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A review of the safety of cosmetic procedures during pregnancy and lactation



The safety of cosmetic procedures in patients who are pregnant and/or lactating is a complex clinical question surrounded by uncertainty. Our objective is to consolidate data on the safety of commonly requested cosmetic procedures during pregnancy and lactation after a systematic review of the current literature to guide evidence-based care in the future. A systematic search of the PubMed database was conducted for articles on cosmetic procedures during pregnancy and lactation. Due to a lack of controlled trials, case reports and series were considered. Minor procedures such as shave, punch, snipping, and electrocautery are considered safe. With respect to chemical peels, glycolic and lactic acid peels are deemed safe; however, trichloracetic and salicylic acid peels should be avoided or used with caution. Although safety data on botulinum toxin A is insufficient, the procedure may be safe because systemic absorption and placental transfer are negligible. Sclerotherapy can be safe during pregnancy but must be avoided during the first trimester and after week 36 of the pregnancy. Laser and light therapies have been considered generally safe for patients with granulomatous conditions and condylomata. Epilation should be limited to waxing, shaving, and topical treatments instead of permanent procedures. In patients who are lactating, most therapies discussed above are safe but fat transfer, sclerotherapy, and tumescent liposuction are not recommended. Better evidence is needed to make concrete recommendations on the safety of cosmetic therapy during pregnancy and lactation but preliminary evidence suggests excellent safety profiles for many commonly requested cosmetic procedures.
A review of the safety of cosmetic procedures during pregnancy
and lactation
M.K. Trivedi, BS, BA
, G. Kroumpouzos, MD, PhD
, J.E. Murase, MD
Department of Dermatology, University of California San Francisco, San Francisco, California
University of Michigan Medical School, Ann Arbor, Michigan
Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
Department of Dermatology, Palo Alto Medical Foundation, Mountain View, California
abstractarticle info
Article history:
Received 30 November 2016
Received in revised form 21 January 2017
Accepted 21 January 2017
Available online xxxx
The safety of cosmetic procedures in patients who are pregnant and/or lactating is a complex clinical ques-
tion surrounded by uncertainty. Our objective is to consolidate data on the safety of commonly requested
cosmetic procedures during pregnancy and lactation after a systematic review of the current literature to
guide evidence-basedcare in the future. A systematicsearch of the PubMed database was conductedfor ar-
ticles on cosmetic procedures duringpregnancy and lactation. Due to a lack of controlled trials, case reports
and series were considered. Minor procedures suchas shave, punch, snipping, and electrocautery are con-
sidered safe. With respect to chemical peels, glycolic and lactic acid peels are deemed safe; however,
trichloracetic and salicylic acid peels should be avoided or used with caution. Although safety data on bot-
ulinum toxin A is insufcient, the procedure may be safe because systemic absorption and placental trans-
fer are negligible. Sclerotherapy can be safe during pregnancy but must be avoided during the rst
trimester and after week 36 of the pregnancy. Laser and light therapies have been considered generally
safe for patients with granulomatous conditions and condylomata. Epilation should be limited to waxing,
shaving, and topical treatments instead of permanent procedures. In patients who are lactating,most ther-
apies discussed above are safe but fat transfer, sclerotherapy, and tumescent liposuction are not recom-
mended. Better evidence is needed to make concrete recommendations on the safety of cosmetic
therapy during pregnancy and lactation but preliminary evidence suggests excellent safety proles for
many commonly requested cosmetic procedures.
© 2017 Women'sDermatologic Society. Published by ElsevierInc. This is an open access articleunder the CC
BY-NC-ND license (
The safety of cosmetic procedures in patients who are pregnant
and/or lactating is surrounded by uncertainty. The population of
women who are pregnant constitutes a signicant proportion of
patients who undergo cosmetic procedures because they often
experience reversible and sometimes irreversible cosmetic changes
during pregnancy. Dermatologists and other practitioners often
defer cosmetic treatment until the postpartum period due to the
lack of controlled data. (See Table 1.)
There is some consensus on the general principles with regard to
cosmetic procedures during pregnancy. Patient counseling is essen-
tial because patients should be made aware of all reported and theo-
retical risks that are associated with cosmetic procedures during
pregnancy. A thorough discussion also should include the current
lack of evidence on the safety of many of these procedures.
Non-essential surgical procedures should be deferred until at least
the second trimester of the pregnancy. The left lateral decubitus posi-
tion is the recommended positioning during surgery because it en-
sures optimum dynamics of the blood circulation. Safe hemostasis
during surgery can be achieved with either radiation surgery or
electrocoagulation but care should be taken to minimize patient ex-
posure to smoke during these procedures. Patients who are pregnant
are generally recommended to avoid the application of certain cos-
metic topical agents with unclear safety data including tazarotene
International Journal of Women's Dermatology xxx (2017) xxxxxx
Corresponding Author.
E-mail address: (M.K. Trivedi).
2352-6475/© 2017 Women's Dermatologic Society. Published by Elsevier Inc. This is an open access article under the CCBY-NC-ND license(
Contents lists available at ScienceDirect
International Journal of Women's Dermatology
Please cite this article as: Trivedi MK, et al, A review of the safety of cosmetic procedures during pregnancy and lactation, (2017), http://
and hydroquinone. The treatment of physiologic gestational changes
that may rebound during gestation and improve postpartum such as
melasma, hypertrichosis, and striae is not recommended (Lee et al.,
We attempted to consolidate data on the safety of commonly re-
quested cosmetic procedures in the population of pregnant and lac-
tating women after a systematic review of the current literature to
update the existing knowledge about the subject matter and guide
evidence-based care in the future. A systematic review of the current
literature was conducted with use of the PubMed database. Search
terms included local anesthetics, chemical peels, botulinum toxin,
llers, laser and light therapy, pregnancy, and safety, which were in-
cluded in several separate searches. The term epidural was excluded
and a lter for human-only studies was applied. In combination, a
total of 330 results were manually sorted to exclude articles that
were unrelated to the topic. A total of 25 articles were extracted
and reviewed. Due to a lack of controlled trials, individual case re-
ports and commentaries were included in the review. Prior review
literature including papers by Goldberg and Maloney (2013) and
Lee et al. (2013) was also referenced.
