What is the best treatment for stretch marks?

Best Treatment for Stretch Marks

The most effective treatment for stretch marks is combining platelet-rich plasma (PRP) with CO2 laser, which demonstrates superior patient satisfaction, histological improvement, and fewer side effects compared to other modalities. 1

Treatment Approach Based on Evidence

First-Line Combination Therapy

PRP combined with CO2 laser is the preferred treatment modality based on the most recent 2025 guideline evidence from Periodontology 2000. 1 This combination showed:

• Better patient satisfaction compared to PRP with pulsed dye laser 1
• Histological improvements including increased epidermal thickness, normalized dermal collagen fiber orientation, increased rete ridge formation, and decreased perivascular inflammatory infiltrate 1
• Fewer side effects than alternative laser combinations 1

Alternative Combination Options

If CO2 laser is unavailable, PRP can be effectively combined with: 1

• Microneedling - significant subjective and objective improvement 1
• Intradermal radiofrequency - demonstrated efficacy in combination 1
• Pulsed dye laser - effective but less optimal than CO2 laser combination 1
• Carboxytherapy - shows benefit when combined with PRP 1
• Microdermabrasion - can be used with PRP 1

Topical Therapy for Early Stretch Marks

For early, active (red/purple) stretch marks, topical tretinoin 0.1% cream applied daily can provide significant improvement: 2

• 80% of patients showed definite or marked improvement after 6 months of daily application 2
• Mean decrease in stretch mark length by 14% and width by 8% 2
• Most effective when started early in the active phase 2

Standalone Device Options

If PRP is not available, consider: 3, 4

• Nanofractional radiofrequency combined with topical beta-glucan formulations - demonstrated efficacy in reducing stretch mark width, improving skin elasticity and collagen density 3
• Various lasers including Er:YAG, diode, Q-switched Nd:YAG, and excimer lasers - variable success rates 4

Critical Timing Considerations

Early treatment initiation is essential - the earlier treatment begins, the better the outcome. 1 Active (red/purple) stretch marks respond better than mature (white/silver) stretch marks. 2, 4

Prevention Strategies

Patients should avoid triggers where possible: 1

• Excessive weight gain or loss 1
• Chronic corticosteroid use 1

Important Caveats

Evidence Quality Limitations

• Clinical trials on PRP for stretch marks are scarce with mostly poor-quality evidence 1
• No standardized assessment scale exists for objective evaluation of stretch marks 1
• Large, controlled studies are lacking 1
• Despite these limitations, the 2025 guideline supports combination therapy based on consistent positive outcomes and histological confirmation 1

Realistic Expectations

• No treatment is 100% effective for stretch marks 5
• Current modalities show only modest improvement overall 1
• Treatment improves appearance but does not completely eliminate stretch marks 2, 4
• Much variability exists in treatment response, though positive outcomes can achieve nice clinical results and patient satisfaction 1

Treatment Selection

The choice between modalities depends on:

• Stretch mark age - active vs. mature 2, 4
• Available technology and expertise 1
• Patient tolerance for procedures 1
• Cost considerations - PRP and laser treatments require multiple sessions 1