So, you’ve made it through 9 months of pregnancy and now that the dust has settled and you are getting down to the joys of motherhood, you are perhaps realising that you might have lost that pregnancy-glow and perhaps haven’t had your anti-wrinkle injections for over a year? Frown lines are creeping back and your skin is looking dull and tired? This is a familiar story we hear from our patients on a fairly regular basis, and the question for many at this point is whether cosmetic procedures are safe to have when you are breastfeeding?
What are the facts about cosmetic procedures when breastfeeding?
Very few actual scientific studies have been conducted looking particularly at the safety of cosmetic procedures during lactation (breastfeeding). Clearly, the main concern in this situation is the possibility of chemicals or medications being absorbed into the mother’s system and from there excreted into her breast milk, which could potentially affect neonatal growth and development. Review articles in Dermatological Surgery in 20131 and in the International Journal of Women’s Dermatology 20172 both summarised that most cosmetic procedures are safe to use during lactation since there is low concern for significant systemic absorption of any of the agents used in these procedures. In more detail….
Chemical Peels when breastfeeding
Superficial and medium depth chemical peels do not lead to absorption into the body, as long as care is taken around mucosal surfaces such as the mouth and eyelids. Therefore, we can be confident that routine cosmetic peels are safe during breastfeeding. Peels containing high concentrations of salicylic acid (including Jessner’s peels) and TCA are not recommended for use in pregnancy but can be used safely when breastfeeding.
Anti-Wrinkle Injections & Dermal Fillers when breastfeeding
Scientifically speaking, the doses of neuromodulators/anti-wrinkle injections (sorry – I am writing this in Australia where the law prevents me from mentioning the names or ingredients of these) that are used cosmetically are very small compared to the doses used for medical reasons and carry only a very low risk of systemic absorption into the mother. On top of this, the molecular size of neuromodulators, and incidentally of dermal filler materials, make them incredibly unlikely to be excreted into breast milk, with their use in lactation being deemed by experts to be safe1,2. However, despite this consensus opinion, the use of these products in lactating mothers remains off-label. No large scale studies have been (or will be) performed, and so as prescription medications they are not technically licensed for use during breastfeeding. For patients who remain concerned, we recommend the “pump & dump” technique – continued breastfeeding with pumping and discarding the breast milk in the first 24 hours after treatment.
Hydrafacial® when breastfeeding
This popular medical-grade facial treatment uses a low concentration of salicylic acid, but at a level that would be considered safe to use both during pregnancy and breastfeeding.
Fat transfer when breastfeeding
Procedures which necessitate the redistribution or removal of fat such as fat transfer or tumescent liposuction are not recommended in the immediate postpartum period, although not specifically because of breastfeeding. These procedures have an invasive nature and there is a lack of safety studies particularly in the postpartum period. Increased fat stores are expected because of pregnancy, and women should allow for stabilization of their postpregnancy weight before pursuing cosmetic procedures. Non-invasive fat removal methods such as cryolipolysis (fat-freezing) and injectable fat-dissolving medications have also not been studied during breastfeeding and therefore safety data is not available, although it would seem reasonable that these could be used during breastfeeding once post pregnancy weight has stabilised.
Sclerotherapy when breastfeeding
Sclerotherapy should also be avoided during lactation1. Generally, hypertonic saline solutions that were traditionally 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 pursued this therapy and continued breastfeeding with pumping and discarding the breast milk in the first 48 hours after treatment. Nevertheless, there are no reports on the outcomes and/or complications of doing this and therefore experts can not make a recommendation on its safety.
Laser & Lights
With regard to laser procedures, the wavelength of light is theoretically not deep enough to affect function of the milk ducts. Low-level laser therapy can be used to treat postpartum mastitis as well as sore nipples and to enhance wound healing after episiotomy, and has been shown to have no serious effects on lactation3,4,5. Laser therapy should not produce adverse effects on lactation, breast milk production, or quality of breast milk1, and so can safely be used for cosmetic facial indications during breastfeeding. This applies to LED light therapy and biophotonic treatments (Kleresca®) such as are used for acne, as well as pigment, vascular and fractional ablative lasers. We should point out that treatment of pigmentary changes (such as melasma) and increased facial hair growth caused by pregnancy-related hormonal changes should not necessarily be treated until the hormones have stabilised as results may be suboptimal in these situations.
1. Lee K.C., Korgavkar K., Dufresne R.G., Higgins H.W. Safety of cosmetic dermatologic procedures during pregnancy. Dermatologic Surg. 2013;39:1573–1586.
2. Trivedi M.K., Kroumpouzos G., MuraseJ.E. A review of the safety of cosmetic procedures during pregnancy and lactation. Int J Women’s Dermatol. 2017; 3(1):6-10.
3. Kymplova J, Navratil L, Knizek J. Contribution of phototherapy to the treatment of episiotomies. J Clin Laser Med Surg, 2003; 21:35–9.
4. Pietschnig B, Pani M, Kafer A, Bauer Wais E, et al. Use of soft laser in the therapy of sore nipples in breastfeeding women. Adv Exp Med Biol, 2000; 478:437–8.
5. Kovalev MI. Prevention of lactation mastitis by the use of low-intensity laser irradiation. Akush Ginekol (Mosk), 1990; 2:57–61.