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TREATMENT OF STRIAE DISTENSAE USING CONTROLLED

SUPERFICIAL EPIDERMAL INTERVENTION: THE BARBARA AGUIAR

METHOD

Barbara Aguiar1

Abstract: Striae distensae (SD), commonly known as stretch marks, can be categorized as red striae

with broken capillaries (Striae Rubrae) or late ﬁ brotic white striae (Striae Albae). Treating stretch

marks remains challenging due to the variable efﬁ cacy of treatments and the risk of post-inﬂ ammatory

hyperpigmentation, particularly with treatments that act on the dermal layer. The Barbara Aguiar

method involves a controlled epidermal intervention combined with the topical application of a

hyaluronic acid-based serum and a nutrient-rich diet. This method has been shown to consistently

reduce the appearance of stretch marks, improving their colour and depth.

Keywords: Striae Distensae; Epidermis; Hyperpigmentation

1 Graduada em  sioterapia, Pós graduação em Estética e Cosmetologia , Formada em Medicina

Tradicional Chinese sistêmica e estética

INTRODUCTION

Striae de distension (DE) are common skin alterations, of multifactorial etiology, with an

important participation of hormonal alterations, and are frequently observed in periods such as puberty

and pregnancy, as well as in situations related to cortisol alterations and the use of corticosteroids. DE

predominantly affects women. From a pathological point of view, they are characterized by alterations

and rupture of collagen, elastic and reticular ﬁ bers of the dermis associated with epidermal alterations.

Treatment remains a challenge due to variable efﬁ cacy and the risk of post-inﬂ ammatory

hyperpigmentation, which varies with treatment, especially when it is reached The dermis (Chaudhury

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et al., 2026).

Stretch marks can be classiﬁ ed into red stretch marks (Striae Rubrae) and white or mature

stretch marks (Striae Albae) (Wu and Wang, 2026). Red stretch marks are characterized by the rupture

of collagen, elastic, and reticular ﬁ bers, associated with the rupture of blood capillaries, responsible

for the characteristic reddish color of the lesion. Contrary to what is often described, red stretch

marks should not be considered easier to treat, since in addition to structural changes, they present

a color change that also needs to be treated. Therefore, treatment should consider both the recovery

of the structural aspect of the stretch mark and the improvement of the color change of the lesion

(Chaudhury et al., 2026).

The treatment of stretch marks is usually organized by modality and by stage of injury: in

the case of red stretch marks, the focus is usually on erythema and vascularization, while in stretch

marks alba, the focus is usually on collagen remodeling and the repigmentation. The main treatments

for stretch marks include topical products, lasers/light devices, radiofrequency, microneedling, peels,

microdermabrasion, carboxytherapy, and combination regimens (Chaudhury et al., 2026; El�Domyati

et al., 2016; Ibrahim et al., 2015; Karimipour et al., 2010; Seiraﬁ anpour et al., 2021; Wu and Wang,

2026).

In this article we demonstrate the step-by-step of a treatment for stretch marks that has been

implemented for 13 years using microdermabrasion, a controlled epidermal intervention (Barbara

Aguiar Method) and some results obtained.

Methodology - The Barbara Aguiar Method (MBA) for the treatment of stretch marks

Therapeutic protocol

Inclusion and exclusion criteria

The exclusion criteria are: patients with uncontrolled diabetes, using anticoagulants, with

anemia, using corticosteroids, undergoing cancer treatment, and pregnant women.

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Materials and patient preparation

Before the procedure, the patient is instructed not to apply cosmetic products or any other

topical substances to the area to be treated. Before the beginning of the procedure, strict asepsis

measures are adopted, including hand hygiene by the professional, the use of procedure gloves, sterile

gauze and disposable sterile needle, the organization of the material in a clean ﬁ eld and the use of a

disposable tissue exclusive to each patient. Next, skin asepsis is performed with 70% ethyl alcohol or

chlorhexidine solution, according to biosafety protocols.

Standardized technique of the Barbara Aguiar Method

The procedure consists of the standardized induction of a controlled superﬁ cial epidermal

abrasion, performed exclusively in the most superﬁ cial layers of the skin through precise and

standardized movements, deliberately avoiding dermal penetration or diffuse capillary bleeding. The

objective of the intervention is to promote a localized mechanical stimulus, capable of triggering the

initial physiological cascade of tissue repair, preserving the structural integrity of the dermis.

The controlled removal of the most superﬁ cial layer of skin is performed by continuous

movements, stretch mark by stretch mark, maintaining gentle, light and constant pressure; in this

way, it does not cause cuts or bleeding. The movement should always be precise in the extension of

the entire stretch mark, like a sweep; however, it should be done only once in each part of the stretch

mark, to avoid cuts or deep injuries.

On our pain scale from 0 to 10, our patients usually report pain from 0 to 3. There has never

been a vagal reaction.