Local and topical anesthetic drugs
Injectable anesthetic drugs
The main concerns when using injectable anesthetic drugs in pa-
tients who are pregnant include the amount of placental transfer and
possibility of teratogenicity (Richards and Stasko, 2002). Heinonen
et al. (1977) demonstrated the relative safety of lidocaine, benzo-
caine, propoxycaine, and tetracaine use during the rst trimester of
Table 1
Key recommendations on the safety of cosmetic procedure on the basis of current evidence
Cosmetic Procedure/Related
Key Recommendations Key Studies
Injectable Anesthetic Drugs Lidocaine: Pregnancy category B, considered relatively safe to use during pregnancy
at doses used in dermatological procedures.
Benzocaine, bupivacaine, and mepivacaine, tetracaine: Pregnancy category C,
no studies to adequately dene risk during pregnancy.
Heinonen et al., 1977
Hagai et al., 2015
Moore, 1998
Richards and Stasko, 2002
Topical Anesthetic Drugs 2.5% lidocaine/prilocaine: Pregnancy category B, considered safe. Avoid ocular surfaces.
Benzocaine: Pregnancy category C, methemoglobinemia in infants.
Tetracaine: Pregnancy category C, preferred for eyelid/periocular procedures.
Guay, 2009
Lee et al., 2013 (Review)
Minor Procedures Snipping, shaving, liquid nitrogen therapy, removal of hemagiomas with electrocautery
or radiation surgery: Considered safe, minimal blood loss/local anesthesia.
Chemical Peels Glycolic acid peels: Relatively safe, limited dermal penetration.
Lactic acid peels: Reports of safe use for gestational acne, limited dermal penetration.
Salicyclic acid peels: Pregnancy category C, signicant dermal penetration, limit use
to small areas of coverage.
Jessners solution and TCA peel: Use with caution, Jessners contains salicylic acid,
TCA in maternal urine correlated with fetal growth retardation although TCA used
to treat genital condylomata in pregnancy safely.
Andersen, 1998
Lee et al., 2013
Bozzo et al., 2011
James et al., 2008
Zhou et al., 2012
Schwartz et al., 1988
Neuromodulators Botulinum toxin A: Multiple case reports suggest no harm to fetus in either cosmetic
botulinum toxin or other medical indications (migraine prophylaxis, achalasia,
cervical dystonia) in majority of patients.
Miscarriages reported in two patients in two individual reports but relation to
toxin injection unclear.
High doses of onabotulinum toxin (N600 U) associated with systemic weakness.
Not enough evidence for concrete recommendations. If cosmetic botulinum toxin
is pursued during pregnancy, consent forms should list pregnancy as contraindication.
Tan et al., 2013
Hooft et al., 2015
Wataganara et al., 2009
Robinson and Grogan, 2014
Bodkin et al., 2005
Newman et al., 2004
de Oliveira Monteiro, 2006
Morgan et al., 2006
Fillers No concrete evidence and no cases that report use of llers during pregnancy.
Denitive recommendations cannot be made at this time.
Sclerotherapy First trimester and after week 36: Absolute contraindications to therapy.
One study and several case reports demonstrated no adverse fetal outcomes
when sclerotherapy was pursued during pregnancy.
Rabe and Pannier, 2010
Abramowtiz, 1973
Reich-Schupke et al., 2012
Laser and Light Therapy No concrete recommendations can be made for use of lasers for cosmetic procedures.
Carbon dioxide and neodymium-doped YAG lasers have been used safely to treat
genital condylomata in pregnant patients in several reports.
Holmium: YAG and pulse-dye lasers have been used successfully and safely to
treat urolithiasis during pregnancy.
Treatment of pyogenic granulomas with laser therapy has been pursued safely.
Schwartz et al., 1988
Adelson et al., 1990 Woźniak et al., 1995
Gay et al., 2003
Buzalov and Khristakieva, 1994
Adanur et al., 2014
Carlan et al., 1995
Lee et al., 2013
Epilation Permanent hair removal is not recommended during pregnancy because of the
lack of safety data. Patients are advised to wax, shave, and use depilatory creams.
CO2, xxx; N/A, not available; TCA, tricholoracetic acid; YAG, yttrium aluminum garnet.
2MK. Trivedi et al. / International Journal of Women's Dermatology xxx (2017) xxxxxx
Please cite this article as: Trivedi MK, et al, A review of the safety of cosmetic procedures during pregnancy and lactation, (2017), http://
a pregnancy in a study that reported no increase in the rate of birth
anomalies for 293 women. However, it should be noted that fetuses
who were exposed to mepivacaine during the rst trimester had
twice the risk of congenital abnormalities compared with control
subjects (Heinonen et al., 1977). Hagai et al. (2015) evaluated the
rate of major anomalies in a 6-year comparative observational
study of 210 patients who were exposed to dental local anesthetic
drugs and of whom half of the patient group was exposed during
the rst trimester of the pregnancy. The rate of major congenital
malformations in the group of exposed patients was 4.8% versus
3.3% in the control population (794 patients) but the difference was
not statistically signicant (Hagai et al., 2015).
