Tag Archives: pregnancy

Safety during Pregnancy: What You Should and Shouldn’t Include In Your Beauty Regiment

6 Sep

It seems like it’s in the water with co-workers and friends (as evidenced by the three pregnant ladies to the left from Sylvestre Franc). I’ve had a lot of questions about what is and isn’t safe to do when you’re pregnant in regards to skin care products, laser, and injectables. It is understandable that women want to look their best during this time and hormonal changes during pregnancy can sometimes result in acne, unwanted hair growth, melasma and other skin problems. So what is safe to use and what isn’t?

Not surprisingly (to me anyways), there really is not a lot of information on product safety during pregnancy. The FDA rates products on their risks during pregnancy as follows:

Rating Definition

A

Controlled Studies Show No Risk.  Studies in pregnant women show the medication causes no increased risk to the fetus during pregnancy.

B

No Evidence of Risk In Humans.  Studies in pregnant women have not shown increased risk of fetal abnormalities despite adverse findings in animals or in the absence of adequate human studies, animal studies show no increased fetal risk.

C

Risk Cannot Be Ruled Out.  Studies are unavailable and animal studies have shown a risk to the fetus or are also lacking. There is a chance of fetal harm if taken during pregnancy but the potential benefits may outweigh the potential harm.

D

Positive Evidence Of Risk. Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk such as in life-threatening situations.

X

Contraindicated In Pregnancy. Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant.

Skin Care Products

Most skin care products fall into the Class C category; however, some products are recommended by doctors not to be used during pregnancy (although there is not enough evidence for or against them).


Not Recommended:

  • Retinoids
    • In A Practical Guide to Dermatological Drug Use in Pregnancy (Zip, MD, FRCPC) category B topical such as erythromycin, clindamycin, and benzoyl peroxide were recommended over topical tretinoin. This study states reports of congenital malformations in infants whose mothers used tretinoin during the first trimester.
    • This ingredient is found in anti-aging products such as moisturizers, and acne products.
    • Chemically a form of vitamin A, which in high doses can cause birth defects.
    • Oral retinoids, such as isotretinoin (Accutane, an acne treatment), are known to cause birth defects.


  • Beta Hydroxy acids (Salicylic Acid)
    • Ingredients used for their exfoliating and acne-treating properties. They penetrate deep inside the pores and clean out excess oil and dead skin cells that can clog pores and cause acne, blackheads and dull-looking skin.
    • High doses of the acid in its oral form have been shown in studies to cause complications and birth defects.
    • Small amounts applied topically are considered safe (over the counter face wash for example), but peels containing Salicylic Acid are not considered safe when pregnant.

  • Hydroquinone
    • Clinically used for pigmentation for conditions such as melasma, and it is used cosmetically as a skin-whitening agent. Although a large percentage of this topical agent is systemically absorbed, the use during pregnancy does not appear to be associated with increased risk of congenital defects. This finding, however, is based off one study, with a small sample size (so it is recommended to avoid hydroquinone during pregnancy).


Safe

  • Vitamin C, Glycolic acid, and Lactic Acid: derived from fruit and milk sugars, considered nontoxic.

  • Hyaluronic Acid. This is a product your body naturally produces (which means its safe). Because of its molecular size, hyaluronic acid cannot penetrate the skin’s surface, and it is not systemically absorbed.


  • Benzoyl peroxide. Only 5% of topical benzoyl peroxide is absorbed through the skin. It is completely metabolized to benzoic acid within the skin and excreted.

Self-Tanners

Dihydroxyacetone is a color additive that is found in self-tanning products to produce an artificial tan. Color develops following topical application. These products contain dihydroxyacetone in concentrations ranging from 1% to 15%, and when applied topically, systemic levels are minimal (0.5%), and are considered safe to use.

