Pregnancy and Aesthetic Treatments with Dr. Simons OBGYN | Episode 20

Welcome to another episode of Fill Me In! In this episode, we dive into the world of pregnancy-safe aesthetic treatments with our special guest, board-certified OBGYN, Dr. Christopher Simons. We explore common questions around pregnancy, from safe skincare and treatments to the physiological changes that occur. Dr. Simons provides expert insights on topics such as melasma, acne, hair changes, Botox, fillers, and more. Nicole, who is currently pregnant, adds her personal experience and questions to the discussion. Tune in to get informed about the do's and don'ts during pregnancy and discover treatments you can safely enjoy. 

*Disclaimer* -The information provided in this podcast is for educational and informational purposes only and is not intended as medical advice. Always seek the guidance of your physician or a qualified healthcare provider regarding any medical condition or treatment.

Follow Dr. Simons on Instagram: https://www.instagram.com/punkrockobgyn/


On Fill Me In: An Aesthetics Podcast, Jon LeSuer NP-C and Nicole Bauer FNP-BC dive deep in the world of aesthetics. As aesthetic nurse practitioners with their own medical practices, Jon and Nicole fill you in on everything in their field.

Follow Fill Me In on Instagram!
https://www.instagram.com/thefillmeinpod/

Follow Nicole on Instagram:
https://www.instagram.com/aestheticnursenicole/

Follow Jon on Instagram:
https://www.instagram.com/injectorjon/

Exhibit Medical Aesthetics website:
https://exhibitmedicalaesthetics.com/

Tox and Pout Aesthetics website:
https://toxandpout.com/


Jonathan LeSuer, MSN, NP-C 

Jonathan LeSuer graduated from Le Moyne College with his Bachelor’s in Nursing in 2014 and a Family Nurse Practitioner degree in 2017. He began his career at St. Joseph’s Hospital as a Registered Nurse on a cardiac medical-surgical unit. He transitioned to the Nurse Practitioner role in 2017, working for Hospitalist Medicine, where he became the coordinator for the team’s Physician Assistants and Nurse Practitioners. In 2020, he started his career as an Aesthetic injector and quickly found out that this was his passion. On March 15th, 2022, he opened Tox & Pout Aesthetics. He is now a Master trained injector & National trainer for Allergan Aesthetics, offering Botox, Dysport, Hyaluronic acid fillers, Kybella, SkinViVe skin booster, and Sculptra. Jonathan is known for his empathy, profound bedside manner, and outgoing/warm personality. He has a deep love for aesthetics, and his patients’ confidence is his main priority. 


Nicole Bauer, MSN, APRN, FNP-BC. 
Family Nurse Practitioner 

Nicole graduated with her Associates in Applied Sciences and began her journey as a registered nurse 10 years ago in 2014. She worked hard to combine her love for beauty with her passion for caring and healing others, attending aesthetics school while working as a hospital night nurse. After graduating as a licensed aesthetician, Nicole left the hospital where she had been for 3.5 years and began working as a registered nurse for a plastic surgeon. An experience of over 6 years that would leave her with so much knowledge and respect for the aesthetic world. It was during those 6 years that she pursued her Master’s Degree and obtained her license as a Family Nurse Practitioner, leading the way for where she is now; owning a state of the art medical aesthetic practice and being a national Allergan Trainer. Nicole takes pride in treating her patients holistically, focusing on facial balancing and enhancing one’s natural beauty. She believes education stands as the cornerstone of aesthetics and is why she is dedicated to both training others while always focusing on expanding her own knowledge as well.  


Producer of Fill Me In: Joseph Ginexi

Chapters

• 0:00 Introduction
• 0:39 Pregnancy-Safe Treatments in Aesthetics
• 4:21 Melasma and Hyperpigmentation
• 6:16 Dermatitis and Other Skin Sensitivities
• 15:13 Botox and Breastfeeding
• 20:13 IVF and Botox Considerations
• 23:00 Hair Changes During and After Pregnancy
• 26:29 GLP-1s and Pregnancy
• 31:50 Preventing and Managing Stretch Marks
• 36:42 DES and Pregnancy
• 38:43 Laser Treatments and Skin Reactions
• 46:26 IV Therapy and Hydration During Pregnancy
• 48:59 Skincare Ingredients to Avoid
• 57:59 Vaginal Rejuvenation and Cosmetic Procedures
• 1:00:18 Hormone Replacement Therapy

Transcript

  Welcome back to another episode of the Fill Me In Podcast, where we dive deeper into the world of aesthetics. This is Injector John 

and Aesthetic Nurse Nicole. 

And we have a very, very special guest today, a board certified OBGYN, Dr. Simons. Thank you so much for joining us today. Thanks for having me, John.

Thanks for Nicole. And he has probably the coolest Instagram name or handle I've ever heard in my life. It's you can follow him at punk rock OBGYN, which is incredible.  And for those of you that are watching on YouTube right now, he totally looks the part. So. Um, but Dr Simons, we wanted to have you on because we have a huge, a huge topic is pregnancy safe treatments in the world of aesthetics.

And there's a lot of literature out there. You know, people want to know, can I get Botox and I'm pregnant, you know, or I'm breastfeeding. Is it really going to harm the fetus? Um, can I continue using retinols while I'm pregnant? Um, what pregnancy safe skincare is there? And obviously. Nicole and I are well averse and a lot of those pregnancy safe, um, medical grade skincare treatments.

