Botox And Dermal Fillers During Pregnancy

Sure, the journey of raising the little one might have just begun, but the wrinkles associated with parenthood may already be making an appearance! We take a look at two common facial rejuvenation therapies, their known safety profiles during pregnancy, and what real options you have for pampering and perfecting your skin.

Botulinum Toxin A in Pregnancy

Botulinum toxin A has been used for years for both medical and cosmetic procedures alike. It is commonly referred to as “Botox® Cosmetic,” which refers to one of the compound’s tradenames marketed by the company Allergen Inc. However, other brands of botulinum toxin also exist including FDA-approved Dysport® and Xeomin.® 

How does this time-tested therapy actually work? The chemical components of this toxin have been known to help relax facial muscles^[1] and therefore reduce the fine lines and wrinkles that come with aging. There are a number of cosmetic contouring techniques,^[2] which Botox can achieve (some of which are FDA-approved and others which are off-label uses) that include but are not limited to the following:

• Eliminating crow’s feet around the eyes
• Reducing smile lines
• Shaping and lifting the eyebrows
• Restructuring the jawline
• Decreasing forehead frown lines
• Increasing the opening of the eye
• Lifting the tip of the nose
• Reducing circles around the neck
• Increasing visibility of the lips

Although many pregnant women request this therapy, the safety of botulinum toxin A in pregnancy is a controversial topic. There have been no scientific studies conducted to effectively assess whether use of this substance is safe for the baby. There have been multiple reports^[3] of botulinum toxin being used in pregnant women unknowingly for other medical procedures. The majority of these cases resulted in no harm to the mother or growing baby. However, should you decide to pursue this therapy during pregnancy, you should discuss it with your doctor.

Filler Use in Pregnancy

Fillers basically do what they sound like they do. A substance, usually hyaluronic acid (most common), collagen, or fat is injected into the area of wrinkles. The substance helps smooth out the texture of the skin and reduce the appearance of any unwanted lines and indentations. There are several major categories^[4] of fillers. As mentioned before, hyaluronic acid is a major component of some fillers. This substance is also a natural component that contributes to the deep layers of the skin. These fillers usually last longer^[4] than collagen-based ones and are also sometimes preferred because filler “mistakes” can be more easily corrected. This is achieved by injecting a substance called hyaluronidase^[5] into the area of filler. This substance can break down the originally injected hyaluronic acid and “undo” the filler. Collagen fillers are another available option. Collagen^[6] is the major protein in the skin that breaks down during the aging process. This leads to a reduction in the strength of the protein network which keeps skin firm. Often times fat (either donated or one’s own) can be used as a filler substance as well.

Unfortunately, the safety of using these substances is unknown, as there have been no scientific studies to test their safety in pregnant women. Unlike botulinum toxin, there have been no reports published about their use in pregnant women either. However, most physicians feel that there is low risk to the pregnancy since these are localized injections and most likely have a low rate of absorption into the bloodstream. One possible concern is the local numbing agent often used with fillers. Lidocaine^[7] is the most common anesthetic combined with fillers in standard filler injections. This agent has been labeled by the FDA as pregnancy category B which means it is likely safe to use during pregnancy. Also, the doses of lidocaine used in fillers are much lower than the recommended maximum dosages of lidocaine. 

What Are the Other Options in Pregnancy?

• Retinoid-based topical applications: These include tretinoin (pregnancy category C), tazarotene (pregnancy category X), adapalene (pregnancy category C), and others. While these can improve sun-damaged skin and wrinkles, the category X rated ingredients should NOT be used during pregnancy since they are vitamin-A derived. The category C rated ingredients should be discussed with a physician. Oral vitamin-A derivatives are known to be harmful to a growing baby. The safety of the topical vitamin-A derivatives is more controversial.
• Chemical peels^[8]: These include alpha-hydroxy acid peels (ex. glycolic acid), beta-hydroxy peels, salicylic acid peels, trichloroacetic acid peels, and many others. These are discussed in-depth in another section of this article series. However, briefly during pregnancy, glycolic acid peels are thought to be generally safe. Salicylic acid peels should be avoided when possible.
• Laser therapies^[9]: These were first introduced for the treatment of aging skin. However, even in the non-pregnant population, there is the risk of redness, irritation, and subsequent darkening effects when these are used. Because lasers act locally, the risks of lasers during pregnancy is not clear. There is very little data on the use of lasers during pregnancy, although they have been used safely for other medical procedures in pregnant women.

All of the methods for reducing wrinkles have one thing in common: they are all temporary and more often than not, you have to get more treatments to keep your skin looking healthy and fresh!

However, there are some things you can do starting today to ensure your skin keeps looking great throughout the years!

Lifestyle Changes for Healthier Facial Skin

• Eat a balanced diet: Your skin is made up of all types of proteins and molecules and is constantly turning over day by day. Therefore, it is important to get a diet with a variety of foods: fruits, vegetables, grains, and proteins. This will keep your skin supplied with the nutrients it needs to stay strong and renew itself. 

• STOP smoking: There is a direct correlation between smoking and wrinkles. More smoking means more wrinkles! 

• UV Radiation Protection: Wear sun protective clothing and your sunscreen! Some experts argue that sun-damage is the number one contributor to aging from wrinkles to darkening to sagging skin.