Hair Removal and Bleaching Agents

  • Sodium, calcium, and potassium hydroxide, which are also found in depilatory creams, disassociate into sodium, calcium, potassium, and hydroxide ions, which are all present in the human body. Topical application of these products would not disrupt serum levels and would not be considered a problem for use during pregnancy.
  • Hydrogen peroxide. Hair-bleaching creams contain low concentrations of hydrogen peroxide, making it unlikely to be systemically absorbed. In addition, should it be absorbed, hydrogen peroxide is rapidly metabolized. Therefore, use of these products during pregnancy is not expected to be a concern when done in moderation.
  • Laser has some controversy as to whether or not it’s safe; again, there isn’t a lot of information. Lasers do not penetrate very deep and there is not chemical exchange into the body. One interesting thought from me, (not speaking from personal experience) the body becomes more sensitive during pregnancy, and some laser treatments hurt to begin with. I’m not sure I’d want to get laser under those circumstances!

Botox and Fillers

The safety of Botox injections during pregnancy is unknown (Class C), and while I wouldn’t recommend intentionally getting Botox injections during pregnancy, many women receive injections prior to being pregnant or when they do not know they are pregnant, and have not had any problems. Botox Cosmetic has never traveled systemically, and works only on the muscles into which it has been injected. Therefore, one could presume it is safe to undergo this procedure. But I still don’t recommend it.  Unless you’re planning on having a “Toddler and Tiara” baby.  Then it’s ok.

 

xoxo,

not pregnant LK


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Why I Chose to Have a Tummy Tuck

10 Jun

The following was written by a patient who had undergone abdominoplasty. She is 40 years old, and had extreme weight loss resulting in extra skin. I think it’s also an important point to mention that she is recently divorced (which is stressful for anyone), and has been thinking about dating again (which is stressful for EVERYONE!). I am very thankful for her to share her story. There are tons of women who want to know more about this procedure.

Abdominoplasty

AKA “Tummy Tuck” is a surgical procedure used to make the abdomen more firm by removing excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. The wall is then stitched together making the abdomen more “tight” in appearance. This procedure is great for women who have had kids (they say you never can get your body back after children—”they” clearly haven’t heard of a good surgeon!) and for individuals who have lots of sagging, excess skin after major weight loss.


This procedure is sometimes also done in conjunction with liposuction of the abdomen. But not always. J

Why I chose to have a tummy tuck

I first considered getting a tummy tuck 2 years ago when I was going through a tough time in my life, thinking it might boost my spirits.  My weight had gone up and down for about 20 years and I had maintained a pretty substantial amount of weight for the latter part of those years.  I had just started to lose some weight due to stress and had talked casually to a surgeon about having it done.  He recommended I have a consult and that was as far as I got with it at the time.   

I thought I had made up my mind when I overheard a friend tell another friend that I was planning surgery for all the wrong reasons.  Something in me snapped and I decided against surgery.  I contacted a personal trainer and started on a plan to lose weight and get in shape.  It was not easy.  I had never been one to exercise and it took me a long time to start choosing the right foods.  The same patterns continued where I would lose some weight, but then put it back on.  I was getting frustrated and knew I had no one to blame but myself.  I continued to work out and eat better but I just couldn’t seem to move forward.

A few months ago I saw the same surgeon who told me I should have the tummy tuck.  He knew I had been working out and eating better and I didn’t look much different.  I took his advice this time and had a consult.  What I learned was that I had loose skin that was never going to get smaller with diet and exercise.  On the contrary, the more weight I lost the more loose skin I had.  It got to the point where I felt like it was both mentally and physically holding me back.  I decided to do the surgery.  The hardest part of my decision was telling my personal trainer.  I was afraid he would think I was taking the easy way out and I respect his opinion.  He was great!  He didn’t realize I was dealing with excess skin and he was very supportive.  He asked me a lot of thought provoking questions to verify that I was doing it for the right reasons and he gave me his blessing.  I thanked him and told him I would see him 6 weeks after surgery.

A week before surgery I had a pre-op where they took photos and went over my health history.  Other than the excess weight I was extremely healthy and a good candidate for surgery.  I was a little nervous, but mostly about the recovery.  I wasn’t nervous about the surgery, just about how I would feel afterward.

The morning of surgery I got up early and went to the hospital.  I was greeted by the wonderful nursing staff and then by my surgeon.  Lastly, I was introduced to my anesthesiologist, and that’s where it all becomes fuzzy.  The next thing I know I was waking up and the nurse said hello to me.  My response: Am I skinny now?  She laughed and told me I was.  I was in the recovery room for a short period of time and then two nurses wheeled me to my room.  My only discomfort at this point was bladder pressure (they adjusted my catheter and all was fine) and my back was sore.  Once I was able to adjust myself on the bed I had no discomfort. 