The procedure is conducted until homogeneous hyperemia is obtained in the treated area,

without bleeding. The absence of bleeding is used as an operational criterion to ensure that the

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intervention remains restricted to the epidermis, avoiding direct damage to the papillary dermis.

Therefore, homogeneous hyperemia is used as a clinical marker of the end point of the procedure,

indicating a transient increase in microvascular perfusion due to the acute inﬂ ammatory response

induced by superﬁ cial epidermal abrasion.

At the end of the procedure, a topical hyaluronic acid serum is applied, with the objective

of maintaining the hydration of the skin barrier during the re-epithelialization process, minimizing

transepidermal water loss, without direct biostimulatory purpose and favoring the physiological

process of tissue repair. No other product is applied immediately after the session.

In the ﬁ rst days after the procedure, the formation of a thin superﬁ cial crust is observed,

which corresponds to the expected evolution of the healing process. In approximately 10 to 15 days,

the superﬁ cial changes become clinically imperceptible. Although clinical re-epithelialization occurs

between 10 and 15 days, the process of remodeling of the extracellular matrix can remain active for

several weeks, involving the progressive reorganization of collagen and elastic ﬁ bers, and may extend

for approximately 60 days depending on the individual characteristics of each patient.

Post-procedure care

During the post-procedure period, patients are advised to avoid direct and indirect sun

exposure to the treated area, as well as to perform aesthetic procedures and apply potentially

irritating substances, including acids, chemical agents, and topical oils. During the ﬁ rst seven days,

it is recommended to clean the treated area exclusively with antiseptic soap without triclosan. The

home protocol consists of the application of a topical serum with hyaluronic acid, as directed by the

responsible team. It also includes the daily intake of Verisol collagen capsules and hyaluronic acid

(150 mg/dose). For stretch marks alba or mature, there is also a daily intake of beta-carotene (6,000

IU of vitamin A).

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Expected chronology of tissue response

The interval between sessions is established according to the clinical presentation of the stretch

marks and the evolution of the tissue repair process. For white stretch marks, a minimum interval of

30 days between sessions is recommended. For red stretch marks, an interval of approximately 60

days is recommended, respecting the time necessary for the resolution of the inﬂ ammatory response

and for skin remodeling before a new intervention.

Red stretch marks, in addition to suffering the injury, are also hyperpigmented. After a week

of dermabrasion, we started using a whitening active to help recover skin color. This active ingredient

(for red stretch marks) contains hyaluronic acid, vitamin E, niacinamide, tranexamic acid, glycolic

acid, palmitic and caprylic acid triglycerides, sunﬂ ower oil, grape seed oil, jojoba oil, rosehip oil and

almond glycolic extract.

Each patient uses this product 2 to 3 times a day until the next session, in which it should not

be applied. This product, dermatologically tested, will help lighten the skin in this region with dark

stretch marks.

However, if the patient has dark and white stretch marks on the same lesion, she should not

use this active ingredient to lighten, as this will prevent the synthesis of melanin in the area where

there was loss of melanocytes.

Standardization, safety and reproducibility

The safety of the intervention is standardized through the adoption of biosafety measures, the

use of sterile and disposable materials, the clinical follow-up of the participants, and the systematic

recording of the clinical evolution throughout the follow-up period. Therefore, in order to ensure the

reproducibility of the study, the materials used, the skin preparation procedures, the form of execution

of the intervention, the post-procedure care, the products used, the intervals between sessions, and

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the clinical evaluation criteria were previously deﬁ ned and standardized, which allows the uniform

application of the method to all study participants.

Biological rationale of the intervention

The proposed intervention consists of performing a superﬁ cial and controlled mechanical

stimulation of the epidermis, associated with a nutritional supplementation protocol, with the

objective of favoring the physiological mechanisms involved in tissue repair. The intervention triggers

a controlled acute inﬂ ammatory response, characterized by the release of cytokines, growth factors,

and other mediators that participate in the stages of healing, re-epithelialization, and remodeling

of the extracellular matrix. Considering that stretch marks present structural changes characterized

by the disorganization and reduction of collagen and elastin ﬁ bers in the dermis, it is assumed that

the activation of these repair mechanisms, associated with adequate nutritional support for tissue

regeneration processes, can favor the synthesis and reorganization of the extracellular matrix,

contributing to the reduction of the depth of the stretch marks and to the improvement of the clinical

appearance of the lesions. In addition, the epidermal renewal promoted by the intervention, in

association with the nutrients involved in the maintenance of skin homeostasis, favors the gradual

recovery of the uniformity of skin color, especially in hypochromic stretch marks, contributing to the

overall improvement of the aesthetic appearance of the treated region. As there is tissue recovery, the

treated lesions do not return.

RESULTS

All images were taken with the same camera, at the same distance, with the same lighting,

and with the patient in the same position, without ﬁ lters. All the cases presented here demonstrate a

reduction in depth, recovery of coloration, and patient satisfaction with the treatment of stretch marks.

