Stretch marks aren’t harmful, but can be mentally or emotionally distressing for some (Photo: Getty Images)
Cover Stretch marks aren’t harmful, but can be mentally or emotionally distressing for some (Photo: Getty Images)

Hong Kong-based general practitioner Dr Lisa Chan gets candid about skin concerns many face—such as striae, scars and dark circles—but aren’t discussed enough

When it comes to skincare, everyone is different and their skin will evolve and respond to factors in different ways. No two people will have the exact same skin type, skin tone or skin texture. The only thing that is universal is that we all face skin issues—maybe it’s milder for some compared to others, but problems will always exist no matter your skin type.

The more frequently discussed issues include acne and hyperpigmentation, and there are so many products and treatments on the market that target these perceived imperfections. However, there is a whole host of skincare concerns that are just as common, but are much less frequently discussed. This can lead those dealing with it to feel like they’re an anomaly, which can result in embarrassment or insecurities, or feeling like there is no way to address these issues.

You might also like: Are at-home beauty devices effective and worth the hype and price tag? What you should know before buying a microneedling or gua sha tool

To debunk that misplaced sentiment, here are some very common skin concerns we don’t talk a lot about, and how they can be managed. From stretch marks to dark circles under the eyes, if you’re struggling with any of the below, just know that you’re not alone and there are ways to treat them.

Stretch marks causes and treatments

What is striae and how does it occur?
Stretch marks, also known as striae, are long, narrow streaks or lines that appear on the skin. They can be different colours like white, reddish, or purplish, and they often show up on the abdomen, breasts, hips, thighs, or buttocks. Stretch marks happen when the skin stretches or shrinks quickly—and they are more common in women—especially those with darker skin—and this stretching causes the middle layer of the skin (called the dermis) to tear, and the deeper layers of skin to become visible.

There are several reasons why stretch marks can occur, including rapid growth during puberty, significant weight changes, the expansion of the abdomen during pregnancy, using corticosteroid medications for a long time, and genetic factors that affect the production of proteins important for skin elasticity.

How does striae affect a person’s physical, mental and emotional wellbeing?
Physically, striae do not pose any health risks or complications. They are purely a cosmetic issue, do not cause any physical pain or discomfort, [and sometimes] fade to a silver or white over time. Though affected areas of the skin may appear thin and wrinkled, or feel slightly indented or grooved when touched.

Mentally [and emotionally], striae might cause embarrassment and self-consciousness, which might affect someone’s clothing choice, social activities, self-image, and self-esteem, or create feelings of anxiety and depression. If the striae occurs after pregnancy, this could potentially compound the stress inherent to pregnancy.

How can striae be treated, and how effectively?
While stretch marks are generally harmless and do not cause any medical complications, they can be a source of cosmetic concern for some individuals. Various treatments, such as topical creams (such as tretinoin, ascorbic acid and hyaluronic acid), laser therapy, microdermabrasion, high-energy devices like monopolar radiofequency, high-intensity focused ultrasound (HIFU) and injectables may help reduce the appearance of stretch marks—although complete elimination is often not possible. Since everyone’s condition is different, a tailor-made, personalised approach to this problem is best.

As a doctor, I have come to recognise that patients with striae often bear deep-seated insecurities that may not be immediately apparent during their initial consultations. It is crucial not to overlook the mental and emotional aspects associated with this condition. It is during these vulnerable moments that we, as clinicians, must approach them with an extra dose of sensitivity and a personal touch.

Scars causes and treatments

How does scar tissue form?
Scar tissue forms as part of the body's natural healing process after an injury. Whenever we get a cut, burn, or any injury, our skin—or sometimes even muscles—get damaged. Right after we get hurt, our body works quickly to fix that damage. It sends extra blood and immune cells to the injured site; this is part of the body’s defence system. This causes the area to become red, warm, and swollen.

Special cells called fibroblasts then move to the hurt area and start building new tissue to replace the damaged ones. The fibroblasts make a protein called collagen, which helps give structure to the new tissue. This new tissue becomes scar tissue, and over time, the scar tissue changes to become flatter and lighter in colour. But this can take many months, or even years.

In your experience, how might scars affect a person in their everyday life?
Scars can have a significant impact on an individual’s everyday life, both physically and emotionally. Scars can affect self-confidence, cause physical limitations and discomfort, trigger emotional trauma, and require adapting to new skills. And people react to scars in various ways—some cover or camouflage their scars, while others seek treatment or tattoo over them. Some embrace them as symbols of resilience and pride. Each person's journey with their scars is unique, and it’s influenced by personal feelings and societal attitudes.

I vividly recall meeting a courageous young woman whose life took an unexpected turn after a devastating accident left her with burn scars on her face and body, which served as a constant reminder of the accident, and profoundly impacted her self-esteem and confidence. Nevertheless, buoyed by the support of loved ones and her unwavering determination to seek treatment, she discovered the strength to embrace her scars as powerful symbols of survival.

Have you had to treat very extreme scars before? 
In my journey as a doctor, I have been entrusted with the profound privilege of tending to the scars borne by courageous breast cancer survivors who underwent a mastectomy. I have walked alongside a resilient young burn survivor, their body adorned with the marks of survival. I have witnessed the indomitable spirit of a car accident survivor, bearing facial scars as testaments to their strength. In the face of unimaginable adversity, I have provided solace and healing to a patient who endured a cutter assault during a harrowing domestic fight. I have marvelled at the resilience of those who carry the scars of life-saving organ transplants, their physical reminders serving as poignant symbols of a second chance at life. 