I opted to stay overnight in the hospital and I am glad that I did.  The nursing staff made sure I got meds on a regular schedule and I felt comfortable knowing I had round the clock care.  I had a few visitors who came and made sure I ate and that I was recovering well.  When the nurse came to give me pain meds I asked for Motrin instead.  I had zero pain, which was unexpected, so I didn’t feel the need to take narcotics.  I spent exactly 24 hours in my hospital bed and barely moved a muscle.  I wasn’t sure what to expect with movement so I decided to wait until the next day to move around.

The next morning the nursing staff asked me if I wanted to get out of bed and walk around.  I had them remove my catheter but told them I wanted to wait to get out of bed.  As soon as they left I got up on my own.  I don’t know why.  I think maybe I wanted to know I could do it on my own.  I walked to the bathroom and washed my face and brushed my teeth.  I walked back to the bed for a half hour and then got back up to get dressed in anticipation of going home.  Imagine the surprise the nurses experienced when thy came to check on me and I was dressed and ready to go!  No discomfort!  My only thought was to stay hunched so I wouldn’t compromise my stitches.

My friend, coincidentally a nurse, came to pick me up around noon.  They wheeled me in a wheelchair to the car and I very carefully climbed in.  I was tired but otherwise felt good.  The ride home was uneventful.  I got home and slowly walked upstairs to my bedroom, knowing I would be staying there for a few days while I recovered.  The doctor had told me to get up and walk around a little bit, but only as needed.  I had 2 drains that would let him know if I did too much activity.  I had another nurse friend stay with me the first night home but after that I felt like I could manage on my own.

I was a pretty good patient, or so I thought.  I felt great so I ended up walking around more than I was supposed to.  I washed my hair every day and fed my cats.  When I went for my post op appointment 6 days after surgery I got bad news.  My drains were pulling in too much fluid which meant I couldn’t have them removed.  I was put on bed rest and told to come back in 2 days.  Lesson learned.  I stayed in bed for the full 2 days, only getting up to go to the bathroom.  It worked.  I had my drains removed 2 days later and went back to work 3 days after that.  The removal of the drains was a source of anxiety for me but I barely felt them being removed. 

For 6 weeks I kept my activity to a minimum and followed all my surgeon’s instructions.  I asked the surgeon why I had such a great experience and he said it was probably because I was in shape from working out so much.  My recovery was not exactly typical.  I was a bit tired from the anesthesia but otherwise I felt pretty good.  Physically, I looked a bit out of proportion as I had a lot of swelling but over time everything evened out.  I am now 3 1/2 months post surgery and I couldn’t be happier with my decision.  I am back to the gym and I am now focusing on other areas of my body that need attention.  It’s been a long road but a trip worth taking.


Before and After

Also, check out how hot those panties are!


Before


After

A Note from Me

Sometimes I wonder if people understand that not all plastic surgery is done by super vain and “plastic” looking people. There are many different types of people who undergo the knife each year for reconstructive purposes and to fix something that has affected their self image. Case studies are the best! You should always talk to people who have done the procedure before (unfortunately most people who are elated with results from plastic surgery aren’t usually telling the world their secrets) so here’s some advice from Joan Rivers, Do Whatever You Want, If It Makes You Happy. But First Take This Quiz..

On a serious note, surgery IS serious and if you’re  Thinking about a NoseJob/Breast Aug/Lipo/Tummy Tuck? … Butt Implants?. you should have the list of questions printed from the blog entry to ask your doctor.

I would also like to remind patients NOT to get out of bed without assistance post-procedures. If you are on narcotics (which you probably still have in your system post-op) you are more likely to fall. And then the nurses have to fill out paperwork and it’s REALLY time consuming. Also, if you ever stand up and you feel dizzy, do NOT look down. Those are my words of wisdom for today.

Thanks!

