Calcium Hydroxylapatite Combined with Microneedling and Ascorbic Acid is Effective for Treating Stretch Marks

Abstract

Background: Stretch marks can have a negative psychological impact on some individuals. Methods are available for treating stretch marks, but high-quality evidence supporting their use is limited. We treat stretch marks using injections of diluted calcium hydroxylapatite (CaHA, Radiesse) filler combined with microneedling and topical ascorbic acid. This retrospective study evaluated the effectiveness of this combined therapy.

Methods: Subjects presented with red (n = 25) or white (n = 10) striae on their buttocks, thighs, knees, abdomen, and breasts. CaHA filler was diluted 1:1 with lidocaine 2% without epinephrine. A maximum of 3.0 mL of filler was injected per patient at all skin depths using a 23G needle. This was immediately followed by microneedling and topical application of 20% ascorbic acid. Microneedling with ascorbic acid was repeated after 1 and 2 months. Skin biopsies were obtained from a patient who later underwent abdominoplasty.

Results: The mean (±SD) pretreatment Manchester Scar Scale scores were 12.0 (±0.8), decreasing to 7.1 (±1.4) 1 month after the final treatment, indicating improvement in stretch mark appearance (P < 0.001). Subjects were very satisfied (n = 22; 62.9%), satisfied (n = 8; 22.9%), neither satisfied nor dissatisfied (n = 4; 11.4%), or unsatisfied (n = 1; 2.8%) with their treatment results. Analysis revealed a significant correlation between Scar Scale scores and Patient Satisfaction scores (r = 0.483; P = 0.003). Skin biopsies showed increased quantity and quality of collagen and elastin fibers in areas treated with combination therapy. Procedures were well tolerated.

Conclusion: Combining 1:1 diluted CaHA with microneedling and topical ascorbic is safe and effective for treating stretch marks.

Figures

Fig. 1.

Treatments and assessments. This diagram shows the treatments and assessments performed for each subject.

Fig. 2.

Microneedling. Microneedling was performed in conjunction with 20% ascorbic acid applied using a sterilized disposable brush before each microneedling pass. The endpoint was mild bleeding (after approximately 20 passes).

Fig. 3.

Patient Satisfaction Scores. Most subjects (85.8%) were satisfied or very satisfied with the appearance of their stretch marks following treatment. Satisfaction scoring: 1 = very unsatisfied; 2 = unsatisfied; 3 = OK (neither satisfied nor unsatisfied); 4 = satisfied; 5 = very satisfied.

Fig. 4.

Correlation of Manchester Scar Scale and Patient Satisfaction Scores. Percentage improvement in Manchester Scar Scale scores was significantly correlated with improvement in Patient Satisfaction Scale scores (r = 0.483; P = 0.003).

Fig. 5.

Histology analysis. Biopsies of treated tissue revealed an increase in the quantity and quality of dermal collagen and elastin fibers in areas treated with the combination therapy vs. untreated skin and areas treated with only microneedling and ascorbic acid. A, D, and G: normal, untreated skin; B, E, and H: tissue treated with microneedling and ascorbic acid only; C, F, and I: tissue treated with 1:1 diluted CaHA injection, microneedling, and ascorbic acid.

Fig. 6.

Pre- and posttreatment images. Pre- and posttreatment images of a 20-year-old subject who developed acute deep striae rubrae in the gluteus region after course of oral prednisone. Baseline appearance of striae (A, B) is much improved after treatment (C) with 1:1 diluted CaHA followed by 3 sessions of topical ascorbic acid and microneedling.

Fig. 7.

Pre- and Post-treatment Images. Pre- and post-treatment images of a 32-year-old subject who developed acute deep striae rubrae in the anterior thigh after pregnancy. Baseline appearance of striae (A) is much improved after treatment with 1:1 diluted CaHA followed by 3 sessions of topical ascorbic acid and microneedling (B).

Fig. 8.

Two-year posttreatment Images. An 18-year-old subject who was treated on the thighs and buttocks was evaluated after 2 years. At that time, her Manchester Scar Scale score was 9 and her satisfaction score was 4 (satisfied).