Which cosmetic skin treatments wait during pregnancy?
Nearly all elective ones do. Injectables, peels, lasers and energy devices are usually postponed until after the baby is born. A 2026 review in the International Journal of Dermatology proposes a framework for cosmetic dermatology in pregnancy and lactation, and its position is that elective cosmetic interventions are deferred during pregnancy. A 2013 review reached the same advice: delay elective procedures until after birth.
The reason is missing data. Trials in pregnant women are hard to justify ethically, so the published record is mostly case reports, observational studies and extrapolation from women who are not pregnant. Pregnancy also changes the skin itself, which can change both the risk and the result.
Does "not studied" mean "unsafe"?
No. "Not studied" means the question is open. It gives no reason to panic about a treatment you had before you knew you were pregnant, and it gives no reason to call a treatment safe either. Doctors postpone elective work because the downside of waiting a few months is small and the downside of an unknown is hard to reverse. That is a judgement about caution. It is not a finding about harm.
What do the labels say about botulinum toxin and fillers?
They say the data are missing. The 2013 US prescribing information for Botox (onabotulinumtoxinA) states that there are no adequate and well-controlled studies in pregnant women, and that it should be used in pregnancy only if the benefit justifies the risk. In animal studies, the two highest doses reduced fetal weight and bone formation. The same label says it is not known whether the toxin passes into breast milk. That is an older version of the label, and current wording may differ.
The published human evidence is a set of case reports. A 2017 review found that most reports showed no harm and still called the data insufficient for firm recommendations. Two miscarriages were reported, and whether the toxin played any part is unclear. A 2026 survey of 177 US dermatologists found that 75% had given or received toxin while breastfeeding, with no adverse effects reported, and fewer had used it in pregnancy. The authors themselves describe the result as hypothesis-generating rather than evidence of safety. The gap between what doctors do for themselves and what the evidence shows is the point.
For hyaluronic acid and other fillers, the FDA says the safety is unknown in pregnancy and while breastfeeding, and a 2017 review found no reported safety data in pregnancy at all. Fillers carry rare risks in anyone, including lumps and blocked blood vessels, so an elective filler is an easy thing to leave for later. How long the effect of a toxin lasts, once treatment does happen, is covered in how long anti-wrinkle injections last.
What about peels, lasers and other devices?
The same principle applies: definitive advice cannot be given, so they wait. A 2013 review said definitive recommendations on peels, fillers and most lasers in pregnancy cannot be made. A 2017 review of case reports considered glycolic and lactic acid peels to have limited absorption through the skin, and asked for caution with salicylic acid, Jessner's solution and trichloroacetic acid peels. Those are small observations, and they are not a licence.
A 2021 systematic review found lasers used in pregnancy for medical problems such as kidney stones and some skin diseases, but that is a different question from a cosmetic pigment or resurfacing laser. Permanent laser hair removal is not recommended in pregnancy because of missing data. The 2026 review also covers energy-based devices, and its overall position is that elective cosmetic interventions are deferred in pregnancy.
Does breastfeeding change the answer?
Yes, a little. The 2026 review says pregnancy and lactation should not be treated as the same, because the body handles them differently. During lactation, many treatments may be considered after an individual risk assessment, if little of the treatment is expected to reach the bloodstream and the treated site does not touch the baby. Some procedures, including fat transfer, sclerotherapy and tumescent liposuction, are not recommended while breastfeeding.
Many treatments still have no direct data, and the FDA and the Botox label both say breastfeeding safety is unknown or not known. So many mothers and doctors choose to wait until nursing ends. That is a personal decision to make with the doctors who know you and your baby.
Which skincare ingredients do doctors ask about?
Retinoids are the main one. The European regulator says that as a precaution, retinoid creams and gels must not be used in pregnancy or by women planning a baby, while adding that absorption through the skin is negligible and that these products are unlikely to cause fetal harm. Retinoid tablets are a separate matter with their own checks, described in isotretinoin (Roaccutane): what a doctor checks. A 2017 review also advised avoiding tazarotene and hydroquinone in pregnancy because their safety data are unclear.
Sun protection stays useful whatever the stage. Pregnancy can bring on melasma, and the sunscreen question is covered in sunscreen in a tropical climate. Ask your doctor about anything with an active ingredient, and do not stop a prescribed medicine on your own.
What about pigment, hair and pelvic floor after birth?
Many Malaysian families observe confinement (pantang) in the weeks after birth. I do not comment on the custom. The medical question is when a body that has just given birth is ready for a given treatment, and that is worth asking your doctor.
Melasma and stretch marks can improve after delivery, and a 2017 review advised against treating them during pregnancy for that reason. For pigment, the background is in melasma in Malaysia. Hair shedding usually appears about 3 to 4 months after a trigger such as birth, and the cause is worked out from history and tests to exclude hormone, nutritional and autoimmune causes. How often it occurs after birth is less firmly measured than people assume, and a 2016 review argued the evidence for it is thin. If the shedding is heavy or lasts long, see hair loss is several diseases and ask a doctor.
Pelvic floor recovery after birth is a separate topic. When to begin any treatment is a decision for the doctor who delivered you and the clinician you choose, and it is described on the Emsella page. I am not stating a start date here.