-LK


Evaluating Your Skin

23 Jan

Like your personality, everyone has different skin, and there are many extraneous factors that affect the physical condition of your skin.  Even though I know a lot about skin, I don’t pretend I know it all, and I often ask my aesthetician friends what they think about my skin’s appearance. Usually, when my skin deviates from the norm, it’s from something I did.  By looking at your skin, an aesthetician determines the classification (Skin Care Classification Systems.) but they should also ask you the following questions to evaluate the overall health of your skin. 

Skin Evaluation Questions 

(Marmur, Ellen, M.D., 2009, Simple Skin Beauty:
Every Woman’s Guide to a Lifetime of Healthy, Gorgeous Skin, 20-21)

  • How does my skin usually behave?  Does it tend to be dry or oily?  Does it get irritated or red or hyperpigment easily (a sign of sensitivity).

My skin is normally a little oily, with rare break outs (because I regularly see an aesthetician and use products that are appropriate for me–but trust me–I’ve had my fair share of acne, hyperpigmentation, and dryness).  Because I take care of my skin, I no longer easily get irritated, red, pigmented, or break out.  But that’s MY skin). 

  • What is my lifestyle like?

I think there is not a woman alive that doesn’t have a high stress lifestyle.  But, when our stress levels get higher than normal, that’s when we can run into problems!  When I opened my first office, I’ve never had such HORRIBLE skin.  I was under so much stress!  I wasn’t eating, drinking, or sleeping (healthy right?).  I was broken out and my skin literally had a blue hue to it from not having enough oxygen and water.  It was NOT attractive.  Now I’m back to a regular level of high stress.

If you look at woman from other countries, you usually see they have nice skin.  Even though they smoke.  Well, the American life-style is high stress.  Women juggle families and careers and high levels of stress due to the pressure to achieve, and I think this is especially true of the Boston Woman.  Read more about  Skin Under Stress.

  •  Have I been doing anything differently in the last few weeks?

First Rule in Nursing:  have you done anything different?

Second Rule in Nursing:  stop whatever it is you did.

Did the symptoms stop too?  Cause and effect!  When it comes to skin reactions I like to ask if you have started using any different skin products, or have you changed your detergents?  (I personally am allergic to dryer sheets and I sleep with my face on a pillowcase… that would have touched a dryer sheet!)

  • What climate do I live in, or have I traveled somewhere recently?

Ugh, it is officially winter.  I know I have my heat on 80 right now and I am so thankful it is not forced hot air!  The type of heat you are using to heat your home will affect the air and your skin. (Check out Hydrating Ingredients in Skin Care Products.)  When the temps start warming up, of course we have the humidity… “it’s not the heat it’s the humidity!”  which can cause our skin to feel more greasy.

Changing climates from the dirty city are to the clean country air can affect your skin.  My skin likes the city 😉

  • What foods have I been eating recently?

Your diet DOES effect the appearance of your skin.  I’m not saying chocolate causes acne (don’t worry, there is zero truth to this one), but certain vitamins and minerals feed the skin.  Certain foods are healthier for your skin, just like certain foods promote a healthy liver (off the top of my head I can think of one food that is bad for your liver- alcohol)!  Avoid things high in sugar, they promote bacterial growth.  Look for foods high in vitamin A, C, and E.

  • What kinds of products do I use on my skin and how often?

I really hope by now you’ve gotten my point about over the counter products, and how they don’t do much but put a hole in your wallet.  But, pharmaceutical products aren’t always good to use everyday.  Case in point – Retin-A.  LOVE IT.  I really think Every Woman Should Own A Retinol Product.  But I don’t  think it’s for everyone EVERYDAY.  I recently upped my topical Retin-A usage to every other day.  My skin looks AMAZING, but if I use it everyday it gets red, dry, and flakey.  Ew.

**I would like to add that I also just read in a medical book that Retin-A and sunblock are the only PREVENTATIVE topicals when it comes to fine lines.

  • What kind of makeup do I wear?

I ask my clients this all the time.  Usually I ask it like this:  “Do you wear MAC make-up”  and they say “yes.”  NOOOO.  Don’t get me wrong.  I love MAC’s eye-shadows.  I love their fake eyelashes.  But their face make-up is “stage make-up” which is NOT for everyday use!  It clogs your pores and can make acne much worse.  PLEASE stop using this product everyday!  Start using good skin products, and throw out your make-up!  Be natural!  (Yes, the Botox Queen supports natural!).  When I do feel the need to wear a face make-up, I stick to mineral make-up.

