Today I'm going to talk about the treatment of stretch marks. In another episode I discussed what they are and what causes them but today let's tackle the very difficult job of treating them. The most important thing I can tell you is that it's very important we be realistic and that we limit our expectations so we are not disappointed because under the best circumstances, stretch mark treatment yields only modest results, sure there is visible improvement but not a great deal of improvement and it's exceedingly unlikely that any treatment is going to completely eliminate your stretch marks. Let me just remind you what happens in a stretch mark. Both the epidermis and the dermis is thinned, they're both compressed so the stretch mark in cross sections sort of sinks in and anything that restores volume to this area or restores volume to the epidermis is of course going to help the appearance of stretch marks. So let's start with topical products because there are a lot of products we use to help improve lines and wrinkles and the way they do that is by restoring volume. The way they restore volume is either by increasing the thickness of the epidermis or by stimulating the production of collagen or even the production of glycosaminoglycans which is the pink area in the middle of the dermis that has the hyaluronic acid and that forms that semi-liquid matrix that the collagen and all the organs float in. so the topical products that we use to do that are retinoids, other exfoliants like glycolics and sometimes we even use microdermabrasion and we also use peptides. Now all of these work through the process of stimulating some collagen production, some glycosaminoglycan production, which again has the hyaluronic which binds the water and fills it up and they also work by thickening the epidermis. But of course, results are going to be modest and side effects usually consist of occasional irritation as with any exfoliants in which case you need to just back off a little bit. If topical products like vitamin E and shea butter and cocoa butter are of any value in treating stretch marks it's only in their improving the appearance of the surface, the very top of that thinned epidermis but it's not going to do anything to increase volume. The next type of treatment concerns mechanical stimulation of the dermis, again to promote collagen and refilling of volume. So again things like derma-rollers may actually help. Last and perhaps most important is the laser treatment of stretch marks. When we're talking about lasers here were talking only about non-ablative lasers, those are the ones that don't break the surface of the skin but they transmit heat and energy into the middle of the dermis to increase the volume of collagen and to stimulate collagen production and glycosaminoglycan production. An example of a laser like this is the Fraxel laser. Most importantly, occasionally we combine all three types of modalities, topical products, mechanical stimulation of the dermis and lasers. But again, beware; limit your expectations, because under the best circumstances your improvement is only going to be modest. Two more points, I know of no products that will prevent stretch marks and if you're developing stretch marks during pregnancy don't ever use retinoids because retinoids during pregnancy can cause birth defects.