Some of the most frequently requested cosmetic consultations I get center on changes that follow pregnancy. Usually, but not always, this involves a woman who was pregnant. Sometimes, however, the stress of a pregnancy can affect men as well. Many dermatologic issues follow pregnancy and these include: striae, acne, telangiectasia, pyogenic granulomata, changes in fat distribution, leg veins and changes in hair patterns.
Striae
Striae are the most common complaint I see following pregnancy. Striae can be divided into two groups — either red and violaceous or beige. For those in the former category, treatment with a pulsed dye laser works well at reducing the erythematous component.
Typical settings that are used with my Candela Scleroplus system are 585 nm to 595 nm with a spot size of 5 mm and an energy setting of 8 J/cm2 to 9 J/cm2. The dynamic cooling device (DCD) is usually set on 60. Results are variable but if patients return for two to four visits and the striae are relatively new and pink-red, they are usually pleased with their outcomes.
One caveat to treating pregnancy-related striae is the need to advise your patients that subsequent pregnancies may cause the striae to return and that treating one series of striae does not preclude other striae from forming in the future.
Acne After Pregnancy
Acne is a problem that many women experience during and immediately after pregnancy. Having observed my wife during three pregnancies, I can only assume that there are some subtle fluctuations in hormones responsible for this and a few other things (that is a discussion for a different column, however).
As hormones in pregnancy increase, the mileau of the pilosebaceous structure changes and many women find they develop more acne. Other reasons that acne tends to increase include the relative immunosuppression associated with pregnancy (bad for those with bacteria- related acne) and the requirement for cessation of most acne medications during pregnancy.
Treatments for pregnancy-associated acne may include topical erythromycin and some cleansers. Despite the low risk associated with many topical acne medications, in today’s medicolegal environment, you must exercise extreme caution when prescribing any medications to a pregnant woman, so be sure to refer to your Physicians’ Desk Reference to check on the risks to pregnant women of individual drugs you’re considering for treatment.
One good way to treat pregnancy-related acne is to prescribe topical erythromycin 2% solution (for oily skin) or gel (for normal skin). When using anything other than erythromycin, you should definitely check in with the patient’s obstetrician.
Telangiectasia
Telangiectasia and pyogenic granuloma are frequently associated with pregnancies. The most common treatment for these conditions is time — most abate within a few months after pregnancy.
Some pyogenic granulomas bleed, are located in inopportune locations or grow rapidly enough to cause clinical concern and thus, warrant treatment. Removal of these lesions may be accomplished with a pulsed dye laser if they aren't too thick and by electrodessication if they are not amenable to laser treatment.
Treatment of telangiectasia is similar to that of granulomas — watchful waiting and then use of laser for lesions on the face and hyfrecation or laser for lesions elsewhere.
Liposuction
Getting back defined abdominal muscles is another reason many post-partum women come to see me. After delivery, some women find it difficult to get their shape back. However, the vast majority of them can get their pre-pregnancies bodies back with diet and exercise, and this is my first advice to them. For those who cannot, liposuction offers an opportunity to sculpt the body and remove unwanted fat.
Before contemplating this procedure in a post-partum woman, it’s important to make sure that she’s not lactating, that she is several months post delivery, that there were no complications that might mitigate against performing liposuction (such as a ventral hernia) and that she understands that subsequent pregnancies may result in the need for additional liposuction procedures (some women elect to defer until they are done with childbearing when they hear this last condition). Also, if there is evidence of post-partum depression during a consultation, it’s best to defer the procedure.
I recommend that diet and exercise be utilized for 6 weeks prior to any procedure being performed, and if this does not resolve the problem, then consideration for tumescent liposuction can be initiated.
Areas including the upper and lower abdomen, flanks, hips and thighs are commonly in need of sculpting following pregnancy.
Leg Vein Treatment
Leg veins are another vascular consequence of pregnancy. Despite the many lasers that promise to treat these veins without injections, I have been unimpressed with them to date.