***Also, did you know that if your skin tends to be greasy you should use powder based foundation, and if it tends to be dry you should use liquid based foundations?

  • How many showers a day do I take?

I know we love long, hot showers in the winter, but try to keep it quick.  Not only does it make you “green,” but long, hot showers dry out your skin.  Moisturize!

  • Do I have a stressful job?

Obviously!  I’m not even going to start on this one!

  • Do I smoke?

I hope the answer to this is no.  It’s funny.  We know how bad smoking is for your health, but for some reason people still do it.  Well, if the threat of cancer hasn’t stopped you, and the insane cost hasn’t stopped you, perhaps this will:  smoking is bad for your skin.  It prematurely ages you.  It thins your dermal layer, destroys your cell’s DNA, and gives a yellow hue (from toxins).  I pray that if you have stopped by medical reasons, perhaps vanity can play some roll in ditching the cancer stick.  I know it’s hard, but it is really, really bad for your skin (and health and wallet).

  • Do I take any medications regularly?

There are TONS of medications which can interfere with the health of your skin.  Read your bottles.  Do any say stay out of the sun?  I promise you, the bottle is not lying to you.  Hypersensitivity to sunlight is a common side affect with many medications.  Be extra careful to wear sunblock, even in the winter.  Please and thank you.

  • Am I pregnant?  Have I recently had a baby?

I can safely say no to these questions, but, as I’m sure you all know, pregnancy comes with MANY hormonal changes.  And do not sound fun (I recently learned from patrons at a Botox Party the most important word to know during pregnancy- Epidural).

  • Have I had surgery or any health problems in the last year?

When your immune system is down, or your body is in a state of repair, the essential vitamins and nutrients your skin requires may be diverted to other organ systems that need them more.

  • Do I wear sunscreen?

EVERYDAY.  Even in the winter.  Like I said earlier, sun damage is the number one cause of fine lines.  Do you know how men can tell your age?  By looking at your hands, because they are always exposed to sunlight.  Ok, it’s winter, we go from home to car to job to home (at which point the sun is already probably gone).  So many of us think we don’t need sunblock.  WRONG.  You are exposed to UV rays in the car.  When looked at under a skin lamp, the drivers side of a face displays 90% more sun damage.

Check out There’s a fine line between tan and looking like you rolled in a bag of doritos.  (It is one of my most highly viewed posts!)

  • Do I pick at my face nervously?

I do.  It’s so bad.  I was actually put on Celexa at one point for this nervous habit.  I’m so glad I was too, because it worked!

  • How many products do I use on my skin and hair everyday?

You don’t need to be using a crazy amount of products, and you don’t necessarily need to be using everything, everyday.  We have this notion that if a little is good, a lot is better.  Not true.  Follow the directions for usage from your aesthetician, or at least the instructions on the products you are using (that are pharmaceutical grade).  As you can see from the picture, I have a lot of products–but I don’t use every one everyday.

  • Do I touch my face a lot?

As a nurse, I can tell you, nails are DIRTY.  Hospitals have banned acrylic nails for nurses in hospitals because of the germs they carry.  By touching your face, you are introducing those germs and bacteria to your skin.  One of the biological roles of skin is to protect the internal organs from infection.  If you are picking at your skin you are essentially breaking the barrier, and allowing an area of access for bacteria.

The skin is a protective barrier against dirt and bacteria.

Bacteria is under your nails.

Picking at your skin with your nails tears the skin.

THEREFORE:

Picking breaks the protective barrier and at the same time introduces bacteria and dirt from your nails.  BAD.

  • Do I use hair gel or pomades?

I don’t know what a pomade is….. I guess that is for short hair! I do know this… I often break out on my hair line when I am on day 3 of not washing my hair (you shouldn’t wash your hair everyday).  Hair products can contains skin clogging ingredients, or might contain ingredients that your skin is sensitive to.

**I’m not sure if I took this picture crooked, or hung the shelf crooked?            ———————–>

  • Is there a specific area on my face that is constantly a problem?

Like perhaps you break out where your cell phone constantly touches?  Swab down your phone with an alcohol pad, daily!

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