What should I ask my obstetrician?
Bring the list. Which treatment am I considering, and does it need to happen now? Would it be different while breastfeeding? Is there a product I use daily that I should stop? What should I do about a treatment I had before I knew I was pregnant?
On the last question, a 2017 review noted that when a patient is injected with botulinum toxin in the first trimester before knowing, providers should reassure her, because the published cases show no fetal harm. That is reassurance from limited evidence, and your obstetrician should hear about it.
Skin treatments rarely have a deadline. Waiting a season costs little, and the doctor who is following your pregnancy is the right person to say when.
Common questions
Is Botox safe during pregnancy?
Nobody can call it safe, because it has not been tested in pregnant women. The US label says there are no adequate studies in pregnant women. Case reports have not shown harm in most cases, but reviews say the data are too thin for firm advice, so elective toxin is usually postponed. Ask your obstetrician.
Is filler safe while breastfeeding?
The FDA says the safety of dermal fillers is unknown during pregnancy and while breastfeeding. Unknown does not mean harmful, and it does mean there is no evidence to lean on, so most treatments wait until nursing ends.
Can I use retinol or a retinoid cream while pregnant?
The European regulator advises that topical retinoids not be used in pregnancy or when planning a baby, as a precaution, while noting that absorption through the skin is negligible. Ask your doctor about any product with an active ingredient, and about accidental use.
Sources
- Kovacs T, Nadir U, Goldenberg M, et al. Cosmetic Dermatology in Pregnancy and Lactation: A Risk-Benefit Framework for Clinical Practice. Int J Dermatol 2026 (online 24 Aug) Narrative review: the literature is mostly observational studies, case reports and extrapolation; pregnancy and lactation are not equivalent counselling states; in pregnancy elective cosmetic interventions are deferred; in lactation many may be considered after individualised risk assessment when systemic exposure is minimal and treatment sites avoid infant contact.
- Lee KC, Korgavkar K, Dufresne RG Jr, Higgins HW 2nd. Safety of cosmetic dermatologic procedures during pregnancy. Dermatol Surg 2013;39:1573-86 Definitive recommendations on peels, injectables, fillers and most lasers in pregnancy cannot be made; no controlled trials; advisable to delay elective cosmetic procedures until after the baby is born.
- Trivedi MK, Kroumpouzos G, Murase JE. A review of the safety of cosmetic procedures during pregnancy and lactation. Int J Womens Dermatol 2017;3(1):6-10 Botulinum toxin data insufficient for concrete recommendations, case reports suggest no harm in most; no reported safety data for fillers in pregnancy; peels, hair removal, tazarotene, hydroquinone, melasma and stretch marks; lactation exclusions.
- Cucalon J, Taylor D, Tolkachjov SN, et al. Practice Versus Protocol: A Survey of Current Botulinum Toxin Use During Lactation and Pregnancy in Dermatology. Dermatol Surg 2026;52(7):653-656 Survey of 177 US dermatologists: 75% reported giving or receiving toxin while breastfeeding with no adverse effects reported; use in pregnancy by 8%, 5% and 7% by trimester; authors call it hypothesis-generating, not evidence of safety.
- US Food and Drug Administration. Dermal Fillers (Soft Tissue Fillers). Content current as of 7 June 2023 The safety of fillers is unknown when used during pregnancy and while breastfeeding.
- US prescribing information for BOTOX (onabotulinumtoxinA), 2013 label, sections 8.1 and 8.3 No adequate and well-controlled studies in pregnant women; animal findings at the two highest doses; not known whether excreted in human milk. This is the 2013 version.
- European Medicines Agency. Updated measures for pregnancy prevention during retinoid use. 23 March 2018 Topical retinoids are less likely to cause harm but must not be used in pregnancy or when planning a baby, as a precaution; systemic absorption negligible.
- Allameh F, Javadi A, Dadkhahfar S, et al. A Systematic Review of Elective Laser Therapy during Pregnancy. J Lasers Med Sci 2021;12:e50 Review of laser use in medical fields (kidney stones, skin disease, varicose veins) during pregnancy; not a review of cosmetic lasers.
- Malkud S. Telogen Effluvium: A Review. J Clin Diagn Res 2015;9(9):WE01-3 Diffuse shedding appears 3 to 4 months after a triggering event; establishing the cause needs history and tests to exclude endocrine, nutritional and autoimmune disorders.
- Mirallas O, Grimalt R. The Postpartum Telogen Effluvium Fallacy. Skin Appendage Disord 2016;1(4):198-201 A retrospective review found no significant data showing different shedding between pregnant and postpartum women; the true incidence of postpartum telogen effluvium is unknown.
Disclosure: In 2022 Dr Ong was a key opinion leader for Botox for Allergan, which makes Botox, the Juvéderm range and CoolSculpting, and he has spoken for Allergan on botulinum toxin and at the CoolSculpting launch in Manila (2019). In November 2018 BTL Aesthetics, which makes Emsella, Emsculpt and Vanquish, named the clinic a HIFEM Centre of Excellence, and in April 2019 Dr Ong spoke at the Malaysian launch of BTL Unison. How he thinks about ties like these: The quiet we kept: what shapes what your doctor recommends.
