06/2024
The “pregnancy glow” that some get is not a myth, but it’s also not the experience everyone has or will have. So what are your options for cosmetic procedures when you’re trying to conceive and pregnant? Today, Dr. Elise Mecham of Real You Plastic Surgery and Wellness and I talk all about facials, botox, fillers and more!
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The pregnancy glow
First, let’s take a closer look at what the “pregnancy glow” actually refers to and why some pregnant persons get it while others don’t. Pregnancy creates huge hormonal shifts, which can do all kinds of things to our skin! For some lucky people, it induces that “pregnancy glow.” That occurs partly due to increased blood flow, estrogen levels, and fluid that causes our skin (and our lips) to appear younger and fuller. This is great if you fall in this category, but for many an increase in oil production, acne, and skin tone changes, including redness and dark spots, is more likely to happen.
Botox
Botox, a neurotoxin that was approved in 1989 for cosmetic procedures, is currently approved by the US Food and Drug Administration (FDA) and in the European Union for the treatment of 12 medical conditions and 3 cosmetic indications. Once the botox binds to the muscle where it’s injected, it doesn’t continue to spread. However, it is not approved for use during pregnancy even though the size of the botox molecule it too large to criss the placenta. We simply don't have enough data to say for certain that it is safe in pregnancy.
With more people receiving botox for medical conditions prior to pregnancy, more studies are needed. A recent article looking at 29 years of studies provided Class III data that demonstrated that the prevalence rate of major fetal birth defects among live births after in utero exposure to botox is comparable with the reported background rates of major fetal birth defects. This article provides reassurance to people who got botox and became pregnant shortly thereafter or got botox before they knew they were pregnant. Another article to check out is here.
My advice would be to avoid botox for cosmetic reasons. If, however, you are receiving injections for a medical condition, a discussion on the risks and benefots of continuing botox therapy should be had between you and your provider.
Fillers
Dermal fillers are made of hyaluronic acid--a substance that is naturally found in the body. With a good understanding of facial anatomy, these substances can be safely injected into the face to restore volume and contour. Like botox, fillers are not FDA-approved for use in patients who are pregnant. The injections also often contain lidocaine to make them more comfortable. Lidocaine is one of those substances we like to avoid during pregnancy, especially during the first trimester, unless it is medically indicated. At this time, there is no medical indication for fillers in pregnancy. Finally, fillers may cause hypersensitivity, injection site infection, local inflammation followed by collagen remodeling.
I highly discourage anyone who is pregnant from having additional treatment with fillers until their pregnancy is over and they are no longer breastfeeding. As with botox, if you are trying to conceive, stopping fillers 3 months prior is ideal.
Laser therapies
CO2 lasers have been used to treat human papillomavirus (HPV) genital condyloma (genital warts) in pregnancy. This laser therpy has limited skin penetration and also coagulates to limit blood loss. Exposure to aerosolized particles can be eliminated by using aspirators, smoke evacuators, and a mask.
Er:YAG (erbium-doped yttrium aluminum garnet) laser therapy is considered safe in pregnancy.
Nd:YAG (neodymium-doped yttrium aluminum garnet) laser for dermatological indications in pregnancy has limited data. Genital condylomas have also been treated with this laser therapy without any reported maternal or fetal complications. Nd:YAG laser can also be used for for severe inflammatory acne and pyogenic granuloma during pregnancy with no reported adverse effects.
Pulsed dye laser [PDL (585 nm)] targets red blood cells within a lesion like a pyogenic granuloma and warts. There is a reported good safety profile for its use in pregnancy.
As with botox and fillers, laser therapies should not be used in pregnancy for purely cosmetic reasons.
For more info, read this article!
Chemical Peels
There are numerous chemical peels available. The ones considered safe in pregnancy when medically indicated are glycolic acid, lactic acid, salicylic acid, and trichloroacetic acid peels.
Microdermabrasion
Microdermbrasion is noninvasive and considered safe in pregnancy.
