Stretch Marks: Causes, Assessment & Treatment Options
A stretch mark is not a mark on the surface of the skin. It is a tear in the dermis, the layer underneath, where the fibres that give skin its recoil have given way and have not grown back. Almost everything that follows is explained by that one fact. A mark that is new and red is a scar still being rebuilt; a mark that has gone pale is a scar that has finished. No cream, needle or device puts those fibres back, so no treatment removes a stretch mark — what treatment can change is colour, texture, and how far a mark reads in ordinary light. The honest aim is improvement rather than erasure, and the ladder runs from doing nothing, which is often the right answer, up to laser and light in selected marks and skin tones.
Patient education reviewed by Tongchun Mao, MD. Marks that appear with muscle weakness, easy bruising, a change in body shape or a family history of connective tissue problems need a doctor rather than an aesthetic assessment.
Six things that tear a dermis, and what each one means
These are the reasons the fibres in the dermis break before the skin can keep up with them. The first is the ordinary mechanical one. The others change how likely it is, how much of the skin is involved, and whether the marks are a sign of something else that needs a doctor.
Stretch that outruns the skin
The dermis is a woven sheet of collagen and elastin, and it has a limit to how far it will stretch and still spring back. A pregnancy, a growth spurt in the teenage years, and weight gained faster than the skin can remodel all pull it past that limit. The fibres tear in the middle of the sheet, deeper than anything you can see from the surface, and the mark you notice later is the scar that formed there.
Genetics: a dermis with less margin
How extensible and how repairable a dermis is runs in families. Two people can gain the same amount of weight at the same rate and end up with very different skin, because one has more reserve in the weave than the other. A mother or a sister with the same marks is useful information rather than a coincidence, and it is worth mentioning at an assessment.
Hormones that soften the fibres
Cortisol and the hormones of pregnancy change the ground substance that holds dermal fibres together, so the same amount of stretch does more damage than it would otherwise. This is why marks appear in places that were never stretched much at all, and why pregnancy marks can appear early, before the abdomen has grown a great deal.
Steroid medicines
Steroids taken by mouth, given by injection, or applied to the skin over a long period weaken the dermis directly and can produce broad marks without any stretch at all. This is the one cause on the list that is a medical matter rather than a cosmetic one, because the marks may be the visible part of an effect on the whole body, and the medicine is reviewed rather than the skin.
Connective tissue conditions
Inherited conditions that affect connective tissue make the dermis more fragile and the marks more widespread. They are a rare cause of stretch marks, and they are considered when the marks come with other features — unusual joint flexibility, a tall lean build, easy bruising, or a family history of problems with the heart valves or the aorta. Rare is not the same as impossible, and these are looked for rather than assumed absent.
Muscle growth and training
Men get stretch marks too, and the commonest setting is a rapid gain in muscle. Shoulders, chest, upper arms, thighs and lower back are the usual sites, and the marks often appear during a period of heavy training or a growth spurt rather than after weight gain. The mechanism is the same as in pregnancy: the dermis is asked to cover more than it can, faster than it can rebuild.
When a stretch mark is a medical sign rather than a cosmetic one
Most stretch marks are an ordinary consequence of stretch, and the conversation about them is unhurried. A small number are a pointer to something else, and the difference is usually made on what else is happening rather than on how the marks look. Marks that appear while taking a steroid medicine, or while using a strong steroid preparation on the skin, are the clearest example: the skin finding and the medicine belong in the same conversation. Marks that appear without any stretch to explain them, and especially in a pattern of broad bands across the abdomen, the flanks, the breasts and the armpits, are assessed for the possibility of a hormone excess rather than treated as a cosmetic problem. So are marks that arrive alongside weight gain around the middle, thinning of the arms and legs, easy bruising, muscle weakness, or a rise in blood pressure or blood sugar. Separately, when marks come with unusual joint flexibility, a tall lean build, or a family history of a torn aorta or of sudden cardiac death in a young relative, the question is whether an inherited connective tissue condition is present, and that question belongs with a physician rather than with a laser. None of these are common, and none of them is diagnosed from the skin alone. Where none is present, the ordinary conversation about what a mark is and what can be done about it can begin on a sound footing, and that conversation is what the rest of this site is about.
What is recorded, and how each finding changes what is offered
This is a description exercise before it is a treatment one. Six findings decide whether anything should be done at all, and which rung of the ladder would answer what you actually object to.
