Q. I just delivered my third child and now have some very ugly stretch marks.  I did not get bad stretch marks with my first two children, but this time they are very noticeable.  Is there anything that can be done for stretch marks after child birth?  My baby was born one month ago. 

A. Stretch marks are a problem in some woman after pregnancy.  They can also occur with rapid weight gain followed by weight loss.  The cause of the stretch mark is a tearing of the deep dermis due to the stretching of the skin.  The epidermis (the top layer of skin) is thinned when the dermis tears, which creates the characteristic shiny red stretch marks.  With time, all stretch marks will lose their bright red appearance, but the torn or stretched dermis will not repair itself.

In my experience, over the counter stretch mark creams that you see advertised do not work well.  A technique that does seem to work is a fractionated CO2 laser to shrink the size of the stretch marks, thus making them less visible.  It may take several treatments to get the optimum result.  The laser treatment works best when the stretch marks are fairly fresh and still have the red color.  If the stretch marks are white at the time of the treatment, the success of the laser treatment is less.  There is no down time after laser treatment, minimal pain, and no medications required after the treatment.  A visit to your board certified plastic surgeon or dermatologist who is familiar with laser treatment of stretch marks is suggested.

Q. What is the earliest age that I can get a breast enlargement?  I am 16 and basically look like a boy.    

A. Under ordinary circumstances, I do not recommend doing a breast augmentation until a patient is at least 18 years old.  The main reason for waiting is to insure that you do not experience any late growth in your breasts.  You certainly do not want to put implants in breasts that are still growing.  You should be aware that if you have a breast augmentation before the age of 22, the FDA mandates that only a saline implant be used and not a silicone gel implant, so this will limit your choices.  However, if you are in fact as small as you say you are, then silicone might be a better choice for you, and a waiver can be applied for in order that silicone can be used.  I still believe that you should wait for the surgery until you are at least 18 years old.  Most plastic surgeons conform to this “unwritten rule”.  You should be aware that getting implants at such a young age (18) means that you will have the implants longer over your lifetime, and as a result, will need to change them more often.  The reason is that all implants, saline or silicone, will eventually fail and leak and require removal and replacement.  The earlier you get the implants, the more often over your lifetime that you will face additional surgery.  You can consult with a board certified plastic surgeon and find out more details about the surgery and why waiting a bit longer is advisable.

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William Byron Barber II, M.D.

has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery.  He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com