Journal

Microneedling for Stretch Marks: What the Studies Show

Microneedling improves stretch marks partially, not completely. Striae rubrae respond better than striae albae. What the dermatology trials actually measured.

Microneedling improves how stretch marks look. It does not remove them. A 2026 Aesthetic Surgery Journal trial scored red striae at 48.89% Manchester Scar Scale improvement. That reading came six months after the last session. White striae reached 41.61%. Earlier marks respond better. Stretch marks are dermal scars, and scars stay.

This article reports what the dermatology literature actually measured, including the parts that undercut the marketing. Stretch marks are the hardest topic on this journal to write honestly. The limitations get their own section.

What are striae distensae?

Striae distensae are linear dermal lesions caused by skin stretching. Early ones run perpendicular to the direction of skin tension. A 2016 review in the Journal of the European Academy of Dermatology and Venereology names both stages. Ud-Din, McGeorge and Bayat describe the acute red form and the chronic white form.

Reported prevalence swings hard. That same review cites figures from 11% to 88%. A 2026 systematic review in the Journal of Cosmetic Dermatology cites a pregnancy-cohort incidence of 56%. Its 95% confidence interval runs 52% to 59%. A 2017 review in the International Journal of Women's Dermatology reports 55% to 90% in pregnancy. That review places pregnancy striae on the breasts, abdomen, hips and thighs.

The spread tells you something. Nobody counts stretch marks the same way twice.

Striae rubrae and striae albae, side by side

The stage decides your options. Red is early and inflamed. White is mature and atrophic.

Feature Striae rubrae (red) Striae albae (white)
Stage Acute, inflammatory Chronic, fibrotic
Appearance Erythematous, flat or slightly raised Hypopigmented, atrophic, wrinkled
Vascularity (Ud-Din 2016) Increased Reduced
Erythema index (Cho 2019) Higher than striae albae and normal skin Lower than striae rubrae
Symptoms Can itch Usually none
Microneedling MSS gain at 6 months 48.89% 41.61%
Topical tretinoin Some evidence of benefit "Of limited value"
Post-procedure reaction Heightened, transient Milder

One caution about that table. A 2019 study in Skin Research and Technology measured 61 women with striae on the abdomen and thighs. Red and white striae differed in brightness and erythema index. They did not differ in hydration, elasticity, roughness or dermal density. Both were rougher than normal skin. Both had lower elasticity and lower dermal echo-density.

So the two stages look different. Structurally they are closer than the colors suggest.

What happens in skin when a stretch mark forms

The elastic fibre network reorganizes and thins. A 1998 study in the British Journal of Dermatology biopsied striae and adjacent normal skin. Vertical fibrillin fibres under the dermal-epidermal junction were significantly reduced. Elastin in the papillary dermis was reduced too.

Deeper fibres realigned parallel to the junction. The dermal matrix looked looser and more floccular. Glycosaminoglycan content rose. Other extracellular matrix components showed no significant change.

Ud-Din adds the inflammatory layer: elastolysis in the mid-dermis, driven by mast cell degranulation and macrophage stimulation. The epidermis atrophies and loses its rete ridges. That architecture repeats in other atrophic scars. Our guide to acne scar types covers the parallel.

Two things follow. Stretch marks are scars, not pigment. And the topical evidence is thin and stage dependent. Ud-Din's review found a distinct lack of evidence for each topical formulation.

What the microneedling studies on stretch marks found

Improvement is real and partial. Here are the four studies worth your time.

Study Design Key finding
Marin 2026, Aesthetic Surgery Journal 29 subjects, 34 regions, 4 monthly sessions, untreated contralateral controls Rubrae improved more than albae overall (P = .012)
Saki 2022, Dermatologic Therapy 40 patients, split-side, microneedling vs fractional CO2, 10-month follow-up Both reduced striae cross-section (P < 0.001), no difference between them
Naspolini 2019, American Journal of Clinical Dermatology 20 women, abdomen split, 5 monthly sessions, biopsies taken Collagen and elastic fibres rose significantly (p < 0.01) with both arms
Mustafa 2025, Lasers in Medical Science Meta-analysis, 6 RCTs, 166 patients CO2 caused far more hyperpigmentation (RR 8.37, 95% CI 1.42 to 49.44)

The Marin study is the one built for this question. Fifteen striae rubrae and 19 striae albae regions received four sessions, four weeks apart. Matched marks on the opposite side of the body served as untreated controls. Treatment covered abdomen, hips and shoulders.

Manchester Scar Scale improvement at three and six months ran 43.89% and 48.89% for rubrae. Albae scored 36.69% and 41.61%. Scores kept trending up between month three and month six. The authors note that trend was not statistically significant. No adverse events were reported.

