Post-partum procedures

Dr Patrick Treacy discusses the affect pregnancy has on the body and what the best treatments are post-pregnancy

Pregnancy causes many changes in a woman’s body. The growing foetus causes mechanical changes by stretching skin, muscle, and fascia. The amount of physiological change during pregnancy varies among women but often persists long after the post-partum period despite the best efforts of the patient regarding exercise and diet.

Many women find it difficult to deal with these major body changes. Humanoid females are almost unique among species in accumulating fat in the lower abdomen midriff, while males seem more prone to develop visceral fat around their organs. During pregnancy human skin often stretches out of shape and loses the ability to spring back, forming sagging breasts and stretch marks.

In this physiological state the dermal tissue of the abdomen has been distended and is sometimes left with long-term stretch marks. Stretch marks occur during pregnancy and are caused by rapid stretching of the dermal tissue of the abdomen during the distension and weight gain of pregnancy. It is thought that nearly 85% of women will develop some degree of stretch marks during their pregnancy and these usually appear after prolonged weakening of the dermal tissues about the beginning of the third trimester.

TREATMENT OPTIONS

Various treatments are available for improving the appearance of existing stretch marks, including radiofrequency, laser treatments, microneedling, dermabrasion, carboxytherapy and prescription retinoids. Many patients ask if there are any topical creams to help with stretch marks, either during their formation or after they have occurred. There are no proper control studies, but some research suggests a daily application of a cream containing Gotu Kola extract, vitamin E, and collagen hydrolysates are associated with fewer stretch marks during pregnancy.

Carboxytherapy is a simple and proven technique that can dramatically improve the appearance of stretch marks by improving local tissue metabolism and perfusion. Treatments are rapid, comfortable, and effective for a high percentage of patients. Also great for treating stretch marks is BTL Exilis Elite, which uses radiofrequency to lightly heat the skin, encouraging collagen production for cell replenishment. This smooths out and contours the area, tightening it in the process. It’s an extremely safe procedure, with temperature control based on the skin’s temperature. The number of sessions will depend on the severity of the stretch marks; however, four sessions are usually required for the desired effect.

DURING PREGNANCY

The safety of cosmetic procedures in patients who are pregnant and/or lactating is a complex clinical question surrounded by uncertainty. It probably goes without saying everyday hair washing, makeup, bathing and showering are perfectly fine. The physician involved in giving the treatment will usually be well versed in whether the procedure is safe or not. However, we shall look at some of the aesthetic procedures in more detail.

Pregnant women should not raise their core body temperature above 39 degrees centigrade. This is considered the maximum temperature one should reach to keep both mother and baby healthy.

Lasers

Although laser hair removal is generally considered a safe procedure, doctors and dermatologists usually advise pregnant women to avoid the procedure. Co2 laser resurfacing uses quite a lot of high concentration lidocaine and should be avoided during pregnancy.

Facials

Pregnant women should be careful about using only natural products. They shouldn’t use any chemicals (including retinoids) directly on their skin as they may be absorbed into the bloodstream, and the developing baby depends on that blood. A mother’s skin is more sensitive during the stages of pregnancy.

Peels

With respect to chemical peels, glycolic and lactic acid peels are deemed safe; however, trichloroacetic and salicylic acid peels should be avoided or used with caution. Again, retinol can damage a developing baby. Though it also resides in FDA category C, which technically means risk to the foetus cannot be ruled out, most physicians feel this family of products is to be avoided at all costs.

Botox

Although safety data on botulinum toxin A is insufficient, the procedure may be safe because systemic absorption and placental transfer are negligible. Because there is insufficient data to be certain, most dermatologists recommend avoiding Botox injections while pregnant.

There have been many studies on pregnant women who had Botox injected when they did not realise they were pregnant, and no untoward effects have been reported. Botox has very little bioavailability in the bloodstream, so it is unlikely to cause a problem, but I would not recommend injecting Botox into pregnant women.

Dermal Fillers

With safe beauty in mind, we typically recommend that patients refrain from injectables during pregnancy. While there have been no proven side effects linked to injectables, this is the safest course for women who wish to protect their babies. We have to be careful as many fillers now also contain a local anaesthetic.

