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PEER-REVIEW | PREGNANCY AND AESTHETICS |


including laser treatments, dermabrasion, and prescription retinoids. In terms of lasers the author has used 585 nm pulsed dye lasers with some effect but prefers a combination of dermarolling with radiofrequency. There are many publications citing this means of therapy25


, and the author finds bipolar and popularity as


doctors and patients alike are comparing the benefits it offers over traditional lipoplasty procedures.


Healthy eating habits combined with regular exercise


also help people lose weight. However, this natural process, possibly as a result of Pawlowski’s theories above, takes more time and determination after pregnancy. Weight loss via exercise and healthy eating carries little risk compared to liposuction.


Stretch marks Solution: Carboxytherapy, radiofrequency, photodynamic therapy, dermarolling, TCA peeling Stretch marks occur during pregnancy and are caused by rapid stretching of the dermal tissue of the abdomen during the distension and weight gain of pregnancy21


Carboxytherapy is


a simple and proven technique that can


dramatically improve the appearance of stretch marks by


improving local tissue metabolism and perfusion.


. It is thought that nearly 85%


of women will develop some degree of stretch marks during their pregnancy and these usually appear after prolonged weakening of the dermal tissues about the beginning of the third trimester. This is also a period of sustained distension22


. It is felt that dermal weakening occurs during


pregnancy as a result of increased glucocortoid hormones, which actually effect the epidermis formation of fibroblasts23


. The reduced numbers of fibroblasts


consequently result in less collagen and elastin being formed and this leaves the dermal tissue supporting structure susceptible to tearing. These skin changes eventually result in reddish or purple lines along the planes of stretching that tend to gradually fade to a lighter skin colour as a tendency towards re-epithelialisation occurs. Over time they can diminish but they do not disappear completely and can cause distress in the post natal female. There is little doubt that stretch marks are also influenced by hormonal changes in pregnancy as is also seen during the rapid growth of puberty or weight gain during muscle building24


.


Various treatments are available for the purpose of improving the appearance of existing stretch marks,


58 ❚ March 2015 | prime-journal.com


tripolar devices to be of the most benefit. The use of RF brings about many questions, the most important is which type of collagen is induced, and if the result of the action is a fibrotic tissue. If fibrotic tissue is being formed to increase the firmness of the skin, then it won’t help to recover the physiology of the connective tissue and the result will be short-lived and not beneficial in the long term. More recently, The author has treated abdominal stretch marks with fractionalised laser resurfacing with some effect. This


CO2


method is limited by little published data but the author has treated approximately 15 cases with lower


density settings over multiple treatments in order to wound the dermis and try and recreate the collagen and elastin underlying structure, which the skin was deprived off. One can expect about 70% benefit over five sessions spaced 1month apart26


. Many patients ask if there are any topical creams to


help with stretch marks, either during their formation or after they have occurred. There are no proper control studies but some research suggests a daily application of a cream containing Gotu Kola extract, vitamin E, and collagen hydrolysates was associated with fewer stretch marks during pregnancy27


. Other favourites include


combinations of cocoa butter, vitamin E, panthenol, hyaluronic acid, elastin, and menthol. It was associated with fewer stretch marks during pregnancy versus no treatment27


. In some cases we have almost complete


resolution with Carboxytherapy and this is the author’s preferred treatment. Carboxytherapy is a simple and proven technique


that can dramatically improve the appearance of stretch marks by improving local tissue metabolism and perfusion. Treatments are rapid, comfortable, and effective for a high percentage of patients. Carbon dioxide (CO2


through a tiny 30 G needle (0.3 mm in diameter)28 the injection point, the CO2


) is infiltrated into the subcutaneous tissue . From


diffuses easily into adjacent


tissues. Unfortunately, nothing much has been published in the literature about this technique, except for its relationship to break down adipose tissue29


.


Various treatments have been proposed for the treatment of post-pregnancy stretch marks but in the author’s opinion most of them are not as good as carboxytherapy.


Sagging skin Solution: abdominoplasty Abdominoplasty or ‘tummy tuck’ is a popular cosmetic surgery procedure used to make the abdomen firmer after pregnancy. The surgery (which can be radical)


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