Lidocaine is a category B drug with a long history of uneventful
use during pregnancy because the fetus can metabolize lidocaine
that crosses the placental barrier (Kuhnert et al., 1979, 1986). The
major concerns of lidocaine use during pregnancy are the accidental
arterial injection and high-dose use of the agent as these two scenar-
ios can result in an increased risk of fetal cardiac and central nervous
system toxicity. Although lidocaine is found in llers and used in
many dermatology surgical procedures, the doses that are employed
are far lower than the recommended maximum subcutaneous dos-
age of 4.5 mg/kg or 300 mg in the United States (Lee et al., 2013).
Fayans et al. (2010) noted that vasoconstrictor use can reduce the
toxicity of local anesthetic drugs by localizing the agent to the area
of delivery and is recommended. Concerns arise from the serious
risk of uterine artery spasms with the administration of increased
doses of epinephrine. However, the doses that are used in dermato-
logic surgeries are relatively low and have not been causally associat-
ed with this side effect (Richards and Stasko, 2002).
Moore conducted a large study in 1998 of local anesthetic drugs in
patients who were pregnant and underwent dental p rocedures. The re-
sults of this study labeled bupivacaine and mepivacaine as category C
drugs because of concerns of fetal bradycardia and preterm labor in
the case of mepivacaine use (Moore, 1998; Richards and Stasko, 2002).
Topical anesthetic drugs
The most common topical agents that are used during dermato-
logic procedures include benzocaine, tetracaine, and lidocaine 2.5%/
prilocaine 2.5% cream. Benzocaine has been labeled as a category C
drug because of the risk of methemoglobinemia in the infant. This is
supported by a study of 242 cases of methemoglobinemia that were
linked to the use of a local anesthetic drug (Guay, 2009; Lee et al.,
2013). Methemoglobinemia is also of concern when used in high
doses of prilocaine. However, 2.5% lidocaine or prilocaine is consid-
ered safe as long as ocular surfaces are avoided because both agents
are classied as a pregnancy category B drug (Lee et al., 2013). Tetra-
caine is classied as a pregnancy category C drug but is the preferred
local anesthetic drug for periocular and eyelid procedures because of
its lower risk of corneal irritation (Lee et al., 2013).
Minor procedures
The most common minor procedures include skin tag removal
with snipping, shaving, or cryotherapy, removal of other benign le-
sions such as seborrheic keratoses and dermatosis papulosa nigra,
shave or punch removal of nevi, and removal of hemangiomas with
electrocautery or radiation surgery. These procedures have a long
safety record in patients who are pregnant.
Chemical peeling
The most common chemical peels include procedures with
glycolic acid, lactic acid, salicylic acid, Jessner, and tricholoracetic
acid. There is also a lack of safety data with regard to this modality.
Glycolic acid peels
Peels with glycolic acid at concentrations that range from 30% to
70% induce epidermolysis and desquamation (Fabbrocini et al.,
2009). Although there are insufcient safety data available, these
peels are generally considered safe because of negligible dermal
penetration (Andersen, 1998).
Lactic acid peels
Lactic acid peels induce keratolysis. Lactic acid 2% has been anec-
dotally used to treat gestational acne with no reported fetal risks and
has shown negligible dermal penetration.
Salicylic acid peels
Salicyclic acid, which is classied as a pregnancy category C drug,
is a beta-hydroxy acid with comedolytic and keratolytic activity
(Fabbrocini et al., 2009). This acid can have signicant dermal pene-
tration of up to 25% if large areas are treated or when it is applied
under occlusion (Lee et al., 2013). However, the reproductive out-
comes of patients who are pregnant and treated with low doses of
oral aspirin were studied and no signicant effects on the health of
the fetus were reported (Bozzo et al., 2011; James et al., 2008). It is
recommended that if salicylic acid is used to treat patients who are
pregnant, the area of coverage should be limited.
Other peels
A Jessner peel is a combination of resorcinol (i.e., a skin-lightening
agent), salicylic acid, and lacticacid. Again, there is a lack of reports on
Jessner peels duringpregnancy. Sincethis peel contains salicylic acid,
it should beused cautiously because of the risks mentioned previous-
ly. Trichloroacetic acid (TCA) peels should also be used with caution
because of the possible dermal penetration as this agent can be
absorbed through ocular and oral mucosal surfaces (Lee et al.,
2013). Zhou et al. (2012) correlated high levels of maternal urinary
TCA levels with low birth weight in a cohort of 398 women, which
suggests that this compound may contribute to fetal growth retarda-
tion. However, TCA has been safely used to treat genital condylomata
in patients who are pregnant (Lee et al., 2013; Schwartz et al., 1988).
Botulinum toxin type A has both cosmetic and medical applica-
tions (Tan et al., 2013). Current data suggest but not entirely conrm
that the toxin does not attain signicant systemic concentrations if
correctly injected intramuscularly or intradermally. Furthermore,
the size of the toxin molecule makes it unlikely to cross the placental
barrier (Tan et al., 2013). There are no clinical trials on the effects of
cosmetic botulinum toxin use in patients who are pregnant. Howev-
er, there are a number of case reports in which the toxin has been
used for various medical procedures in patients who are pregnant
without adverse outcomes to the fetus. Two recent case reports dem-
onstrated the safety of botulinum toxin A to treat achalasia in women
who were pregnant.
Hooft et al. (2015) reported the administration of an
intrasphincteric injection of botulinum toxin A at 14 weeks of gesta-
tion with no adverse fetal outcomes and otherwise healthy term de-
liveries. Wataganara et al. (2009) reported a similar case where
botulinum toxin A was injected at 33 weeks of gestation to treat
persistent achalasia and subsequent malnutrition. Again, no adverse
outcomes to the fetus were reported and noevidence of infantneuro-
muscular blockade was noted at 5 days postpartum (Wataganara
et al., 2009). Robinson and Grogan (2014) reported on the safe ad-
ministration of onabotulinum toxin A at 18 weeks of gestation to
treat migraine prophylaxis in a woman with refractory migraine
headaches. No adverse effects were reported in the infant who was
followed for 6.5 years (Robinson and Grogan, 2014).