Stretch marks occur during pregnancy and are caused by rapid stretching of the dermal tissue of the abdomen

Lidocaine

Pregnancy category B, considered relatively safe to use during pregnancy at doses used in dermatological procedures. However, I refrain from using it during the first trimester. Regarding general anaesthetics, it does not appear that anaesthetic agents have teratogenic effects in humans. However anaesthesia and surgery during pregnancy are associated with an increased risk of miscarriage, premature birth, low birth weight infants and infant death.

Sclerotherapy

Sclerotherapy can be safe during pregnancy but must be avoided during the first trimester and after week 36 of the pregnancy. Consider also the differing sclerosing agents and question the physician.

Dental work

While pregnant,dental work such as cavity fillings and crowns, should be treated to reduce the chance of infection. If dental work is done during pregnancy, the second trimester is preferable. It is best to avoid dental work while pregnant if possible and avoid exposing the developing baby to any risks, even if they are minimal.

Holistic treatments

Massage is beneficial to help a mother relax and reduce stress. It will also help those pregnancy aches and pains. Acupuncture is also generally considered safe as are manicures and pedicures.

Oxygen facials

These facials are considered safe and can help increase blood circulation and plump out any fine lines or wrinkles.

POST-PARTEM

The ‘post-baby’ body type with fat now distributed subcutaneously especially in the buttocks and thigh area. There are breast volume changes with sagging, especially if the female has breast fed her infant. Breast volume may increase but usually we get shrinkage. When one refers to the “Mummy Makeover” what are the most typical kinds of treatments related to this post childbirth makeover? What are women most likely looking to treat or enhance post birth?

Most of these makeovers are related to the removal of fat. Liposuction has been the mainstay of this quite recently.

This is a cosmetic surgery operation that removes fat from the abdomen, thighs, and buttocks and elsewhere. There are many differing mechanisms of liposuction.

Conventional liposuction is mostly performed under general anaesthesia, and largely practised by plastic surgeons. The whole procedure lasts two to three hours. It is possible to remove large amounts of fat, often eight to 10 litres, quickly in one to two hours. However, it has many disadvantages, including the fact that the patient must be hospitalised, which adds significantly to the cost. Recovery time is slow, as after any procedure under general anaesthesia. More recently, it can be combined with other procedures (i.e. radiofrequency) that involve a level of skin retraction. The result is affected by the age of the patient, quality of skin, presence of underlying disease or smoking, and the presence of previous skin damage such as those caused by childbirth and surgery. The risks, financial costs, and lengthy downtime associated with surgical procedures for fat reduction have led to the development of several noninvasive techniques.

Non-invasive body contouring

Non-invasive body contouring now represents the fastest growing area of aesthetic medicine. There are currently four leading non-invasive techniques for reducing localised subcutaneous adipose tissue: low-level laser therapy (LLLT), cryolipolysis, radiofrequency (RF), and high-intensity focused ultrasound (HIFU). Cryolipolysis is the non-invasive cooling of adipose tissue to induce lipolysis — the breaking down of fat cells — to reduce body fat without damage to other tissues. Cool Sculpting initially received FDA clearance for fat reduction in the abdomen and flanks, and more recently there has been significant interest in nonsurgical fat reduction for other sites, such as the inner and outer thighs.

BTL Exilis Ultra is a dual technology of monopolar radio frequency (RF) and ultrasound for non-invasive wrinkle reduction and reshaping of the body parts. Exilis skin tightening works by stimulating collagen production within the skin. The Vanquish ME is also used for body shaping and circumferential reduction of abdomen and thighs. It represents the only contactless and operator-independent technology that targets the largest treatment area in a single session.

Emsculpt is based on high-intensity focused electromagnetic energy. A single treatment session causes thousands of powerful muscle contractions which are extremely important in improving the tone and strength of the muscles. It is the only procedure which helps patients build muscle and sculpt the body. In addition, it allegedly provides the world’s first noninvasive buttock toning procedure.

By maintaining a healthy diet and exercise patients can expect long-term results. None of these procedures are recommended during pregnancy. With any of the procedures, it takes about 90 days for new collagen to form. After that results last approximately two years.