to work with. Treatment at that point is influencing something already in motion, rather than trying to restart repair in tissue that settled years ago. Redness also gives light-based treatments something to target directly.
White stretch marks are harder work, and treatment aims at texture and at stimulating new collagen rather than at colour. Improvement is realistic. A return to skin that looks untouched is generally not, and any clinic promising that is overselling.
Can stretch marks be removed completely?
No, and it is worth being direct about that. They are scars, and scar tissue can be improved in texture, colour and visibility, but the structural change in the dermis does not reverse. What good stretch mark treatment does is make them significantly less noticeable, and results vary between individuals.
The gap between reduce and remove is where most disappointment with stretch mark treatment comes from, and it is usually created before the patient ever walks into a clinic.
Which treatments reach the dermis?
The ones that create a controlled injury deep enough to prompt new collagen, or that target the colour in the early stage. Which is appropriate depends on the stage, the area, and your skin type.
- Radiofrequency microneedling such as Morpheus8 delivers energy at depth through fine needles, aimed at collagen remodelling in the layer where the damage sits
- Fractional laser resurfacing treats the skin in a grid of microscopic columns, prompting repair across the treated area
- Light-based treatment can help with the redness of early marks, addressing colour rather than texture
- Microneedling without energy is a lighter option, generally for milder cases or as part of a longer plan
Skin type matters as much here as the stretch marks themselves, because some of these treatments carry a higher risk of pigment change in deeper skin tones and the settings and device choice change accordingly. A patch test is carried out first.
How long does treatment take to show?
Collagen remodelling is slow, so the skin at three months looks different from the skin at three weeks, and a course is planned around that rather than around how quickly someone wants to see change. The number of sessions depends on the area, the stage and how your skin responds, and it is agreed after assessment rather than sold as a set package.
Photographs at the start are worth taking. Gradual change in texture is genuinely difficult to judge in the mirror.
Is there anything worth doing early?
If stretch marks are new and still coloured, that is the point at which treatment has most to work with, so it is worth having them looked at sooner rather than waiting for them to fade. Keeping skin well moisturised and protecting the area from sun will not prevent stretch marks, but sun exposure can make the contrast between marked and unmarked skin more obvious.
For anyone currently pregnant or breastfeeding, treatment is generally deferred, and that is a conversation to have at consultation rather than a reason to avoid asking.
What does a treatment session involve?
Numbing cream goes on first and is left to work for around half an hour, because these treatments reach the dermis and that is not somewhere you want to feel. Radiofrequency microneedling on the abdomen or thighs takes roughly an hour depending on the area covered.
Afterwards the skin is red, warm and slightly swollen, much like mild sunburn, and on microneedling there is often a faint grid pattern visible for a day or two. Most people are back in normal clothes the same day, though tight gym leggings over a freshly treated thigh are worth avoiding for forty-eight hours.
Aftercare is undramatic. Keep the area clean, moisturise it, and keep it out of the sun between sessions. A tan changes how the skin responds at the next appointment, which is the practical reason clinics ask about holidays before booking a course.
What will not work, and why it is sold anyway
Cocoa butter, bio-oil and the rest of the pregnancy aisle are pleasant to use and will keep skin comfortable. None of them reach the dermis, so none of them change a stretch mark that has already formed. The studies that get quoted in the marketing usually measure comfort or hydration rather than the appearance of the marks themselves.
The same applies to dry brushing, coffee scrubs and at-home derma rollers. The last of those is worth avoiding for a separate reason: rollers long enough to reach the dermis are long enough to cause damage in untrained hands, and infection in a freshly needled area is a genuinely unpleasant outcome.
Why assessment comes first
The same treatment applied to the same body at two different stages produces two different outcomes, and no photograph shows a practitioner what stage the marks are actually at or how your skin behaves when it is treated.
Pulse Light Clinic is CQC-registered and doctor-and-nurse-led, and has been treating skin in London since 2001. A consultation covers what stage your stretch marks are at, which approach suits your skin, and what improvement is realistic.
Book a consultation to have your stretch marks assessed before starting any course of treatment.