How old the mark is
A mark that is still forming and a mark that has finished are at different stages. New marks are the ones with something to gain from treatment; established ones are far less responsive, and saying so before a course is booked is more useful than discovering it afterwards. The date the marks appeared is recorded rather than estimated.
Colour, above everything else
This is the single most useful finding. A red or purple mark still has blood vessels active in the scar, and that is the part light and laser can act on. A white or silver mark has no vessel activity left, and it answers only to treatments that work on texture. Two marks of the same size are treated differently on colour alone.
Width and length
Marks are measured at their widest point and described in relation to the area they occupy, because a broad band of scarring behaves differently from a set of narrow lines. Width is recorded at the level it was found, since a mark is often wider in one place than another along its length.
Depth and texture
The surface over a mark is examined for whether it is level with the surrounding skin, depressed, or finely wrinkled. A depressed mark has lost dermal volume as well as dermal fibres, and that is a separate finding from colour. Texture is what microneedling is aimed at, and it is also the part that changes least.
Where the marks are
The distribution is recorded because it changes what is suspected and what is offered. Marks confined to the abdomen, breasts, hips and thighs after a pregnancy tell one story. Broad bands across the trunk, or marks in someone who has never been pregnant and has not gained weight, tell another and are investigated rather than treated.
Skin tone and how it behaves
How easily your skin tans, how easily it burns, and whether it marks with darkening after injury are all recorded, because they decide whether a treatment that removes pigment is safe to use on you. In skin that darkens readily after injury, laser carries a real risk of leaving a worse mark than the one being treated, and that risk is discussed before, not after.
The ladder, and the ceiling it runs into
These rungs run from doing nothing to laser and light, and the important part is the matching rather than the order: each rung answers a different part of a mark, and most people stop well before the top. At the bottom, doing nothing is a real option and often the correct one, because a new mark fades from red towards pale over about a year on its own, and a pale mark in a place nobody sees may never need to be anything other than what it is. Above that sits moisturiser and massage, which make the skin comfortable, keep a habit of care, and do not change the scar — that distinction is worth holding on to, because it is the one most often blurred by what is sold for stretch marks. Retinoid creams have a modest effect on early red marks, at the cost of irritation and of sun sensitivity, and they are not used in pregnancy. Scar care of the kind used for any maturing scar, including silicone where it is advised, is a reasonable rung for a mark that is still changing. Microneedling is aimed at texture and delivered over a course rather than a session, with a change that is usually modest and is judged from standardised photographs rather than from memory. Laser and light can act on the colour of a red mark and, with resurfacing devices, on texture, in selected marks and selected skin tones, and the pigment risk in skin that darkens readily is a genuine limit rather than a caution. Above all of it sits the ceiling this site keeps returning to: nothing erases a stretch mark, and every option on the ladder changes appearance only.
Five ways money and hope get spent for nothing
The first is to buy a cream in pregnancy expecting it to prevent marks. Moisturising is pleasant, and the trials of topical products for prevention have not shown a dependable effect; a product sold on the promise that it stops marks forming is selling certainty that does not exist. The second is to treat a pale mark as though it were a red one. A white mark has no vessel activity left, so the treatments aimed at colour have nothing to act on, and a course bought for it is a course bought for the wrong stage. The third is to keep going past the point where anything is still changing. A mark that has not altered across a course is unlikely to alter across the next one, and the honest move at that point is to stop and say so rather than to add sessions. The fourth is to treat the marks while ignoring what is producing them. Marks from a steroid medicine, or marks that come with other body changes, are a question about the cause, and no amount of work on the skin answers it. The fifth is to have something injected into a mark by someone who will not say what is in it. Unregulated preparations offered for scarring carry risks that have nothing to do with the mark itself, and a practitioner who does not describe what they are using is not one to let near your skin. None of these are rare, and every one of them is easier to avoid at the start than to correct afterwards.
If the decision moves toward a treatment
This site deliberately stops short of describing devices and operations, because the treatments themselves are explained properly elsewhere in this cluster. What a course of microneedling involves, session by session and including the days between them, is set out on its own site, and fractional laser resurfacing covers what an ablative and a non-ablative device each reach, along with the pigment risk in darker skin. Where the surface texture rather than the colour is what bothers you, chemical peeling explains what a peel can and cannot do to a scarred surface. Where a mark sits on skin that has also lost its elasticity, mesotherapy sets out honestly how little an injection changes a dermal scar. Marks left by pregnancy are often considered alongside the abdomen itself, so abdominal skin removal covers what an operation does about skin that will not tighten, and liposuction of the abdomen explains what removing fat does and does not do to the skin over it. How treatment is sequenced, and what it is reasonable to combine, is described on Dr. Mao’s breast and body site, what the weeks after a procedure involve is on the Aftercare site, and how safety is organised inside the hospital is described by quality and surgical safety.
