Sir,

Striae distensae are common dermal lesions resulting from mechanical stretching, hormonal influences, and connective tissue alterations [1–3]. White striae (striae distensae alba) represent a chronic stage characterized by dermal atrophy, disruption of collagen and elastic fibers, hypopigmentation, and reduced local vascularization [2,3].

Several therapeutic modalities have been proposed to stimulate dermal remodeling in striae, including lasers, radiofrequency, and microneedling [4–6]. However, outcomes remain variable, especially in long-standing white striae [1,4].

Vacuum therapy is applied using low to moderate negative pressure, adjusted according to the tissue response and patient tolerance, promoting transient tissue deformation and increased microcirculation [7].

Following vacuum stimulation, superficial micropuncture is performed at the epidermal–dermal interface using a dermograph equipped with a single-tip needle [5,6].

An immediate localized inflammatory response following the combined procedure, characterized by transient hyperemia, is illustrated in Fig. 1 [7].

Figure 1: Immediate localized inflammatory response observed after the application of the combined vacuum therapy and superficial micropuncture technique in the gluteal region, characterized by transient hyperemia and capillary micro-extravasation.

Mechanical negative pressure has been associated with increased cutaneous microcirculation and stimulation of fibroblast activity, contributing to collagen synthesis and dermal remodeling [7] (Figs. 2 – 4).

	Figure 2: Female patient with hypopigmented atrophic striae in the gluteal region before treatment and after the completion of the combined vacuum therapy and superficial micropuncture protocol, showing improved texture uniformity and partial repigmentation.
	Figure 3: Female patient with post-pregnancy white atrophic striae in the abdominal region before treatment and after the completion of the combined vacuum therapy and superficial micropuncture protocol, demonstrating improved tone uniformity and dermal texture.
	Figure 4: Male patient with horizontal white striae developed during puberty in the dorsal region before treatment and after the completion of the combined vacuum therapy and superficial micropuncture protocol, showing reduced visibility of the striae and improved surface homogeneity.

Superficial micropuncture induces controlled micro-injuries that activate a wound-healing cascade [5,6].

Consent

The examination of the patient was conducted according to the principles of the Declaration of Helsinki.

The authors certify that they have obtained all appropriate patient consent forms, in which the patients gave their consent for images and other clinical information to be included in the journal. The patients understand that their names and initials will not be published and due effort will be made to conceal their identity, but that anonymity cannot be guaranteed.

REFERENCES

1.  Elsaie ML. Striae distensae:A review and evidence-based evaluation of treatment options. J Cosmet Dermatol. 2009;8: 293-303.

2.  Watson RE, Parry EJ, Humphries JD, Jones CJ, Polson DW, Kielty CM, et al. Fibrillin microfibrils are reduced in skin exhibiting striae distensae. Br J Dermatol. 1998;138:931-7.

3.  Ud-Din S, Bayat A. New insights on striae distensae. J Eur Acad Dermatol Venereol. 2013;27:679-89.

4.  Alexiades-Armenakas M. Laser and light-based treatments of striae distensae. J Drugs Dermatol. 2009;8:1023-5.

5.  Fernandes D. Minimally invasive percutaneous collagen induction. Oral Maxillofac Surg Clin North Am. 2005;17:51-63.

6.  Lima EV, Lima MM, Takano D. Microneedling in facial recalcitrant melasma. An Bras Dermatol. 2015;90:919-21.

7.  Atiyeh BS, El Khatib AM, Dibo SA. Pressure and vacuum-assisted therapies in dermatology and wound healing. Ann Plast Surg. 2013;70:241-7.