Medical Aesthetics in Pregnancy and Breastfeeding: Which Treatments Should Be Postponed, and What Should You Discuss with Your Physician?

Why are most procedures postponed?

It is not ethically acceptable to carry out experiments on pregnant women to study the safety of medicines and medical procedures in pregnancy. For this reason, for most products and devices used for aesthetic purposes, safety data for pregnancy and breastfeeding are either absent or very limited.

Aesthetic procedures are usually not essential, and postponing them for a few months causes no loss in terms of health. Waiting, rather than taking an unknown risk, is the most cautious option for both mother and baby. This is why many physicians and clinics prefer not to perform aesthetic procedures during pregnancy and breastfeeding.

The skin also changes during pregnancy: because of hormones, pigmentation, visible blood vessels, swelling and sensitivity may increase. The risk of side effects and the predictability of the result may also be different for procedures done in this period.

Which procedures are usually postponed?

For detailed information on each of these procedures, see the articles “Botulinum Toxin”, “Hyaluronic Acid Filler” and “Chemical Peels”.

If you had an aesthetic procedure before you knew you were pregnant, do not panic. Tell the physician who performed the procedure and the obstetrician-gynaecologist who is following your pregnancy; finding out which procedure was done, when, and with which product will help with the assessment.

Skin care steps that are usually considered acceptable

During pregnancy and breastfeeding, keeping skin care simple is enough for most people. The steps below are usually considered acceptable; still, you can ask your physician for advice when choosing products.

• Sun protection: choosing a broad-spectrum sunscreen, a hat and shade. Some physicians recommend products with mineral filters (containing zinc oxide or titanium dioxide) in this period.
• Gentle cleansing: a non-irritating, fragrance-free cleanser
• Moisturising: simple, fragrance-free moisturisers for dryness and itching
• Trying new products few at a time and one by one: the skin may be more sensitive in pregnancy.

Evidence that the creams used for the stretch marks common in pregnancy prevent stretch marks from forming is limited. Moisturising can help with itching and dryness; however, it should not be expected to prevent stretch marks.

Ingredients you should discuss with your physician

Some skin care and treatment ingredients are generally not recommended in pregnancy or should be used with caution. Show your physician the ingredients of the products you use; do not start a product on your own, and do not stop a prescription treatment on your own.

• Retinoids: medicines derived from vitamin A that are taken by mouth, such as isotretinoin, can cause serious birth defects and must never be used in pregnancy; people taking these medicines need to use contraception. Retinoids in cream form (including retinol) are also among the ingredients that are usually recommended to be stopped in pregnancy.
• High-strength salicylic acid: it is recommended to avoid high-concentration products applied to large areas, such as peels. The use of wash products containing a low concentration should be discussed with your physician.
• Hydroquinone: because this substance, used to treat pigment spots, can be absorbed through the skin to a relatively large extent, it is generally not recommended in pregnancy and breastfeeding.
• Prescription creams and medicines taken by mouth: some medicines used for acne, rosacea and pigment spots are not suitable in pregnancy; changes should only be made on a physician’s advice.
• Herbal and “natural” products: being “natural” does not mean being safe in pregnancy; essential oils and herbal blends should also be discussed with your physician.

For problems such as acne or rosacea in pregnancy, your physician may suggest options considered more suitable for use in this period. Which option is suitable varies with the person and the stage of pregnancy.

Melasma in pregnancy (the “mask of pregnancy”)

Melasma consists of brown patches that appear on the face, especially on the forehead, cheeks and upper lip. It is common in pregnancy because of hormonal changes and is also popularly known as the “mask of pregnancy”. Sunlight makes the patches markedly worse.

In some people, melasma that appears in pregnancy may fade on its own in the months after giving birth; in others it persists. The basic approach in this period is regular and careful sun protection. Treatments such as lightening creams, peels and lasers are usually left until after pregnancy and breastfeeding. For details, see the article “Dark Spots and Melasma”.

During breastfeeding

During breastfeeding, safety data for aesthetic procedures and some products are also limited. Whether a substance passes into breast milk and whether it affects the baby is often unknown. For this reason, many physicians recommend leaving procedures such as injections, lasers and peels until after breastfeeding.

If you apply a cream or product to the breast area while breastfeeding, remember that it may come into contact with the baby’s mouth. Ask your physician or the paediatrician who is following your baby about the products and medicines you use.

If there is a chance you may be pregnant

Before any aesthetic procedure, your physician should ask whether there is a chance you may be pregnant, whether you are planning a pregnancy or whether you are breastfeeding. Even if you are not asked, share this information yourself. If you are planning a pregnancy, it is helpful to discuss the timing of procedures and the products you use with your physician in advance.

For what to look for when choosing a clinic and physician for a safe procedure, you can use the article “A 10-Point Safety Checklist for Choosing a Clinic and Physician for Medical Aesthetics”.