Self-tanners
The main coloring agent found in self-skin tanners is dihydroxyacetone. It works by binding with amino acid in the stratum corneum of the skin and can be found in concentrations between 1% to 15%. Systemic absorption is minimal so it is considered sage in pregnancy.
Skincare products
Up to 80% pregnant individuals use cosmetic products, facial cleansers, creams, and makeup. Because many of the products various chemical substances (e.g. phthalates, parabens, formaldehyde, dioxane, nitrosamine, hydroquinone, phenol, organic solvents) and heavy metals (e.g. Pb, Hg, As, Cd, Cr, Sb, Ni), it important to know what is considered safe in pregnancy and what should be avoided.
While most skin care products are safe to use during pregnancy, the following ingredients are best to avoid if possible:
Retinoids and retinol
Common acne and anti-aging treatment in creams and other formulations
Potential to cause birth defects
Hydroquinone
Skin lightener in many creams and other formulations
Highly absorbed after application
Phthalates
Chemical used in synthetic fragrances and nail polish
May affect hormone development (endocrine disruptor)
Parabens
Chemicals used in many personal care products
May affect hormone development (endocrine disruptor)
Triclosan
Antibacterial chemical in soaps and other personal care products
Can affect your liver and thyroid
Oxybenzone
Chemical sunblock in sunscreens
More easily absorbed after application and may interfere with hormone system
PTFE
Fluorinated chemical in cosmetics, shampoo, and sunscreen
Absorbed in the skin and may affect thyroid and reproductive systems
Formaldehyde and formaldehyde releasers:
- 5-bromo-5-nitro-1,3-dioxane
- bronopol, also called 2-bromo-2-nitropropane-1,3-diol
- diazolidinyl urea
- DMDM hydantoin
- hydroxymethylglycinate
- imidazolidinyl urea
- quaternium-15
The key ingredients in anti-aging skincare products are antioxidants--vitamin C, vitamin E, lipoic acid, and ubiquinone. These antioxidants suppress the oxidation process cells to neutralize reactive oxygen species (ROS)¸ and restoring the homeostasis within the skin. Products with these antioxidants to minimize fine lines and wrinkles and increase skin hydration and fullness are considered safe in pregnancy.
Sunscreen
When considering sunscreen, there are two types available: mineral/physical/barrier and chemical. Mineral sunscreens physically block the sun’s rays from reaching your skin by forming a barrier, plus they don’t carry the chemicals other sunscreens have. The good thing is that we no longer have to walk around with a white stripe down our noses to be safe from UV rays. Now mineral sunscreens can go on clear or have a mild, neutral tint that is good for all skin types. These sunscreens are preferred in pregnancy and include titanium oxide and zinc oxide. An SPF of 30+ (preferably 50+) is recommended.
Chemical sunscreens produce a chemical reaction in the skin to protect the skin from UV rays. A study in 2019 showed that blood concentrations of byproducts of chemical sunscreens above the FDA recommended limit were found in study subjects, namely oxybenzone, octocrylene, and ecamsule. Although these findings were dose-dependent, chemical sunscreens with these ingredients should be avoided if possible.
Here are some tips for picking a sunscreen:
- Choose broad-spectrum protection. Sunscreens labeled broad-spectrum protection against both UVA rays and UVB rays.
- Choose an adequate SPF. Dermatology providers recommend at least SPF 30; 50_ is best!
- Pick a sunscreen that goes on white. Sunscreen that goes on white and dries clear can help you see that you’re completely covered.
- Check the expiration date. Sunscreens have a shelf life that may be lessened when exposed to heat and direct sunlight.
- Choose water-resistant and fragrance-free. Water-resistant sunscreen offers added protection while you’re swimming or playing in the waves. Read the label to find out how long the water resistance lasts. Fragrance-free sunscreen is less likely to contain non-essential ingredients that could possibly irritate your skin.
Click here to learn more about common skin and hair conditions in pregnancy and how to manage them!