For my patients, I usually rely on sclerotherapy to treat the veins. The solution that I use is hypertonic saline, although in Europe and Canada aethoxysclerol is used with great results. I make sure that the patients do not have a predisposition toward blood clots, that they are not pregnant and that they understand that treatment involves multiple sessions.
My regimen is to inject about 2 ml of 23.4% NaCl at intervals of approximately 3 to 4 weeks. I use either a 30-g or 32-g needle depending on the size of the vessels. On average, three to six treatments are required for improvement to be noticeable.
When there are varicose veins in addition to the spider veins, it’s important to refer the patient for vascular evaluation for endovenous closure (in my area this is performed by invasive radiologists as well as vascular surgeons).
As with other procedures, patients should be told that subsequent pregnancies may result in a return of the vessels or formation of new ones.
Hair Pattern Changes
Changes in hair patterns that follow pregnancy are typically the result of either hormonal fluctuations or telogen effluvium. Hormonal fluctuations that may occur after pregnancy include increased androgens (causing a male pattern of alopecia) or thyroid disease (which can cause a diffuse alopecia). If there is any clinical suspicion for endocrine abnormality, you need to check the appropriate hormone panels for proper diagnosis.
Telogen effluvium may follow a pregnancy by a few months and is marked by a diffuse pattern of hair loss. Fortunately, this type of alopecia is self-limiting and may be treated with observation or minoxidil (Rogaine) (if there is no lactation). I advise patients to use minoxidil twice daily.
Post-Partum Nose Droop
One final condition that has been noted is post-partum nose droop (PPND). This is occasionally noted following delivery and is characterized by a drooping of the nose tip. It may be related to the stretching of ligaments that are hormonally mediated.
Treatments for this include injections of Botox into the depressor nasi and injections of soft tissue augmentation products into the nose bridge and dorsum.
Nowell Solish, M.D., illustrated this technique to me. He injects about 2 units of Botox into the depressor nasi and then a small amount of hyaluronic acid (Restylane in many cases) into the dorsum of the nose.
Providing Care for Pregnant and Post-Partum Patients
Pregnancy and the post partum period are stressful for all concerned.
In many instances, dermatologic and cosmetic dermatologic issues assume a large role in the patient’s life.
Recognition of the various conditions associated with pregnancy, as well as familiarity with the various treatments available, will enable the cosmetic dermatologist to provide expert skin care for pregnant and post-partum patients (and enable them to avoid getting their skin care from the gynecologist who probably has the equipment if not the knowledge to care for their skin).
Also, don’t forget to consider the various options available for treatment of hair loss, weight gain and irritability in the spouse of the pregnant woman.
Some of the most frequently requested cosmetic consultations I get center on changes that follow pregnancy. Usually, but not always, this involves a woman who was pregnant. Sometimes, however, the stress of a pregnancy can affect men as well. Many dermatologic issues follow pregnancy and these include: striae, acne, telangiectasia, pyogenic granulomata, changes in fat distribution, leg veins and changes in hair patterns.
Striae
Striae are the most common complaint I see following pregnancy. Striae can be divided into two groups — either red and violaceous or beige. For those in the former category, treatment with a pulsed dye laser works well at reducing the erythematous component.
Typical settings that are used with my Candela Scleroplus system are 585 nm to 595 nm with a spot size of 5 mm and an energy setting of 8 J/cm2 to 9 J/cm2. The dynamic cooling device (DCD) is usually set on 60. Results are variable but if patients return for two to four visits and the striae are relatively new and pink-red, they are usually pleased with their outcomes.
One caveat to treating pregnancy-related striae is the need to advise your patients that subsequent pregnancies may cause the striae to return and that treating one series of striae does not preclude other striae from forming in the future.
Acne After Pregnancy
Acne is a problem that many women experience during and immediately after pregnancy. Having observed my wife during three pregnancies, I can only assume that there are some subtle fluctuations in hormones responsible for this and a few other things (that is a discussion for a different column, however).