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Bodkin et al. (2005) reported two cases of inadvertent botulinum
toxin A injection during the rst trimester of pregnancy in patients
who were treated for cervical dystonia. One patient who had a prior
history of miscarriages had a miscarriage at 10 weeks at which time
she was noted to have a twin pregnancy (Bodkin et al., 2005). Newman
et al. (2004) reported the case of a woman with severe cervical dysto-
nia who was treated with botulinum toxin injection throughout four
consecutive pregnancies. No complications were reported with the de-
livery or health of any of her four children (Newman et al., 2004).
Two cases of cosmetic use of botulinum toxin were reported by de
OliveiraMonteiro (2006) in two women at6 and 5 weeks of gestation
with no fetal adverse events. A 2006 survey of 900 physicians that
was conducted by Morgan et al. (2006) ascertained that 12 physi-
cians had experiences with incidental botulinum toxin injection in
16 patients who were pregnant. Only one patient with a history of
spontaneous abortions experienced a miscarriage after injection of
botulinum toxin (Morgan et al., 2006). There is concern that high
doses (N600 U) of onabotulinum toxin is associated with cases of sys-
temic weakness (Lee et al., 2013). However, doses that are used in
cosmetic procedures are usually less than 100 units.
Although the above cases demonstrate the general safety of botu-
linum toxin A, there is still insufcient data to make concrete recom-
mendations on whether cosmetic botulinum toxin procedures
should be conducted in women who are pregnant. However, it
should be noted that if patients who are pregnant are inadvertently
injectedwith botulinum toxin duringthe rst trimester of pregnancy,
efforts should be made by theprovider to alleviate patient anxiety be-
cause of the current lack of evidence on adverse outcomes on the
fetus in published case literature. If patients who are pregnant re-
quest a cosmetic botulinum toxin procedure, consent forms should
state pregnancy as a contraindication to cosmetic botulinum toxin A
There are 21 llers that have been approved by the U.S. Food and
Drug Administration including collagen, hyaluronic acid, calcium hy-
droxylapatite, and poly-L-lactic acid (Chacon, 2015). There are no re-
ported safety data on the use of cosmetic llers during pregnancy.
Adverse events that are associated with the use of llers in the gener-
al population include most commonly injection site reactions and
rarely delayed onset foreign body granulomas, nodule formation,
vascular compromise, hypersensitivity reactions, and cellulitis (Lolis
et al., 2015). Because of the lack of safety evidence in patients who
are pregnant, recommendations on the use of llers in this popula-
tion cannot be denitive. Steps should be taken to avoid the adverse
events as discussed previously in any patient population. The injector
should consider the potential risks from inadvertent arterial injection
of lidocaine mixed with the ller.
Varicose veins that develop during pregnancy have a high proba-
bility of spontaneous improvement postpartum. Therefore, it is advis-
able to wait 6 to 12 months after pregnancy prior to pursuing this
treatment. There are very limited data on the safety of sclerosing so-
lutions in women who are pregnant. However, these solutions can
cross the placenta and sclerotherapy is an absolute contraindication
in the rst trimester and after week 36 of a pregnancy (Rabe and
Pannier, 2010). In 1973, Abramovitz demonstrated that there was
no difference in pregnancy outcomes between 45 patients who
were treated with sclerotherapy compared with 56 control patients
(Abramowtiz, 1973). In 2015, Reich-Schupke and colleagues demon-
strated that there was no increased riskof adverse fetal outcomes and
evidenced their ndings with several case reports in which common
sclerotherapy agents were used inadvertently during pregnancy
(Reich-Schupke et al., 2012).
Laser and light therapy
The cosmetic use of lasers hasnot been studied in women whoare
pregnant.However, lasershave been used safelyto treat medical con-
ditions in patients who are pregnant. The safety of carbon dioxide la-
sers in the treatment of genital condylomata in patients who are
pregnant is supported by several studies (Adelson et al., 1990; Gay
et al., 2003; Schwartz et al., 1988; Woźniak et al., 1995).
Neodymium-doped yttrium aluminum garnet lasers have also been
safely used to treat genital condylomata in patients who are pregnant
(Buzalov and Khristakieva, 1994). Laser therapy for use in lithotripsy
in women who are pregnant has also been safely pursued. Adanur
et al. (2014) demonstrated the safety of a holmium yttrium alumi-
num garnetlaser to successfully and safely treat ureteral stones in dif-
ferent locations. Carlan et al. (1995) published a case report in which
pulsed dye laser was used to successfully treat symptomatic urolith-
iasis in a woman who was 20 weeks pregnant. Several other case re-
ports also suggest that acne and pyogenic granulomas have been
safety treated with laser therapy during pregnancy (Lee et al., 2013).
Laser therapy is relatively safe in patients who are pregnant when
employed for the treatment of various medical conditions. However,
laser and intense pulsed light therapy are not indicated for cosmetic
procedures during pregnancy due to the lack of safety data.
Permanent hair removal by means of laser therapy or electrolysis
is generally not recommended during pregnancy due to the lack of
safety data. There is a theoretical concern about electrolysis because
amniotic uid is a conductor of galvanic current. Patients are recom-
mended to treat excess hair growth with waxing, shaving, and depil-
atory creams during pregnancy.
