Managing Stretch Marks and Skin Changes During Pregnancy: Expert Advice

Stretch marks and areolas..?

Doctor, I would like to ask you a question.
I am currently over six months pregnant, but I have developed unwanted stretch marks on my thighs and buttocks.
When I was 20 years old and pregnant with my first child, I didn't understand how to take care of my skin, so I ended up with stretch marks after giving birth.
Now that I am pregnant with my second child, I have started to diligently apply lotion and stretch mark cream (I became pregnant again just over five months after giving birth to my first child, so the color of my stretch marks is still somewhat red and purple, although some have faded to a silvery white).
However, I know that it is difficult for existing stretch marks to completely disappear with just stretch mark cream; currently, using the cream can only reduce the likelihood of more stretch marks appearing.
So I would like to ask you, doctor:
1.
If I visit a dermatologist, what methods are available to remove stretch marks? Is it laser treatment, microdermabrasion, or chemical peels? I have heard that Botox can eliminate wrinkles; can it also help with stretch marks, or is it already hopeless? If there are ways to eliminate stretch marks, I would like to consult you later.
What would the cost be, and is it covered by health insurance?
2.
Additionally, after giving birth and completing my postpartum confinement, I noticed that the pigmentation in my external genital area has become more severe than before I had children.
Is this related to the lochia that lasted for more than a month, causing it to continuously contact the skin and darken? I remember that just a few days after giving birth, it wasn't this dark.
Despite frequently changing maternity pads and washing the area with warm water to keep it clean during my confinement, why did it not help? Furthermore, since I have been breastfeeding for over five months, my areolas have also darkened more than before I had children.
Doctor, do you have any skincare products or ointments that can help lighten the pigmentation in my external genital area and areolas? How much would they cost, and are they covered by health insurance?

Taoyuan de Obasan, 20~29 year old female. Ask Date: 2005/11/21

Dr. Zheng Lizhen reply Dermatology

Hello,
1.
Treatments such as intense pulsed light (IPL), pulsed electromagnetic field therapy, cold laser therapy, and dye laser can be used to improve stretch marks.
Botox cannot eliminate stretch marks.
Currently, our facility does not have the aforementioned equipment.
These treatments are considered cosmetic procedures and are not covered by health insurance.
2.
During pregnancy and childbirth, changes in pigmentation are a natural phenomenon and will fade over time.
If you wish to lighten pigmentation, a milder L-ascorbic acid product can be used, but it is not recommended during breastfeeding.
This treatment is also not covered by health insurance.
Sincerely, Dr.
Cheng Li-Chen, Dermatology

Reply Date: 2005/11/21

More Info

Managing skin changes during pregnancy, particularly stretch marks (striae gravidarum) and pigmentation changes, is a common concern among expectant mothers. As you are currently six months pregnant and experiencing stretch marks on your thighs and buttocks, it's important to understand both the nature of these changes and the options available for management.

Understanding Stretch Marks
Stretch marks are a form of scarring that occurs when the skin is stretched rapidly due to factors such as pregnancy, weight gain, or puberty. They typically appear as red, purple, or dark brown streaks initially, which may fade to a lighter color over time. While the exact cause of stretch marks is not fully understood, they are believed to be related to hormonal changes and the physical stretching of the skin.

Prevention and Management
1. Topical Treatments: While there is no guaranteed way to prevent stretch marks, using moisturizers and creams specifically designed for pregnancy may help improve skin elasticity. Products containing ingredients like hyaluronic acid, cocoa butter, or vitamin E are popular, although scientific evidence supporting their effectiveness is limited. Regularly applying these products can help keep the skin hydrated and may reduce the severity of new stretch marks.

2. Dermatological Treatments: If you are considering professional treatments to reduce the appearance of existing stretch marks, options include:
- Laser Therapy: This method can stimulate collagen production and improve skin texture. Different types of lasers can target various aspects of stretch marks, and results can vary.

- Microdermabrasion: This technique involves exfoliating the skin to promote new skin growth, which may help reduce the appearance of stretch marks.

- Chemical Peels: These can help improve skin texture and pigmentation but should be approached cautiously during pregnancy.

- Microneedling: This involves creating tiny injuries in the skin to promote collagen production and can be effective for stretch marks.

3. Botox: While Botox is commonly used for wrinkle reduction, it is not indicated for treating stretch marks. Its primary function is to relax muscles, and it does not address the skin's structural changes that lead to stretch marks.

Cost and Insurance Coverage
The cost of dermatological treatments can vary widely based on the type of procedure, the provider's expertise, and geographic location. Typically, laser treatments and microdermabrasion can range from a few hundred to several thousand dollars per session. Insurance coverage for cosmetic procedures is often limited, so it is advisable to check with your insurance provider regarding coverage options.

Addressing Pigmentation Changes
Regarding the pigmentation changes you mentioned, such as darkening of the vulvar area and areolas, these are common during pregnancy due to hormonal fluctuations. The increased melanin production can lead to hyperpigmentation, which may persist postpartum.

1. Postpartum Care: After childbirth, many women notice that these pigmentation changes gradually fade. However, if they persist, topical treatments containing ingredients like hydroquinone, kojic acid, or azelaic acid may be recommended. Always consult with a dermatologist before using any products, especially while breastfeeding.

2. Skin Care Products: There are various skin care products available that claim to lighten hyperpigmentation. Look for those that are safe for postpartum use and avoid harsh ingredients that could irritate sensitive skin.

Conclusion
In summary, while stretch marks and pigmentation changes during pregnancy are common and often unavoidable, there are various management strategies available. Maintaining skin hydration, considering dermatological treatments post-pregnancy, and consulting with a dermatologist for personalized care can help address these concerns. Always prioritize safety and consult with healthcare providers before starting any new treatments, especially during pregnancy and breastfeeding.

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