As hormones in pregnancy increase, the mileau of the pilosebaceous structure changes and many women find they develop more acne. Other reasons that acne tends to increase include the relative immunosuppression associated with pregnancy (bad for those with bacteria- related acne) and the requirement for cessation of most acne medications during pregnancy.
Treatments for pregnancy-associated acne may include topical erythromycin and some cleansers. Despite the low risk associated with many topical acne medications, in today’s medicolegal environment, you must exercise extreme caution when prescribing any medications to a pregnant woman, so be sure to refer to your Physicians’ Desk Reference to check on the risks to pregnant women of individual drugs you’re considering for treatment.
One good way to treat pregnancy-related acne is to prescribe topical erythromycin 2% solution (for oily skin) or gel (for normal skin). When using anything other than erythromycin, you should definitely check in with the patient’s obstetrician.
Telangiectasia
Telangiectasia and pyogenic granuloma are frequently associated with pregnancies. The most common treatment for these conditions is time — most abate within a few months after pregnancy.
Some pyogenic granulomas bleed, are located in inopportune locations or grow rapidly enough to cause clinical concern and thus, warrant treatment. Removal of these lesions may be accomplished with a pulsed dye laser if they aren't too thick and by electrodessication if they are not amenable to laser treatment.
Treatment of telangiectasia is similar to that of granulomas — watchful waiting and then use of laser for lesions on the face and hyfrecation or laser for lesions elsewhere.
Liposuction
Getting back defined abdominal muscles is another reason many post-partum women come to see me. After delivery, some women find it difficult to get their shape back. However, the vast majority of them can get their pre-pregnancies bodies back with diet and exercise, and this is my first advice to them. For those who cannot, liposuction offers an opportunity to sculpt the body and remove unwanted fat.
Before contemplating this procedure in a post-partum woman, it’s important to make sure that she’s not lactating, that she is several months post delivery, that there were no complications that might mitigate against performing liposuction (such as a ventral hernia) and that she understands that subsequent pregnancies may result in the need for additional liposuction procedures (some women elect to defer until they are done with childbearing when they hear this last condition). Also, if there is evidence of post-partum depression during a consultation, it’s best to defer the procedure.
I recommend that diet and exercise be utilized for 6 weeks prior to any procedure being performed, and if this does not resolve the problem, then consideration for tumescent liposuction can be initiated.
Areas including the upper and lower abdomen, flanks, hips and thighs are commonly in need of sculpting following pregnancy.
Leg Vein Treatment
Leg veins are another vascular consequence of pregnancy. Despite the many lasers that promise to treat these veins without injections, I have been unimpressed with them to date.
For my patients, I usually rely on sclerotherapy to treat the veins. The solution that I use is hypertonic saline, although in Europe and Canada aethoxysclerol is used with great results. I make sure that the patients do not have a predisposition toward blood clots, that they are not pregnant and that they understand that treatment involves multiple sessions.
My regimen is to inject about 2 ml of 23.4% NaCl at intervals of approximately 3 to 4 weeks. I use either a 30-g or 32-g needle depending on the size of the vessels. On average, three to six treatments are required for improvement to be noticeable.
When there are varicose veins in addition to the spider veins, it’s important to refer the patient for vascular evaluation for endovenous closure (in my area this is performed by invasive radiologists as well as vascular surgeons).
As with other procedures, patients should be told that subsequent pregnancies may result in a return of the vessels or formation of new ones.
Hair Pattern Changes
Changes in hair patterns that follow pregnancy are typically the result of either hormonal fluctuations or telogen effluvium. Hormonal fluctuations that may occur after pregnancy include increased androgens (causing a male pattern of alopecia) or thyroid disease (which can cause a diffuse alopecia). If there is any clinical suspicion for endocrine abnormality, you need to check the appropriate hormone panels for proper diagnosis.