Patients who are lactating
There are very few studies and reports on the safety of cosmetic
procedures in patients who are lactating. The main concern of pursu-
ing any modality in patients who are lactating is the systemic absorp-
tion of agents and subsequent incorporation into breast milk, which
can affect neonatal growth and development. Lee et al. (2013) sum-
marized that most cosmetic procedures such as botulinum toxin A,
chemical peeling, and lasers are safe to use during lactation since
there is low concern for signicant systemic absorption of any of
the agents used in these procedures. Procedures which necessitate
the redistribution or removal of fat such as fat transfer or tumescent
liposuction are not recommended. Sclerotherapy should also be
avoided during lactation (Lee et al., 2013). Generally, hypertonic sa-
line solutions that are used in sclerotherapy are safe but there are
no data on whether other sclerosing solutions are excreted in breast
milk, which has led to the recommendation to avoid this therapy
while breastfeeding. However, anecdotally, some women have pur-
sued this therapy and continued breastfeeding with pumping and
discarding the breast milk in the rst 48 hours after treatment. Nev-
ertheless, there are no reportson the outcomes and/or complications
or success rates of this methodology. Therefore, the safety of this pro-
cedure during lactation cannot be meaningfully commented on at
this time.
The available evidence indicates promising safety proles for
many commonly used cosmetic procedures. Although unnecessary
4MK. Trivedi et al. / International Journal of Women's Dermatology xxx (2017) xxxxxx
Please cite this article as: Trivedi MK, et al, A review of the safety of cosmetic procedures during pregnancy and lactation, (2017), http://
surgical procedures should be avoideduntil thesecond trimester of a
pregnancy, judicious use of lidocaine with epinephrine and topical
prilocaine/lidocaine preparations is safe in patients who are preg-
nant. Minor procedures such as supercial punch and shave biopsies
or lesion removal are deemed safe because of their minimally inva-
sive nature and long safety record. Glycolic acid and lactic acid peels
are most likely safe to use due to the limited dermal penetration
but solutions that contain salicylic acid should be used with caution
due to the higherrates of absorption.Trichloroacetic acid has been as-
sociated with low infant birth weight and these peels should be used
with caution, especially because of the risk of dermal penetration.
Botulinum toxin A has been used safely in patients who are pregnant
for various medical conditions and cosmetic purposes as evidenced
by multiple case reports and series. There is little evidence to support
the safety of llers during pregnancy. Sclerotherapy should not be
considered hastily in patients who are pregnant since varicose veins
may improve postpartum. Laser and light therapy seems to be safe
for the treatment of genital condylomata and ureteral calculi in pa-
tients who are pregnant. However, the lack of safety evidence in a
cosmetic context prevents a concrete recommendation on laser and
light therapy during pregnancy. Because excess body hair growth
may resolve postpartum, temporary epilation treatments are recom-
mended during pregnancy.
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Please cite this article as: Trivedi MK, et al, A review of the safety of cosmetic procedures during pregnancy and lactation, (2017), http://
... 1,2 Although lasers are used to treat some diseases in non-pregnant patients, 3 selective laser therapy during pregnancy is generally not recommended by health care professionals and is therefore recommended to be performed after delivery. 4 Conditions such as acne, granuloma gravidarum, other vascular lesions, condyloma, keloids, verrucae, hypertrichosis, hyperpigmentation or even other cosmetic cases can benefit from laser treatment during pregnancy. 5,6 Due to the lack of standard guidelines and a misunderstanding of the potential risks to the fetus, the use of lasers is postponed as much as possible during pregnancy until after delivery. ...
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Introduction: Currently, lasers are used to treat many diseases and their complications. However, the use of lasers in pregnant patients is still controversial. Methods: In this review, the application of lasers in the fields of urology, surgery, obstetrics, dermatology, and musculoskeletal disorders is evaluated. The following keywords were used to search through PubMed, Google Scholar, and Scopus: pregnancy, laser, urolithiasis, endovenous laser ablation (EVLA) or treatment, leg edema, varicose vein, venous insufficiencies, hair removal, pigmentation, telangiectasia, vascular lesions, Q switch laser, diode laser, holmium, holmium-YAG laser, erbium laser and Pulsed dye laser, low-level laser therapy, high-intensity laser therapy, pain, musculoskeletal disorders, twin to twin transfusion syndrome (TTTS), amnioreduction, and safety. Results: Totally, 147 articles were found, and their abstracts were evaluated; out of 53 articles extracted, 14 articles were about dermatology, 24 articles were about urology, 12 articles were about obstetrics and gynecology, 10 articles were about musculoskeletal disorders and three articles were related to surgery. Conclusion: Laser therapy can be used as a safe treatment for urolithiasis, skin diseases, TTTS and varicose veins of the lower extremities. However, the use of laser therapy for musculoskeletal disorders during pregnancy is not recommended due to lack of evidence, and also we cannot recommend endovenous ablation.
... However, there are some reports of safely laser and phototherapy use during gestational period for several dermatological and other medical conditions. 10,47 Highlights Currently, there is no evidence to recommend laser or phototherapy for LE management during pregnancy. ...
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Lupus erythematosus is an autoimmune disease that often affects the skin. Cutaneous manifestations are generally subdivided into different subtypes, including acute, subacute and chronic courses. Management of lupus erythematosus cutaneous manifestations during pregnancy remains a clinical challenge until nowadays. To date, no recommendations have been published specifically for the treatment of this condition in pregnant women, so therapeutic strategies are mainly based on recommendations for general population and other rheumatologic and dermatologic diseases during pregnancy. This challenge is compounded by a lack of evidence‐based studies, as clinical trials in pregnant women are considered unethical in many circumstances, so data are often extrapolated from low‐evidence sources. The aim of this article consists in review currently evidence of treatment of lupus erythematosus cutaneous lesion in pregnant women. This article is protected by copyright. All rights reserved.