These remarkable individuals have taught me the true meaning of courage, and have had a profound impact on me.

These experiences serve as a reminder of the Hippocratic Oath I tool as a doctor and the importance of humanity in healthcare. Our patients are not simply a collection of symptoms; they are human beings with unique experiences and stories. In the realm of healthcare, it is crucial to approach our patients with empathy, compassion, and a deep understanding of the significance of their scars. 

Read more: Fala Chen shares skincare secrets from movie sets, the importance of a daily routine and why ‘authenticity is beauty’

What is the success rate of treating scars and what are the improvements for the patient after treatment?
The success rate of scar treatment can vary widely depending on several factors. These factors include the type, size, and location of the scar, the age and health of the patient, the specific treatment method used, and the patient's adherence to post-treatment care. 

There is a variety of treatment options available for scars, ranging from topical treatments and injections to laser therapy, dermabrasion, and surgical revision. There are also preventive measures like proper early wound care, avoidance of picking at the scabs or scratching the wound, sun protection ... and together with topical treatments like silicone sheets and gels, these can effectively reduce scar visibility. 

Injections with corticosteroids are often used for keloid and hypertrophic scars and can help to flatten the scar and reduce redness, itching, and burning. A novel method that has shown promising results is the use of botulinum toxin. Injecting this substance when surgical wounds are being closed can help minimise the appearance of a scar by reducing tension in the surrounding tissues. 

Laser therapy can also be highly effective, particularly for acne scars, but surgical revision is typically used for more severe scars or contractures. And the success rate depends on the skills of the surgeon and the healing capacity of the patient.

Having said all that, it's important to make patients’ expectations realistic, as the success rate in scar treatment is not always measured by the complete removal of the scar, but rather by reducing its visibility and the physical or emotional discomfort it causes. 

Dark under-eye circles causes and treatments

Is it true that dark circles under the eyes are mostly genetic?
Although quite a number of dark circles and the eyes are genetic, it is not the only cause. Dark circles under the eyes can indeed be influenced by both genetic and environmental factors. 

Genetics:

  • Some people have thinner skin around the eyes due to genetics, allowing dark blood vessels and tissues beneath to show through, causing the appearance of dark circles. Genetics can also increase the likelihood of conditions like skin allergies, allergic rhinitis or eczema, which can contribute to dark circles.

Non-genetic causes include:

  • Age: As we get older, our skin becomes thinner and loses fat and collagen, making dark blood vessels more visible, which leads to the appearance of dark circles. Also, the appearance of tear troughs tends to be more prominent as one ages, and those hollows can create a shadowing effect. The tear troughs can also accentuate the visibility of blood vessels and underlying tissues.
  • Sleep deprivation and fatigue: Lack of sleep can make the skin pale and dull, allowing dark tissues and blood vessels beneath the skin to show through.
  • Eye strain: Prolonged screen time can strain the eyes and enlarge blood vessels around the eyes, resulting in darkening of the skin.
  • Allergies: Allergies and allergic rhinitis can contribute to dark circles under the eyes. This is because the body releases histamines when it reacts to allergens, which can cause blood vessels to dilate and become more visible beneath the skin, leading to the appearance of dark circles.
  • Dehydration: Lack of hydration can make the skin under the eyes appear dull and the eyes look sunken, [resulting in the appearance of darkness].

How can dark circles be treated?
The treatment of dark circles should be based on the underlying cause of the dark circles and individual patient factors. For example, patients with allergies should have their allergies treated at the same time; and potentially irritating treatments like chemical peels would not be suitable for someone [whose under-eye dark circles are due to] active eczema causing excessive pigments under the eyes. 

Topical treatments with ingredients like retinol, vitamin C, and caffeine may help reduce the appearance of dark circles, and prescription-strength topical treatments may also be an option for some individuals. 

Hyaluronic acid fillers can be injected into the tear trough areas under the eyes to improve volume loss or thinning skin; 1064-nm laser can help reduce the pigments of the skin underneath the eyes,; and vascular laser and intense pulsed light can effectively target the haemoglobin within blood vessels, which can help reduce the prominence of these vessels [that are causing the] appearance of dark circles.

In some cases, surgery may be recommended, particularly for individuals with significant fat prolapse or skin excess. but lifestyle modifications like getting adequate sleep, staying hydrated, reducing alcohol intake, and managing allergies effectively would also be helpful in combating dark circles.

Is there anything a patient can do between treatments to optimise and prolong best results?

Lifestyle modifications, [as mentioned above can help;] but practising sun protection, and limiting alcohol and cigarette consumption, can also significantly enhance the effectiveness of treatments.

In addition, regular and gentle massage around the eyes can promote improved blood circulation and potentially reduce the appearance of dark circles. 

For individuals who spend a significant amount of time in front of screens, it is advisable to consider blue light protection measures. Lastly, adopting a good skincare routine that includes thorough cleansing, adequate moisturisation, and sun protection can promote overall skin health. If there are no allergic reactions, eye creams containing ingredients like vitamin C, [skin-brightening] arbutin, peptides, and retinoids may be worth considering.


This is part of a monthly column in collaboration with Dr Lisa Chan, a Hong Kong-based general practitioner who has an avid interest in medical beauty. Dr Chan, MBChB (CUHK), MScPD (Cardiff), PgDipPD (Cardiff), PGDipClinDerm (Lond), DipMed (CUHK), DCH (Sydney), also holds a master's degree in practical dermatology with distinction at Cardiff University.

Topics