Telogen effluvium may follow a pregnancy by a few months and is marked by a diffuse pattern of hair loss. Fortunately, this type of alopecia is self-limiting and may be treated with observation or minoxidil (Rogaine) (if there is no lactation). I advise patients to use minoxidil twice daily.
Post-Partum Nose Droop
One final condition that has been noted is post-partum nose droop (PPND). This is occasionally noted following delivery and is characterized by a drooping of the nose tip. It may be related to the stretching of ligaments that are hormonally mediated.
Treatments for this include injections of Botox into the depressor nasi and injections of soft tissue augmentation products into the nose bridge and dorsum.
Nowell Solish, M.D., illustrated this technique to me. He injects about 2 units of Botox into the depressor nasi and then a small amount of hyaluronic acid (Restylane in many cases) into the dorsum of the nose.
Providing Care for Pregnant and Post-Partum Patients
Pregnancy and the post partum period are stressful for all concerned.
In many instances, dermatologic and cosmetic dermatologic issues assume a large role in the patient’s life.
Recognition of the various conditions associated with pregnancy, as well as familiarity with the various treatments available, will enable the cosmetic dermatologist to provide expert skin care for pregnant and post-partum patients (and enable them to avoid getting their skin care from the gynecologist who probably has the equipment if not the knowledge to care for their skin).
Also, don’t forget to consider the various options available for treatment of hair loss, weight gain and irritability in the spouse of the pregnant woman.
Some of the most frequently requested cosmetic consultations I get center on changes that follow pregnancy. Usually, but not always, this involves a woman who was pregnant. Sometimes, however, the stress of a pregnancy can affect men as well. Many dermatologic issues follow pregnancy and these include: striae, acne, telangiectasia, pyogenic granulomata, changes in fat distribution, leg veins and changes in hair patterns.
Striae
Striae are the most common complaint I see following pregnancy. Striae can be divided into two groups — either red and violaceous or beige. For those in the former category, treatment with a pulsed dye laser works well at reducing the erythematous component.
Typical settings that are used with my Candela Scleroplus system are 585 nm to 595 nm with a spot size of 5 mm and an energy setting of 8 J/cm2 to 9 J/cm2. The dynamic cooling device (DCD) is usually set on 60. Results are variable but if patients return for two to four visits and the striae are relatively new and pink-red, they are usually pleased with their outcomes.
One caveat to treating pregnancy-related striae is the need to advise your patients that subsequent pregnancies may cause the striae to return and that treating one series of striae does not preclude other striae from forming in the future.
Acne After Pregnancy
Acne is a problem that many women experience during and immediately after pregnancy. Having observed my wife during three pregnancies, I can only assume that there are some subtle fluctuations in hormones responsible for this and a few other things (that is a discussion for a different column, however).
As hormones in pregnancy increase, the mileau of the pilosebaceous structure changes and many women find they develop more acne. Other reasons that acne tends to increase include the relative immunosuppression associated with pregnancy (bad for those with bacteria- related acne) and the requirement for cessation of most acne medications during pregnancy.
Treatments for pregnancy-associated acne may include topical erythromycin and some cleansers. Despite the low risk associated with many topical acne medications, in today’s medicolegal environment, you must exercise extreme caution when prescribing any medications to a pregnant woman, so be sure to refer to your Physicians’ Desk Reference to check on the risks to pregnant women of individual drugs you’re considering for treatment.
One good way to treat pregnancy-related acne is to prescribe topical erythromycin 2% solution (for oily skin) or gel (for normal skin). When using anything other than erythromycin, you should definitely check in with the patient’s obstetrician.
Telangiectasia
Telangiectasia and pyogenic granuloma are frequently associated with pregnancies. The most common treatment for these conditions is time — most abate within a few months after pregnancy.
Some pyogenic granulomas bleed, are located in inopportune locations or grow rapidly enough to cause clinical concern and thus, warrant treatment. Removal of these lesions may be accomplished with a pulsed dye laser if they aren't too thick and by electrodessication if they are not amenable to laser treatment.
