What can you do about pigmentation, stretch marks & thread veins post-pregnancy. Dr Nick Lowe explains some treatment options.

There’s so much that’s wonderful about becoming a new mum but for some women pregnancy comes with a few physical changes that they’d like to address. Fortunately these days there are a number of post-baby skincare strategies that can deliver good results.

These are some of the most common concerns we see at the clinic and some suggestions for dealing with them.

Melasma (Mask of Pregnancy)

Melasma, ofter referred to as the ‘mask of pregnancy’ is the formation of irregular pigmented patches that often appear on sun-exposed areas such as the face, usually on the cheeks, forehead and above the top lip.

It’s often more noticeable in women with olive skin and is a very common condition during and after pregnancy with an estimated 50 per cent of women experiencing melasma to some degree. Hormones are responsible and it can also be triggered by the contraceptive pill.

It’s thought to be caused by increased levels of the hormones oestrogen and progesterone, which stimulate melanocytes to produce more melanin – the same pigment that causes skin to tan. It can occur many months – or even years – after pregnancy or taking the contraceptive pill. We believe that the hormonal shifts may alter the pigment cells, so they become more sensitive and responsive to low levels of UV light.

After giving birth, some women see a spontaneous fading without treatment. Most though only see an improvement in the winter, and the melasma returns in sunnier months.

But the good news is there are treatments that can help. The ones I select are dependent on whether the melasma is deep or superficial.

Melasma Treatment plan

The include:

• During pregnancy: I suggest that both during and after pregnancy, patients use a broad-spectrum sun protection daily. I would advise against using sunscreens containing oxybenzone. There’s no point in commencing any other treatment unless you are prepared to apply moisturiser with sunscreen every day as even low levels of UVA coming through windows can darken melasma.

After your baby’s delivery:

• More than likely, I will then prescribe a lightening cream from the selection of prescription strength hydroquinones. I suggest prescription lightener is applied to the whole face at night.
• Active treatments vary. One of the best is the new Fraxel Dual laser, so-called because it has two wavelengths. With this laser, I can treat the melasma and also any other sun damage and wrinkling if necessary.
• Follow up treatments can include mircodermabrasion, IPL (Intense Pulsed Light) or peels.

Stretch Marks

Stretch marks are another common issue after pregnancy and are stripe-like areas of skin that can be mildly discoloured, silvery or even reddish/purple.

We don’t know the true mechanism that causes stretch marks to form but we think that as well as the physical stretching of the skin, oestrogen may have an effect on the collagen and elastin.

As there is often little correlation between the size of the mother or baby and the appearance and severity of stretch marks, there may be a genetic component too.

Post-Pregnancy Stretch Marks Treatment Plan

• As stretch marks can improve and disappear after giving birth, I advise waiting at least three or four months – maybe even longer – before embarking on treatment.
• If they don’t improve, some of the stronger prescription retinoids can help. I usually suggest an application twice a week to start with, which is then washed off after ten minutes. Usually this has to be continued for at least 6 months.
• The Fraxel laser can prove useful, with the Fraxel Dual more suitable for milder marks. For those that are more prominent,  I will sometimes run over them very lightly with a low setting Fraxel CO2 laser to stimulate new collagen and elastin to tighten the stretch mark. If they are purple, then the vascular lasers can be used instead to reduce the darkness.

Sagging Skin

As the abdomen stretches during pregnancy and some of the muscles lose tone, the skin can become saggy following childbirth. If the mother-to-be is having her child later in life, as many women are, the skin’s loss of elasticity as a result of the ageing process may contribute to the problem.

Post-Pregnancy Sagging Skin Treatment Plan

• It’s worth waiting a few months after childbirth to let your weight stabilise and allow the skin to contract as much as it can naturally in problems areas such as the abdomen, thighs and love handles. Once it has stablised, and if you feel you are left with excess, stubborn areas of fat, our latest fat freezing treatment Zeltiq is highly effective on these areas.
• If you still have lax skin on the abdomen, it’s possible to treat it with radiofrequency (RF), which produces energy that heats areas of collagen in the skin, causing it to tighten. Over time, the body may also form new collagen, increasing the tightening effects. I’m impressed with the results that can be obtained with the latest Thermage or Mono-polar Radiofrequency Comfort Pulsed Technology (CPT) machine. It’s more comfortable for the patient than older models. This means we can use more energy, which in turn, produces more noticeable effects.

Thread Veins

Another problem that patients report during and after pregnancy is the appearance of thread veins/spider veins. They are most commonly found on the face, chest and legs and are associated with increased levels of oestrogen.

Again, my advice is to wait at least three to four months following childbirth before embarking on treatment as they often go away without intervention.

However, if they don’t, they can be treated in various ways depending on their severity and location.

Post-Pregnancy Thread Vein Treatment Plan

• For the face and body, I can use a vascular laser, which heats the tiny veins, and coagulates the blood inside. The vessel wall then collapses and over the following weeks, as the body works to remove the blood, the appearance of the vein clears.
• If the spider veins are on the legs, I will often treat them with sclerotherapy. Using a very fine needle, a painless solution is injected into the vein, which causes its walls to stick together. This means that vein become less visible or disappears altogether.

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