Plastic & Reconstructive Surgery:
Percutaneous Collagen Induction Therapy as a Novel Therapeutic Option for Striae Distensae
Aust, Matthias C. M.D.; Knobloch, Karsten M.D., Ph.D.; Vogt, Peter M. M.D., Ph.D.
Plastic, Hand, and Reconstructive Surgery; Hannover Medical School; Hannover, Germany
Correspondence to Dr. Knobloch; Plastic, Hand, and Reconstructive Surgery; Hannover Medical School; Carl-Neuberg-Str. 1; 30625 Hannover, Germany; email@example.com
The occurrence of striae distensae is a well-recognized, common skin condition that rarely causes any significant medical problems but is often a significant source of distress to those affected. Striae are atrophic linear plaques, most often found on the breasts, abdomen, hips, and thighs in the dermal layer. This disruption of collagen-elastic matrix may develop in a variety of circumstances, such as during adolescent growth spurts, and during hormonal changes, such as Cushing syndrome. Striae gravidarum are widely known to occur in pregnancy and, aesthetically, they can be a cause of great concern for many women. Maternal age, body mass index, weight gain, and neonatal birth weight were independently associated with the occurrence of striae gravidarum.1 It appears that the group at highest risk of developing severe striae are teenagers. Treatment is often anecdotical. To date, no therapeutic option offers complete treatment.2 Cocoa butter was recently studied in a randomized controlled trial for prevention of striae gravidarum but failed to be effective.3
Percutaneous collagen induction therapy is capable of dermal rejuvenation by smoothing of the skin by thickening the epidermal layers and expression of genes and proteins relevant for dermal regeneration without the risk of dyspigmentation.4,5 Percutaneous collagen induction works best in combination with a scientific skin care program. In contrast to ablative laser therapy, the epidermis remains intact. Thus, the procedure can be repeated safely if needed, and it is also applicable to regions where laser treatments or deep peelings cannot be performed.
Twenty-two female patients with stretch marks underwent single percutaneous collagen induction therapy in an outpatient setting. All patients had conventional tumescence anesthesia. The procedure took a mean time of 30 minutes, without any immediate adverse effects, such as abdominal perforation or infection. Follow-up assessment was performed 6 months after the intervention. Assessment of the result revealed improved skin texture, skin tightening, dermal neovascularization, and no change of pigmentation (Fig. 1). Biopsy specimens obtained 6 months after the intervention revealed an increase of collagen I and elastin (Fig. 2). Collagen III was not affected at all.
Given this preliminary clinical observation of percutaneous collagen induction therapy in striae distensae, we strongly believe that further large-scale and possibly randomized controlled trials are mandatory to elucidate the value of this promising technique.
Dr. Aust is a medical consultant for Care Concept, distributors for Environ Skin Care Products and Roll-CitR in Germany. Neither of the other authors has any financial information to disclose.
Matthias C. Aust, M.D.
Karsten Knobloch, M.D., Ph.D.
Peter M. Vogt, M.D., Ph.D.
Plastic, Hand, and Reconstructive Surgery
Hannover Medical School
1.Atwal GS, Manku LK, Griffiths CE, Polson DW. Striae gravidarum in primiparae. Br J Dermatol. 2006;155:965–969.
2.Elsaie ML, Baumann LS, Elsaaiee LT. Striae distensae (stretch marks) and different modalities of therapy: An update. Dermatol Surg. 2009;35:563–573.
3.Oswan H, Usta IM, Rubeiz N, Abu-Rustum R, Charara I, Nassar AH. Cocoa butter lotion for prevention of striae gravidarum: A double-blind, randomised and placebo-controlled trial. BJOG. 2008;115:1138–1142.
4.Aust MC, Fernandes D, Kolokythas P, Kaplan HM, Vogt PM. Percutaneous collagen induction therapy: An alternative treatment for scars, wrinkles, and skin laxity. Plast Reconstr Surg. 2008;121:1421–1429.
5.Aust MC, Reimers K, Repenning C, et al. Percutaneous collagen induction: Minimally invasive skin rejuvenation without risk of hyperpigmentation. Fact or fiction? Plast Reconstr Surg. 2008;122:1553–1563.
Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less time sensitive than Letters and other types of articles. Please note the following criteria:
* Text—maximum of 500 words (not including references)
* References—maximum of five
* Authors—no more than five
* Figures/Tables—no more than two figures and/or one table
Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/. We strongly encourage authors to submit figures in color.
We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.
©2010American Society of Plastic Surgeons