Treatment of telangiectasia is similar to that of granulomas — watchful waiting and then use of laser for lesions on the face and hyfrecation or laser for lesions elsewhere.
Liposuction
Getting back defined abdominal muscles is another reason many post-partum women come to see me. After delivery, some women find it difficult to get their shape back. However, the vast majority of them can get their pre-pregnancies bodies back with diet and exercise, and this is my first advice to them. For those who cannot, liposuction offers an opportunity to sculpt the body and remove unwanted fat.
Before contemplating this procedure in a post-partum woman, it’s important to make sure that she’s not lactating, that she is several months post delivery, that there were no complications that might mitigate against performing liposuction (such as a ventral hernia) and that she understands that subsequent pregnancies may result in the need for additional liposuction procedures (some women elect to defer until they are done with childbearing when they hear this last condition). Also, if there is evidence of post-partum depression during a consultation, it’s best to defer the procedure.
I recommend that diet and exercise be utilized for 6 weeks prior to any procedure being performed, and if this does not resolve the problem, then consideration for tumescent liposuction can be initiated.
Areas including the upper and lower abdomen, flanks, hips and thighs are commonly in need of sculpting following pregnancy.
Leg Vein Treatment
Leg veins are another vascular consequence of pregnancy. Despite the many lasers that promise to treat these veins without injections, I have been unimpressed with them to date.
For my patients, I usually rely on sclerotherapy to treat the veins. The solution that I use is hypertonic saline, although in Europe and Canada aethoxysclerol is used with great results. I make sure that the patients do not have a predisposition toward blood clots, that they are not pregnant and that they understand that treatment involves multiple sessions.
My regimen is to inject about 2 ml of 23.4% NaCl at intervals of approximately 3 to 4 weeks. I use either a 30-g or 32-g needle depending on the size of the vessels. On average, three to six treatments are required for improvement to be noticeable.
When there are varicose veins in addition to the spider veins, it’s important to refer the patient for vascular evaluation for endovenous closure (in my area this is performed by invasive radiologists as well as vascular surgeons).
As with other procedures, patients should be told that subsequent pregnancies may result in a return of the vessels or formation of new ones.
Hair Pattern Changes
Changes in hair patterns that follow pregnancy are typically the result of either hormonal fluctuations or telogen effluvium. Hormonal fluctuations that may occur after pregnancy include increased androgens (causing a male pattern of alopecia) or thyroid disease (which can cause a diffuse alopecia). If there is any clinical suspicion for endocrine abnormality, you need to check the appropriate hormone panels for proper diagnosis.
Telogen effluvium may follow a pregnancy by a few months and is marked by a diffuse pattern of hair loss. Fortunately, this type of alopecia is self-limiting and may be treated with observation or minoxidil (Rogaine) (if there is no lactation). I advise patients to use minoxidil twice daily.
Post-Partum Nose Droop
One final condition that has been noted is post-partum nose droop (PPND). This is occasionally noted following delivery and is characterized by a drooping of the nose tip. It may be related to the stretching of ligaments that are hormonally mediated.
Treatments for this include injections of Botox into the depressor nasi and injections of soft tissue augmentation products into the nose bridge and dorsum.
Nowell Solish, M.D., illustrated this technique to me. He injects about 2 units of Botox into the depressor nasi and then a small amount of hyaluronic acid (Restylane in many cases) into the dorsum of the nose.
Providing Care for Pregnant and Post-Partum Patients
Pregnancy and the post partum period are stressful for all concerned.
In many instances, dermatologic and cosmetic dermatologic issues assume a large role in the patient’s life.
Recognition of the various conditions associated with pregnancy, as well as familiarity with the various treatments available, will enable the cosmetic dermatologist to provide expert skin care for pregnant and post-partum patients (and enable them to avoid getting their skin care from the gynecologist who probably has the equipment if not the knowledge to care for their skin).
Also, don’t forget to consider the various options available for treatment of hair loss, weight gain and irritability in the spouse of the pregnant woman.