A 2024 meta-analysis in Aesthetic Plastic Surgery pooled 11 studies, six of them randomized. Microneedling matched lasers for clinical improvement (P = 0.35). Patients preferred microneedling (P = 0.04). Microneedling hurt more than laser (P < 0.00001).

Why the red stage responds better

Early striae are still an active wound-healing site. Late striae are settled scar. A procedure that nudges remodeling has more to work with in the first case.

Ud-Din puts the principle plainly: intervention at the initial stages may limit the epidermal changes that arrive later. The same review reports tretinoin working on striae rubrae and being of limited value on striae albae.

The pattern repeats outside microneedling. A 2014 Dermatologic Surgery trial compared pulsed dye laser and intense pulsed light. Striae rubra gave a superior response to both. Read the authors' own caveat, though: the histological changes could not verify that clinical difference.

Marin found the same shape and reported it just as carefully. On the Manchester Scar Scale, rubrae beat albae across pooled visits. Single timepoints on that scale did not reach significance. On the clinician global scale the gap was significant at both follow-up visits.

Microneedling versus lasers for stretch marks

Efficacy is close. Side effects are not.

The 2025 meta-analysis in Lasers in Medical Science pooled six RCTs and 166 patients. Clinical improvement showed no significant difference (RR 0.97, 95% CI 0.74 to 1.28). The cross-sectional area of the largest striae matched too. Over 70% of patients improved on either.

The split appears in pigment. Post-inflammatory hyperpigmentation ran far higher after CO2 laser than after microneedling. The relative risk was 8.37, with a 95% confidence interval of 1.42 to 49.44. The authors call microneedling the safer option on that basis. Our comparison of microneedling and laser covers the wider case.

Cost is the other lever. Saki concluded microneedling is more economical, having found equal results across 10 months of follow-up.

How body microneedling differs from facial microneedling

Depth, area, pain and healing all change below the jaw. Abdominal and hip skin is thicker than facial skin, and stretch mark regions are large.

Marin used two Revance instruments, SkinPen Precision and MicroPen EVO, each with 14 needles at 32 gauge. Sessions ran three passes at depths from 0.25 to 2.5 mm. The investigator set depth per site and per patient. Depth generally increased across visits. Prescription numbing cream went on for at least 20 to 30 minutes beforehand.

One secondary observation is worth noting. The authors report no considerable correlation between penetration depth and outcome at any timepoint. They mark that analysis as data not shown, so the underlying numbers are unpublished. Depth was set by the investigator per subject and per site, not randomized. Our depth guide covers depth settings on the face.

Pain is the other difference. Naspolini recorded a mean pain score of 5.23 for microneedling. The non-ablative laser scored 2.39 (p < 0.001). That was on the abdomen, with microneedling on one half and the laser on the other. Both halves belonged to the same patient. See what microneedling feels like for context.

What the literature does not show

Complete clearance. That is the headline limitation, and it is not close.

A 2024 systematic review in Dermatologic Surgery examined 151 studies and 4,806 treatment outcomes. Complete response was rare across the board. Injection-based devices reached 7% on striae distensae. CO2 lasers reached 4% on striae alba. Platelet-rich plasma reached 31% on striae rubra, from only 13 outcomes. The authors read that as a lack of effective treatments.

Three more honest notes on the Marin study, which is the best evidence for the timing argument:

  • It was open-label, and the authors rate it Level of Evidence 3.
  • It was funded by Revance, all authors were employed by Revance, and the devices tested are Revance products.
  • Follow-up stopped at six months. Sample size was small and 89.7% of participants were women.

Nothing in that list makes the data wrong. It does mean you should treat one industry-funded open-label trial as a signal, not a settled answer. A 2026 systematic review in Actas Dermo-Sifiliográficas evaluated 69 articles. It concluded current evidence cannot define a single treatment. Some of that work is low quality with small samples.

Who should not microneedle stretch marks

Clear these before anything else. Marin's own exclusion list is a reasonable starting point.

  • History of keloid or hypertrophic scarring
  • Pregnancy, plans to become pregnant, or nursing
  • Active skin disease in the treatment area
  • Immunosuppressive conditions, or illness affecting wound healing
  • Systemic corticosteroids, anticoagulants, or topical retinoids
  • Known allergy to topical lidocaine or to skincare products
  • Recent lasers, microneedling, radiofrequency or PRP in the same region

Add one more of your own. Any active infection in the area is a reason to wait.

The keloid point needs an asterisk. A 2021 systematic review in the Journal of Clinical and Aesthetic Dermatology reviewed 51 articles and 1,029 patients. It notes most studies excluded people with keloidal or hypertrophic tendencies. The real risk is therefore difficult to assess. Absence of evidence, not evidence of safety.