... Due to the paucity of data and unpredictability of complications and their management, fillers are deemed inadvisable during pregnancy or lactation. 21 Should a patient fall pregnant shortly after treatment, no specific action other than routine follow-up is needed. ...
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Izolda Heydenrych,1 Koenraad De Boulle,2 Krishan Mohan Kapoor,3 Dario Bertossi4 1Cape Town Cosmetic Dermatology Centre, Century City, Cape Town, South Africa; 2Aalst Dermatology Clinic, Aalst, Belgium; 3Department of Plastic Surgery, Fortis Hospital, Mohali, India; 4Maxillofacial Department, University of Verona, Verona, ItalyCorrespondence: Izolda HeydenrychCape Town Cosmetic Dermatology Centre, Central Park on Esplanade, Postnet Suite 136, Century City, Cape Town, 7442, South AfricaTel +27 21 552 7220Fax +27 21 552 7229Email izoldaheydenrych@gmail.comAbstract: Dermal filler treatments require constant reassessment for improving and safeguarding the rapidly evolving aesthetic field. Suboptimal injection technique, patient selection and product knowledge have touted a concerning increase in filler complications, with new challenges such as the COVID-19 pandemic leading to new paradigms in the understanding, prevention, diagnosis and treatment of complications. The updated 10-point plan has been developed to curtail complications through consideration of causative factors, categorized as patient, product, and procedure-related. Patient-related factors include a preprocedural consultation with careful elucidation of skin conditions (acne, rosacea, dermatitis), systemic disease (allergies, autoimmune disease, underlying bacterial and viral disease (herpes simplex virus, COVID-19 infection), medications (antineoplastic drugs, recreational drugs) and previous cosmetic procedures (including fillers and energy-based devices). Patient assessment should include standardized photography and also evaluate the role of social media, ethnicity, gender, generational, and LGBTQ+ needs. Specified informed consent for both adverse events and their treatment is essential due to the increase in vascular complications, including the risk of blindness. Product-related factors include the powerful advantage of reversibility when using hyaluronic acid (HA) products. Product characteristics such as molecular weight and filler degradation should be understood. Product layering over late or minimally degradable fillers is still inadvisable due to the initial filler being teased into reactivity. Procedural factors such as consistent photographic documentation, procedural planning, aseptic non-touch technique (ANTT), knowledge of topographical anatomy and angiosomes, and technical dexterity including pinch anatomy and needle skills are of pivotal importance. The final section is dedicated to algorithms and checklists for managing and treating complications such as allergic hypersensitivity reactions, vascular events, infection, edema and late-onset adverse events (LOAEs). The updated 10-point plan is a methodical strategy aimed at further minimising the risk of dermal filler complications.Keywords: assessment, complications, dermal fillers, prevention, treatment
... (Tablo 1). Gebelik döneminde kozmetik ürünlerin kullanımı sağlık açısından belirsizdir (Trivedi et al., 2017). ...
Conference Paper
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Giriş ve Amaç: Doğum hizmetlerinin niteliğini geliştirebilmek ve kadın odaklı bir sağlık bakımı gerçekleştirmek için doğum ortamında bireyin gizliliğini sağlama, mahremiyete saygı gösterme oldukça önemlidir. Bu çalışma “Doğum Mahremiyeti ve Gizlilik Ölçeği - Childbirth Intimacy and Privacy Scale-CIPS” nin Türkçe’ye uyarlanarak, Türk toplumunda geçerlik ve güvenirliğinin belirlenmesi amacıyla uygulanmıştır. Ölçeğin kadınların doğum hizmetlerinde yaşadıkları mahremiyet deneyimlerini değerlendirme konusunda önemli bir araç olacağı ve mahremiyete yönelik uygulamaların geliştirilmesine katkı sağlayacağı düşünülmüştür. Yöntem: Metadolojik tipte olan araştırmanın evrenini T.C. Sağlık Bakanlığı İzmir Sağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi Ege Doğum Evi ve Kadın Hastalıkları Ek Hizmet Binasında Haziran-Aralık 2018 tarihleri arasında doğum yapan ve çalışmaya dahil edilme kriterlerine uyan 362 kadın oluşturmuştur. Rados ve arkadaşları tarafından 2015 yılında geliştirilen ölçeğin Türkçeye uyarlanabilmesi için Melinda Rados’tan yazılı izin ve Ege Üniversitesi Tıp Fakültesi Dekanlığı Klinik Araştırma Etik Kurulu’ndan izin alınmıştır. Kadınlara, Doğum Mahremiyeti ve Gizlilik Ölçeği’nin Türkçe Formu yüz yüze görüşme yöntemi ile uygulanmıştır. Bulgular: Açıklayıcı Faktör Analizleriyle (AFA) ölçek altı alt boyut altında toplanmış, orijinal faktör yapısı ile benzer sonuçlar elde edilmiştir. Ölçeğin tümü için elde edilen iç tutarlık katsayısı 0.87 olarak belirlenmiş, çok iyi düzeyde güvenilir olduğu sonucu ortaya çıkmıştır. Ölçeğin korelasyon katsayıları -.046 ile .722 arasında değişmektedir. Sonuç ve öneriler: Yapılan analizler, Doğum Mahremiyeti ve Gizlilik Ölçeği’nin Türkçe formunun geçerli ve güvenilir bir ölçme aracı olduğunu göstermektedir. Elde edilen sonuçların özgün ölçek ile benzer özellikler göstermesi ve her bir maddenin konuyla olan ilişkisi göz önüne alınarak ölçekten madde çıkarılmamıştır. Anahtar Sözcükler: Mahremiyet, Doğum, Ölçek, Geçerlik ve Güvenirlik
Objective Pregnants and puerperas show different perceptions of their body image and appearance, so authors investigated their perceptions related to pregnancy and puerperium, evaluating their views on cosmetic surgery, by a cross-sectional study. Materials and Methods 5-item questionnaires were administrated to women at first pregnancy and puerperas. Patients were submitted also to Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Body Image Inventory (BII) analysis, indicating the level of anxiety, depression and body dissatisfaction for somatic changes during pregnancy and after childbirth. Results 186 healthy women, aged between 25–35 years, equally divided in pregnancy and puerperium, were compared in terms of body image, with no significant difference between groups. Analyzing the item “cosmetic surgery is required after all pregnancies”, there was a significant difference in puerperas and the item “cosmetic surgery is necessary for postpartum” was the principal. The comparison of BII, BDI, BAI values between pregnants and puerperas showed a significant difference between groups (p<0.00), with higher scores in postpartum patients. Conclusion Body shape and physical dissatisfaction during pregnancy is linked with increased risk of depression in pregnancy and puerperium, pushing women to opt for cosmetic surgery, especially in puerperium.
