Pregnancy: Dealing with Stretch Marks and C-section Scars

1. Why do stretch marks occur during pregnancy?

Pregnancy stretch marks, or striae gravidarum, occur as a result of rapid abdominal distention, partly because of the normal hormonal changes of pregnancy and partly due to the scarring of the skin caused by the tearing of the dermis layer. This may cause reddish streaks to appear on the abdomen.

2. How can I prevent stretch marks?

Stretching exercises, light massage, and a healthy diet may help reduce the development of stretch marks. While many creams and oils have been touted as being able to prevent their formation, a systematic review in the Cochrane database published in 2012 by Brennan et al has found no evidence that these applications are effective in preventing pregnancy stretch marks.

3. What treatment options are available?

Recent studies have offered conflicting results regarding the efficacy of various topical ointments and any improvement is subjective.

Limited clinical information exists on the efficacy of topical treatment including 0.1% tretinoin (all-trans-retinoic acid) cream mixed with various lotions and moisturizers.

Different types of laser treatments have been tried with varying results. Pulsed-dye laser treatments are able to address the reddish scars but risk increasing pigmentation in darker skin types. Fractional laser resurfacing is another option to create scattered tiny wounds over 5-6 treatments to allow the regrowth of collagen which improves the texture and appearance of the scars.

In severe cases where there is excess skin associated with these stretch marks, a surgical procedure such as a tummy tuck can be considered to remove the affected area below the belly button.

4. I have a thick C-section scar that is both itchy and red. How can I treat it?

Skin wounds heal by scar formation. The scar maturation process can take 6 weeks to 6 months on average. Mildly raised scars can be treated with topical silicone applications such as gels or patches, which keep the wound hydrated and minimizes excess collagen formation. Scars that are thicker and more symptomatic may require a few sessions of intralesional steroid injections. This reduces the itchiness and redness and also enables the scar to shrink.

5. Could my scaring have been prevented?

The tendency to form thick scars depends on race and family history, with those of darker pigmentation being more prone. It also depends on the site of the scar, where the central chest and abdomen are more susceptible, as well as the limbs, which are subject to skin tension due to movement.

It is advisable to reduce tension on the wound for the first 6 weeks by applying surgical tape to the wound even after it has healed. This will continue to minimize the scar formation with hydration and support.

6. What should I do if I have another C-section?

The first step is good, accurate tissue apposition from the repair. Surgical tape support should follow. If you have a tendency to develop thick scars, have the scar assessed 2 weeks after repair. A decision can then be made to consider intralesional steroid injections or topical silicone treatment.