Plastic Surgery and Pregnancy

An exposed pregnant woman's tummy

One of the first questions we’ve been asked us regarding Botox and filler’s during pregnancy. Botox is a neurotoxin that was approved in 1989 for cosmetic procedures by the FDA. It is injected into the soft tissues of the face to stop movement of the facial muscles and The formation of wrinkles. Since its approval, many different types of neurotoxins have come on to the market that work in a similar fashion and seem to be fairly equitable in effectiveness. However the FDA has not approved the use of Botox during pregnancy or while breast-feeding. I’m consenting patients for treatment with botox a Consent them for a risk of spread, bruising, allergic reaction, infection, and other side effects. Although we believe that once the Botox binds to the muscle where it’s injected that it doesn’t continue to spread, Botox has not been studied in the setting of pregnancy or in breast-feeding. So don’t worry if you get pregnant just after getting Botox, but I highly discourage anybody from getting further treatment while pregnant or breastfeeding.

Dermal fillers are a little different in that most are made of hyaluronic acid, which is a substance that is naturally found in the body. With a good understanding of facial anatomy, these substances can be safely injected in to the face to restore volume and contour. Unfortunately, like Botox, fillers are not FDA approved for use in patients who are pregnant, breastfeeding, or under the age of 18. They also often contain lidocaine when first injected, to make the injection more comfortable for patients, and lidocaine is one of those substances we like to avoid during pregnancy, especially during the first trimester. These products carry a higher risk of infection compared to Botox, as they are semi-permanent medical treatments, meaning they maintain shape and volume anywhere from 6 months to 2 years. What this means is that if you have recently been treated with facial fillers and then discover you are pregnant, don’t worry, this should not affect the development of your infant. But I highly discourage anyone pregnant from having additional treatment with either of these products until their pregnancy is over and they are no longer breastfeeding.

I also recommend avoiding other treatments that might stress the skin or break down it’s protective barrier during pregnancy. Most facial peels are not a good idea during pregnancy, and micro needling as well as high energy treatments such as laser treatments should also be avoided. So how do we help ourselves find that elusive “pregnancy glow”? We have a lot of great options.

One challenge that we face during pregnancy is huge hormonal shifts. This does all kinds of things to our skin. For some lucky people, it induces that pregnancy glow. Sometimes that is due to increased blood flow, estrogen levels, and fluid that causes our skin (and our lips) to plump and appear younger and fuller. This is great if you fall in this category, but for the rest of us we notice an increase in oil production, acne, and skin tone changes that include redness and dark spots.

First, lets talk about what you should avoid during pregnancy. For those of us who fall in the “geriatric pregnancy” category, we may already be using skin care products to help prevent and treat fine lines and wrinkles. Many of these products are not safe during pregnancy. Retin- A, tretinoin, adapalene, chemicals in peels, and some of the newer products on the market are not safe during pregnancy. Also, oral treatments such as spironolactone, hormonal therapies, many types of antibiotics, and isotretinoin should be avoided during pregnancy as well. For specific questions on what is safe, ask your OBGYN provider, and stop using the product until you have verified it is safe for you and your baby.

During pregnancy, our skin can often darken and produce dark spots. This is called melasma. This can be made worse by sun exposure during pregnancy. While this darkening usually fades after pregnancy, some of us can experience the results for years after words. The number one thing you can do to prevent this from worsening is to avoid sun exposure on your face. Wear a good sunscreen and a wide-brimmed hat. There are two types of sunscreens available on the market. Barrier sunscreen and chemical sunscreen. Chemical sunscreens produce a chemical reaction in the skin to protect the skin from UV rays. These are FDA approved, but studies recently show we may absorb more of the chemicals through our skin than previously thought. This hasn’t changed FDA recommendations regarding use, but this is still being evaluated. Because of this I recommend a good barrier sunscreen. We are talking old-school “Beach Boys” era blocking sunscreen, typically made with titanium oxide and zinc. These physically block the sun’s rays from reaching your skin by forming a barrier and don’t carry the chemicals our other sunscreens have. The good thing is, we no longer have to walk around with a white stripe down our noses to be safe from UV rays. Barrier sunscreens now can go on clear or have a mild, neutral tint that is good for all skin types. One of my favorite brands is ELTA MD, but there are also brands carried at stores like walmart that are also barrier, and those are the types I tend to use on my own children.

Most of us will experience acne during pregnancy, even if you had clear skin before hand. There are a lot of safe treatments for acne during pregnancy, including topical salicylic acid, azelaic acid (which also helps with hyperpigmentation), benzoyl peroxide, and glycolic acid. Both glycolic acid and salicylic acid can also help to brighten skin and reduce fine lines and wrinkles, so they are great additions to a pregnancy skin care routine. If your acne is still out of control, there are a few oral antibiotics that can be safely prescribed, but you should see your ObGyn for those prescriptions.

Additionally, there are a few other products that are staples in my own skin care routine that are safe for use during pregnancy. One of my favorites is vitamin C serum, as well as topical vitamin E. These help brighten and rejuvenate skin, and help with fine lines and wrinkles. They are antioxidants that help protect skin against damage throughout the day. Also, even though we discourage injecting hyaluronic acid fillers during pregnancy, it is safe to use this on your skin and it can help to minimize fine lines and wrinkles, and increase skin hydration and fullness. Finally, using a wash or scrub that gently exfoliates can help to improve skin tone and remove dead and dry skin, really helping achieve a refreshed look during pregnancy. One of my favorites is ZO face scrub. It contains lipids, glycerine, vitamins A, C, E, tea tree oil, and magnesium crystals. It’s a staple in my skin care routine and has been for years now.

Finally, and probably most importantly, we should talk about supplements that are safe during pregnancy that also help our skin to tolerate all of the changes coming our way. Supplements can be risky during pregnancy. Each product needs to be evaluated for safety and needs to be a brand that is trusted to ensure there aren’t any “extra” additives. The best supplement you can take during this critical time is your prenatal vitamin. It will have all of the appropriate vitamins and minerals that both you and your baby will need, when combined with a healthy diet. Additionally, fruits and vegetables high in vitamin C and antioxidants (bell peppers, oranges, berries, etc) can make a big difference in both how you feel and look. You can also add collagen peptides to help your skin maintain it’s elasticity and glow, as well as make sure you are getting enough protein for both you and baby to remain healthy. Finally, during pregnancy, make sure everything you do is in moderation and balance. Follow the recommendations of your ObGyn or MFM that are specific to your pregnancy and health, and stay active and moving as long as you are safely able to.

I hope this helps answer your questions! Enjoy your pregnancy and your skin.