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There were no adverse effects.

The elbow stretch marks were treated with the MBA (Figure 1). Total improvement was

observed in the areas with stretch marks, which were completely closed. For the thicker and deeper

stretch marks, there was no closure, but there was recovery of the skin and color. It is also possible to

observe an improvement in the depth of the stretch marks (Figure 1).

Figure 1: Anterior elbow striations, with a thickness of 5 to 9 mm, in a male patient. Results after 1

session of the Barbara Aguiar Method (MBA).

The treatment of post-pregnancy dark skin on the side of the abdomen of the patient with 5

mm thick red and pearlescent stretch marks is shown in Figure 2. After 3 sessions of the procedure

with an interval of 60 days, several stretch marks closed completely. Others involved skin restoration,

and did not evolve to white stretch marks due to the treatment for full recovery of skin color (see

methodology). White stretch marks with less deep lesions showed total improvement of lesions and

color. In deeper stretch marks, there was partial improvement and, even so, closure occurred at 2

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millimeters thick. It is also possible to observe an improvement in the depth of the stretch marks

(Figure 2).

Figure 2: Dark post-pregnancy stretch marks on the side of the abdomen, red and pearlescent. The

red ones are between 5 and 11 mm thick, and the white ones are 5 mm. Results after 3 sessions of the

Barbara Aguiar Method with an interval of 60 days between one session and another.

Treatment was performed for a 50-year-old patient with old white stretch marks on the

buttocks, developed during adolescence, with a thickness of 3 to 8 mm (Figure 3). Some stretch marks

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were reduced to the point of disappearing, with a thickness of less than 3 mm. Stretch marks with a

thickness of 8 mm recovered their color and reduced their thickness to 3 to 4 mm. It is also possible

to observe an improvement in the depth of the stretch marks (Figure 3).

Figure 3: A 50-year-old patient with white and old adolescent stretch marks, with a thickness of 3 to

8 mm. 3 sessions of the Barbara Aguiar Method were performed, with an interval of 30 days between

sessions.

Figure 4 shows stretch marks on the thighs with a thickness of 3 to 5 mm. The recovery after

treatment was 100% in the stretch marks and coloration.

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Figure 4: A 30-year-old patient with stretch marks on the thighs due to the use of corticosteroids. For

red stretch marks, a total of 5 sessions were performed, with an interval of 60 days between them.

A 32-year-old patient with white postgestational stretch marks with a thickness of 2 to 5

mm, including 11 mm stretch marks in the navel region, is shown in Figure 5. After the sessions, we

observed that the thinner stretch marks disappeared; the skin and color were fully recovered. The 5

mm stretch marks decreased to 2 and 3 mm, and the 11 mm stretch marks, in the umbilical region,

showed improvement in color and ﬂ accidity (Figure 5).

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Figure 5: A 32-year-old patient with white post-gestational streaks. 3 sessions were performed, with

an interval of 30 days between them.

Pain Scale (VAS), before, during and after treatment

Patients report pain from 0 to 3 on the pain scale, and the post-treatment maintains this

pattern. Patients who do the whole body report burning in the post-treatment, with a pain scale of 4

to 6, especially at bath time and only on the ﬁ rst day. From the second day onwards, they no longer

feel any discomfort.

DISCUSSION

Our microdermabrasion method (MBA), associated with the topical application of hyaluronic

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acid-based serum for 7 days and the intake of nutrients for both red stretch marks and stretch marks

alba, presents consistent results in reducing stretch marks and improving coloration.

In all reviews on the topic, there is no gold standard treatment, and most of the evidence

is limited by small clinical trials, heterogeneous protocols, and measures with inconsistent results

(Chaudhury et al., 2026). Stretch marks present epidermal atrophy, disruption of dermal collagen, and

alterations in ﬁ broblast signaling; therefore, communication between the epidermis and the dermis is

a plausible mechanism to explain the results achieved here (Borrelli et al., 2022).

In this case, the dermal-epidermal junction appears to be structurally altered in stretch marks,

with less deep dermal papillae and collagen ﬂ attening. Our method seems to corroborate that only a

controlled abrasion of the epidermis can activate signaling pathways (“epidermal-dermal crosstalk”)

capable of inducing dermal remodeling, without direct mechanical injury of the dermis layer (Borrelli

et al., 2022; El�Domyati et al., 2016). This hypothesis is biologically plausible and has already been

discussed for microdermabrasion, but it still lacks robust clinical demonstration speciﬁ c to stretch

marks (Borrelli et al., 2022) . This pattern suggests that a superﬁ cial intervention produces a deeper,

more restorative dermal response.

CONCLUSION

The Barbara Aguiar method consists of microdermabrasion, through superﬁ cial and

controlled mechanical stimulation of the epidermis, associated with a nutritional supplementation

protocol and topical creams. The treatment favors the physiological mechanisms involved in tissue

repair of alba and red distension stretch marks.

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