Purpose of review: This article discusses the many tools available for the treatment of pregnant and postpartum patients with headache. Adequate treatment of headache is an essential part of good prenatal and postnatal care. Recent findings: New therapies such as the calcitonin gene-related peptide monoclonal antibodies, lasmiditan, direct calcitonin gene-related peptide antagonists, and neuromodulation devices are available for the treatment of headache. This article contextualizes these new therapies in practice as they relate to the treatment of migraine in pregnancy and lactation. Summary: Headache is common in pregnancy, and neurologists should be prepared to care for pregnant patients with headache. Preconception counseling is an important part of providing safe care to patients of childbearing potential with headache. Identifying potentially dangerous secondary headache syndromes during pregnancy and the puerperium is also essential. The repertoire of available acute and preventive headache treatments is expanding. It is important to discuss the effectiveness and safety of these therapies in the context of individual patient circumstances during pregnancy and lactation in coordination with the patient's obstetric team.
There is a growing trend for women to delay having children, with a significant number of women postponing motherhood until the third or fourth decade of life. At the same time, these middle-aged women may be more concerned about skin aging and use cosmetic procedures to delay or repair the signs of aging, environmental factors and oxidative stress. It has been suggested that one of these factors, the use of cosmetics and procedures, may affect the reproductive system, although their possible effects have not yet been clearly elucidated. Another crucial factor that needs to be raised in this context is poor sleep, which seems to have an important relationship with both reduced fertility and accelerated skin aging, especially when it is associated with greater oxidative stress and hormonal imbalance. This review aimed to discuss this important triad of sleep, cosmetology, and reproduction, a subject that has received relatively little attention, and, given its potentially wide-ranging implications, one that deserves more frequent and detailed consideration in future studies. Understanding this complex web of interactions could help to provide outcomes that include healthier skin, safety, improved self-esteem, and successful fertility treatments, all of which can directly affect quality of life.
Striae distensae, or stretch marks, are common linear lesions of atrophic skin characterized histologically by epidermal atrophy, absent rete ridges, and alterations in connective tissue architecture. Hormonal excess, mechanical stress, and genetic predisposition are all associated with striae distensae, but their exact pathogenesis remains unknown. Despite a multitude of options, no single treatment has yet proven effective. In this article, the authors describe an up-to-date overview of striae distensae in terms of their etiology, pathophysiology, and therapeutic options. Further research is required to better elucidate their pathophysiology and to develop targeted effective treatments.
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. Achalasia, a rare esophageal motility disorder that may cause malnutrition during pregnancy, can result in fetal and maternal morbidity and mortality. Many medical treatment regimens are contraindicated or not tolerated during pregnancy, and surgery is generally avoided due to potential risks to the fetus. Case Report . Severe, medically refractory achalasia in a 23-year-old pregnant woman that caused malnutrition was successfully managed by administering a botulinum toxin A injection to the lower esophageal sphincter. The injection was performed at approximately 14 weeks’ gestation and the patient reported clinically significant relief from dysphagia. She gained weight and ultimately delivered a healthy baby girl at term, but her symptoms returned a few months postpartum. She underwent a second treatment of botulinum toxin A injection, but it offered only one month of relief. Roughly eight months after delivery, the patient underwent a laparoscopic extended Heller myotomy and Dor fundoplication. The patient resumed a normal diet one week postoperatively, and her baby has had no complications. Conclusion . This is only the second reported case of botulinum toxin A injection being used to treat achalasia in pregnancy. This treatment proved to be a safe temporary alternative without the risks of surgery and anesthesia during pregnancy.
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Objectives: The aim of this study was to assess the safety and effectiveness of ureteroscopy and Holmium: Yttrium-Aluminum-Garnet lithotripsy for the treatment of ureteral stones with different localizations in symptomatic pregnant women. Methods: A retrospective analysis was performed on 19 pregnant patients referred to our center between January 2005 and December 2012 with symptomatic hydronephrosis requiring surgical intervention. 7.5 F and 9.5 F semirigid ureterorenoscopy with Holmium laser lithotripsy was used for treatment in all patients. Complications were stratified according to modified Clavien criteria. Results: The mean age of patients was 25.4 (18-41) years, and the mean gestation duration was 24.8 (7-33) weeks. Six cases (31.5%) had a history of stone. Solitary kidney secondary to previous nephrectomy was observed in 2 patients and 1 patient had a hypoplastic kidney. Abdominal ultrasonography was used as the main diagnostic tool. Mean stone size was 9.2 mm (6-13). The location of the stones was the lower, middle, and upper ureter in 8 (42.1%), 5 (26.3%) and 6 (31.5%) cases, respectively. All stones were fragmented with Holmium laser lithotripsy. Of the 19 patients, 11 (57.8%) required double J stent insertion peroperatively. Intraoperative urological and obstetric complications were not observed. Postoperatively two complications were noted. According to Clavien criteria a complication was level 1, and the other was level 2. Conclusions: For treatment of pregnant women with symptomatic ureteral stones in every location, Holmium laser lithotripsy with a semirigid ureteroscopy can be used as judicious treatment. This approach is effective and safe with an acceptable complication rate.
