Improving Striae Distensae With Combined Hyperdiluted Calcium Hydroxylapatite Injection and Fractional Microneedling Radiofrequency: A Pilot Study

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ID: 320307
2026
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Abstract
Abstract Background Striae distensae (SD), or stretch marks, are dermal scars resulting from disrupted collagen and elastin due to mechanical stress. Effective treatments, particularly for chronic striae alba, remain limited. Calcium hydroxylapatite (CaHA), a biostimulatory dermal filler, and fractional microneedling radiofrequency (RF) have individually demonstrated regenerative effects. Objectives This pilot study investigates the safety and efficacy of combining CaHA and fractional microneedling radiofrequency in improving SD. Methods Eight female patients with abdominal SD (rubra or alba) underwent one session of hyperdiluted CaHA injection (1:4 dilution, 3 mL), followed by three monthly sessions of RF microneedling. Outcomes were evaluated six months after the final session using the Manchester Scar Scale (MSS), patient satisfaction scores, and adverse event monitoring. Results All participants (mean age 36.6 ± 7.3 years) completed the protocol. Mean MSS scores improved significantly from 14 ± 0.93 at baseline to 6.88 ± 1.64 post-treatment (p < 0.0001). The mean satisfaction score was 8.12 ± 1.72. Mild, transient erythema occurred in two cases; no serious adverse events were observed. Conclusions This pilot study suggests that combining hyperdiluted CaHA with RF microneedling is a safe and effective approach for treating SD, yielding both clinical and patient-reported improvements. Larger controlled studies are warranted.
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Authors Haitham M. Saleh, Daniella Fakih, Ahmed Elbeltagy, Sham AlZahabi, Hossam Elenany, Lorena Arrien, Nabil Fakih‐Gomez
Journal Aesthetic Surgery Journal Open Forum
Year 2026
DOI
10.1093/asjof/ojag121
URL
https://doi.org/10.1093/asjof/ojag121
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