Stretch marks: a scar in the dermis, and what can be changed
What tears on the left, and the ladder of options on the right, from least to most invasive. Note that the first rung is doing nothing, that the second changes comfort rather than the scar, and that the last rung is a limit rather than a treatment.
Guides
Ten guides, ordered the way the question usually unfolds: what a stretch mark actually is, why the dermis tears, how a red mark differs from a white one, how marks are assessed, and then what creams, microneedling and laser can each change — and what none of them can.
What a Stretch Mark Actually Is
A stretch mark is a tear in the dermis and the scar that closed it, not a mark on the surface. Why that one fact explains every limit that follows.
Read the guide →Why the Dermis Tears When Skin Stretches Quickly
Collagen and elastin give skin its recoil, and they have a limit. What overwhelms them, why speed matters more than size, and how hormones soften the fibres.
Read the guide →Red Marks and White Marks Are Different Problems
An early red mark is a scar still being built and a pale one has finished. They do not answer to the same treatment, and telling them apart decides what is done.
Read the guide →Who Gets Stretch Marks, and Why They Run in Families
Pregnancy, growth spurts, weight change, steroid medicines and connective tissue conditions. What each setting implies, and why two people can differ so much.
Read the guide →When Stretch Marks Are a Medical Sign
Most marks follow from stretch. A few point at a steroid effect, a hormone excess or an inherited connective tissue condition, and those are looked for first.
Read the guide →How Stretch Marks Are Assessed
What is recorded about a mark: its age, colour, width, depth and distribution, and how each of those findings decides whether anything should be offered.
Read the guide →Start with the stage of the mark, not with a treatment
Arrange an assessment. We record how old your marks are, whether they are still red or have gone pale, and how deep they sit, then say which of them anything can be offered for and how much it would realistically change.
Frequently asked questions
Is a stretch mark a scar, or something that sits on the surface of the skin?
It is a scar, and it lies in the dermis rather than on the surface. The fibres in that layer tore when the skin was stretched faster than they could adapt, and the pale or red line you see is the scar that formed where they tore. Scar tissue is different tissue from the skin around it, which is why a mark looks and feels unlike its surroundings and why nothing applied to the surface reaches it.
Do stretch marks ever disappear completely, or only become less obvious?
They become less obvious, and they do not disappear. A new mark fades from red or purple towards pale over roughly a year as the vessels in it settle down, and after that it stays. Fading is real and it is worth waiting for. Erasure is not something any cream, needle or device offers, and a practitioner who suggests otherwise is describing something that does not exist.
Why does one person get stretch marks when another with the same pregnancy does not?
Because the dermis you start with differs from the dermis someone else starts with. The amount of collagen and elastin in the weave, how extensible it is, and how readily it repairs all vary between people and run in families. Two women can carry the same pregnancy and gain the same weight, and one tears where the other does not. Effort, diet and skincare are not what separates them.
Does it matter whether a stretch mark is still red or has already turned white?
It is the most useful thing to know about a mark. A red or purple mark still has active vessels within the scar, and those are what light and laser can act on. A white or silver mark has none left, so treatments aimed at colour have nothing to work with and only treatments aimed at texture apply. The same mark at a different age is a different problem.
Can someone get stretch marks without ever being pregnant?
Yes, and it is common. A growth spurt in the teenage years, weight gained faster than the skin can follow, a rapid gain in muscle from training, and long courses of steroid medicines all tear a dermis without any pregnancy involved. Men get them on the shoulders, chest, thighs and lower back, usually during a period of heavy training or a growth spurt.
Which stretch marks should be seen by a doctor rather than treated as a cosmetic concern?
Marks that appeared while you were taking a steroid medicine, marks that came with weight gain around the middle, easy bruising or muscle weakness, and marks that came with unusual joint flexibility or a family history of heart valve or aortic problems. These point at a cause rather than at the skin, and the cause is what needs looking at first.
Part of After Pregnancy — 5 sites on this topic