That review also flags what goes wrong at home. One reported case involved a home roller spreading varicella from a woman's chest to her face. Three patients developed a delayed granulomatous hypersensitivity reaction after topicals went on first. Their symptoms included fever, malaise and joint pain. Two of the three cases were attributed to a vitamin C serum.

Read that last one twice. Anything applied immediately after a session goes onto skin whose barrier is temporarily disrupted. How long that lasts has been measured. A 2011 study in the Journal of Controlled Release tested that. Unoccluded microneedle sites recovered barrier function within two hours. Occlusion stretched that to between 3 and 40 hours.

Our pages on sterilization, aftercare, who should not microneedle and side effects go further.

Where a home device fits

Not here, on current evidence. The Marin trial ran in a clinic, with trained operators, prescription numbing cream and depth set per site. The other trials cited here were clinic-based too.

The re:tones Tap Pen ships two cartridges, an 8 micron tip and a 15 micron tip. It is built for facial use, once a week, and we make no claim about stretch marks. If striae are your goal, that is a conversation with a board-certified dermatologist.

The distance between a clinic protocol and a home routine is the whole point of this section. Trained operators, prescription anesthetic and per-site depth are not available at home. Read our home versus professional comparison for how the two settings differ.

Frequently asked questions

Does microneedling get rid of stretch marks?

No. It improves appearance partially. The 2024 Dermatologic Surgery review covered 4,806 treatment outcomes. Complete response reached 7% for injection-based devices on striae distensae. CO2 lasers reached 4% on white striae. Manchester Scar Scale gains near 48% describe a visible change, not clearance. Expect softening, not removal.

Do old white stretch marks respond to microneedling?

Yes, less well than red ones. Marin recorded 41.61% Manchester Scar Scale improvement for striae albae at six months, against 48.89% for striae rubrae. Both stages improved significantly from baseline. On the Manchester Scar Scale that gap reached significance only across pooled visits. On the clinician global scale it was significant at both follow-up visits.

How many sessions do stretch marks need?

Published protocols run four to five sessions at monthly intervals. Marin used four sessions four weeks apart. Saki used four monthly sessions. Naspolini used five. Marin and Saki followed patients for months afterward. Naspolini assessed after the third and fifth sessions. Scores trended upward past the last session in the Marin data, though not significantly. Our guide to microneedling frequency covers the face.

What needle depth did the stretch mark studies use?

Clinic protocols ranged from 0.25 to 2.5 mm on abdomen, hips and shoulders, set per patient. Do not read that as a target. The Marin authors report no considerable correlation between penetration depth and outcome at any timepoint. They did not publish the underlying data. Depth on body skin is an operator decision, not a home setting.

Is microneedling or laser better for stretch marks?

Efficacy is comparable. A 2025 meta-analysis of six RCTs found no significant difference in clinical improvement (RR 0.97). Striae cross-section matched too. Hyperpigmentation was the split: the CO2 group carried a relative risk of 8.37 against microneedling. Laser hurts less. Microneedling costs less.

Can I microneedle stretch marks during pregnancy?

No. Pregnancy and nursing were exclusion criteria in the Marin trial. Pregnancy striae also fade over months to years and turn white. The red stage you see now is not your final result. Ask your obstetrician before any procedure or any active ingredient.

Do stretch mark creams work?

Mostly no. The 2017 review looked at prevention during pregnancy. Olive oil and cocoa butter did not lower incidence versus placebo. Centella asiatica extract, hyaluronic acid and daily massage showed some promise at preventing marks, not at removing them. Tretinoin has some evidence on red striae and is of limited value on white ones. Prescription products need a doctor.

Does microneedling hurt more on the body?

Yes, and the trials measured it. Naspolini recorded a mean pain score of 5.23 on a visual analog scale for abdominal microneedling. The non-ablative laser scored 2.39 on the same patients. Clinics apply prescription numbing cream for at least 20 to 30 minutes beforehand. Home devices have no such option.

The short version

Stretch marks are dermal scars with a reduced elastic fibre network. In one industry-funded open-label trial, scar-scale scores improved between about 37% and 49%. That took four monthly clinic sessions. Red striae respond better than white. Nothing on record removes them. Treat the timing finding as the useful part, and treat the marketing as the noise.

Sources

Related reading

  1. What Is Microneedling? How It Works, and What It Actually Does to Skin Microneedling7 min read
  2. Microneedling Depth: What 0.25 mm to 1.5 mm Actually Reaches Microneedling7 min read
  3. What Causes Sagging Skin: Collagen, Elastin and What Holds Skin Up Skin concerns9 min read