Injectable fillers were introduced in dermatology as a method for reconstructing facial deformities and restoring the aging face. Although fillers have become a popular option among cosmetic patients, clinical experience has shown that fillers must be used with caution, as complications can occur. This article provides a brief review of the history of filler agents currently available for soft tissue augmentation. Although no single filler is ideal for all patients, indications, and situations, residents should be aware of the properties and characteristics that make each product unique.
Dental treatment and use of local anesthetics during pregnancy generally are considered harmless because of lack of evidence of adverse pregnancy effects. Data on the safety of dental treatment and local anesthetics during pregnancy are scant. Dental care is often a reason for concern both among women and their health care providers. The primary objective of this study was to evaluate the rate of major anomalies after exposure to local anesthetics as part of dental care during pregnancy. The authors performed a prospective, comparative observational study at the Israeli Teratology Information Services between 1999 and 2005. The authors followed 210 pregnancies exposed to dental local anesthetics (112 [53%] in the first trimester) and compared them with 794 pregnancies not exposed to teratogens. The rate of major anomalies was not significantly different between the groups (4.8% versus 3.3%, P = .300). There was no difference in the rate of miscarriages, gestational age at delivery, or birth weight. The most common types of dental treatment were endodontic treatment (43%), tooth extraction (31%), and tooth restoration (21%). Most women (63%) were not exposed to additional medications. Approximately one-half (51%) of the women were not exposed to dental radiography, and 44% were exposed to radiation, mostly bite-wing radiography. This study's results suggest that use of dental local anesthetics, as well as dental treatment during pregnancy, do not represent a major teratogenic risk. There seems to be no reason to prevent pregnant women from receiving dental treatment and local anesthetics during pregnancy. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.
Cosmetic procedures are growing in popularity and are associated with unique risks. Considering potential complications and prioritizing patient safety will help practitioners improve outcomes of elective procedures. In part II of this continuing medical education article, we provide a comprehensive review of patient safety in cosmetic procedures, including medical and legal issues surrounding the supervision and training of physician extenders.
Botulinum toxin (btx) received U.S. Food and Drug Administration approval for migraine treatment in 2010 with a pregnancy category C. There are minimal reports of its usage in pregnancy with no adverse effects; however, there are no reported cases of usage in a known pregnancy for the successful treatment of migraines. We present a patient with a history of 4 to 5 migraines per week refractory to treatment who was subsequently controlled with btx. She initially stopped injections, however, her migraines increased to 5 to 6 per week while using standard medications for migraine treatment in pregnancy. She requested btx while 18 weeks pregnant after which she had full resolution of her migraines. She gave birth to a healthy full-term girl with no neuromuscular or developmental concerns spanning the first 6.5 years of her life, the longest reported follow-up of an infant whose mother received btx while pregnant. This is the first reported case in the literature of a patient requesting btx injections for migraine treatment while knowingly pregnant. The foundation of a btx pregnancy registry, similar to those used for antiepileptics, would be greatly beneficial to gather more safety data in regard to its further usage during pregnancy.
Question: My patient received 62 units of botulinum toxin type A (BTX-A) for facial lines. Two weeks later, she found out that she was pregnant. Will this cause any harm to her fetus? Answer: Botulinum toxin is not expected to be present in systemic circulation following proper intramuscular or intradermal injection. Moreover, BTX-A, which has a high molecular weight, does not appear to cross the placenta. From the 38 pregnancies reported in the literature, including women who had botulism poisoning during pregnancy, exposure to BTX-A does not appear to increase the risk of adverse outcome in the fetus.
Safety of cosmetic procedures in pregnant women has not been extensively studied. Maternal and fetal health risks are important to consider in any procedure performed. With the increasing popularity of cosmetic procedures, dermatologic surgeons will be faced with scenarios necessitating knowledge regarding the safety of such procedures during pregnancy. Furthermore, dermatologic surgeons may inadvertently perform cosmetic procedures during the first trimester, before the patient is aware of the pregnancy. To investigate the safety of cosmetic procedures during pregnancy and the postpartum period. A literature search of PubMed and Google Scholar was conducted of all English-language articles published from 1960 through 2012. Definitive recommendations on the safety of procedures such as chemical peels, injectables, fillers, and most laser therapies during pregnancy cannot be made. The safety of onabotulinum toxin usage is well documented in the neurology literature, although isolated events of miscarriage have been reported with high doses of toxin in women with a previous history of miscarriage. Carbon dioxide laser therapy for genital condylomas has considerable evidence supporting its safety during pregnancy. There is a lack of controlled trials addressing the safety of cosmetic procedures during pregnancy and postpartum periods. It is advisable to delay elective cosmetic procedures until after the baby is born.
Dermatologic surgery is changed in the pregnant and postpartum patient. The physiologic changes associated with pregnancy require attention to the timing of surgery as well as the positioning and technique to maximize the outcome for the patient. The surgeon must also remember the risks to the fetus or nursing newborn in planning any surgical procedure. This is the one time when there is more than one patient in every procedure. This article will review the timing of surgery, tumors of pregnancy, surgical positioning, local anesthetics, surgical technique, and cosmetic procedures. This information should help provide a safe surgical procedure for the mother and the child.