But, um, we wanted you on here and Nicole is pregnant as well. So, yes, yes. 

Yes. Yeah. So I just been getting so many questions, so many DMs about what's safe and what can I be doing? What shouldn't I be doing? So We thought it'd be a great episode. Uh, we kind of wanted to start out with the changes that pregnancy causes.

Uh, definitely we see increased pigmentation, stretch marks, sensitivity, acne. Uh, but if you could kind of dive into that a little bit, melasma. Yes.  

So sure. So, uh, pregnancy hormones. Um, you know, when we think of traditionally, you know, you have a lot of changes in hormones overall in pregnancy. The first, uh, really is. 

Uh, your beta HCG, which is what's positive when you take a pregnancy test. So this beta, HCG sends a surge of progestins as well as estrogens in the female body. And then subsequently you have a gradual rise of progestin and estrogen over the course of pregnancy until they abruptly are taken away after you deliver.

And so what that leads to is actually a lot of changes when it comes to hair, when it comes. when it comes to your nail  many other systems  that w to touch on today. But in  um, can play havoc on a  p or how they feel. And so, and progesterone are your  probably the ones that we But you see a lot of chan  to this pregnancy hormones  You know, and that can be evident even when patients are just taking hormones, um, or having changed their hormones, they might have skin changes and inherent, uh, nail changes as well.

Right. Now, does it matter if, you know, whether we're having a boy or a girl, is there, you know, does it depend on, cause I, you know, you hear so many different stories from women saying, Oh my God, you know, I had two girls and my melasma was so bad with them. I had a boy, I had none or, you know, or is it just kind of like your body? 

Yeah, 

boys have more heartburn. I hear that one a lot in the office. I just go 

say I've been having heartburn. So,  

yeah, that's also, that's a, that's a progestin mediated, um, mediated one. Progestin is kind of, you can point your finger at all of that because it dilates your smooth muscles, slows down your GI tract.

So, yeah, You know, when it comes to things like heartburn, constipation, um, all of those, uh, you know, poor digestive issues, it's really, 

yeah,  

it's, that's because of that progestin. But I don't think that there's many differences in estrogen and progestin, um, based on the sex of baby. So, you know, I think that we have a lot of anecdotal things, you know, every pregnancy is different, right?

Every, um, and, uh, so people like to have answers for those questions, but that's not going to matter. So. You know what you're having yet? Yeah, it's a, 

it's a boy. All right. 

All right. Well, Chris is a great name for a boy or a girl. I'm just throwing that out there. 

I'll keep it in mind. Add to the list. My ever growing list.

Oh my God.  I think our major thing that we get all the time is the melasma talk. And, um, when I was kind of diving into this, I also saw, I'm going to probably butcher the name, but  

Colasma, 

so the differences and not everyone gets melasma, right? I think they're the same thing, aren't they? Yeah, 

it's just a diagnostic 

term, 

right?

Yeah. So it's really just, um, so there's different places that you can get melasma and colasma, you know, it's kind of just a, another way to. To say about the to talk about the same thing, but what it is is really, it's a  kind of a characteristic hyper pigmentation. And that can be very apparent, like, in the cheeks and upper lips nose.

And it's actually very, very common. You'll find that about 75 percent of pregnant women will report some sort of hyper pigmentation and changes. And again, that is estrogen and progestin 

mediated. Um,  

You know, there are risk factors, right? If you have a family history of it, if you have a lot of exposure to sunlight and then characteristically, if you are closer to the equator, traditionally that you're going to have greater amount of plasma clinically. 

Yeah. But you know, the good news on this one is for a lot of people, it will clinically regress. So as those hormones go back down, um, you will see an improvement. Um, some people can have like a little bit of change that stays with them kind of forever. Um, and then, you know, then the more pregnancies that you have, the more up and down your hormones go, these things can, you know, stay and then bother more people over time.

But we usually say that, um, the majority of people, it will regress within a year. And. A year is a lot of time,  you know, but maybe we're hoping that they don't come back and ask about it again,  you know, or they've moved on, you know, to, to you guys where, you know, they're going, moving on to getting peels and treatments to, to deal with it at that point.

No. Also too, I know Nicole, you're suffering a little bit from dermatitis, which I know can, I think be exacerbated during pregnancy and like the hormonal changes. So is that something common that can happen to as well, Dr. Simons? Oh, yeah. 

So everything. So mucous membranes in general kind of go by the same concepts as the rest of the body.

So when we talk about those physiologic changes that are mediated by progestin, a lot of those is because you're taking on extra fluid. And that fluid Is going into those extra spaces inside your cells and inside your skin and all of these extra tissues. And so your mucous membranes are no different.

You know, classically, one of the things we talk about our pregnant patients are difficult to intubate. Why? Because their throats, everything gets Bigger and full of fluid. More ADEMs. Mm-hmm  . But then also that plays part into, when we think of like lower extremity swelling, when we think of, you know, your face and neck, your hands, all of these spaces are actually taking on fluid physiologically over the.

Course of nine months. And this could be a physiologic adaptation of us over time. Just actually preparing for hemorrhage, right? If you store a lot of fluid, then as you have that, you know, rapid remodeling of your heart during delivery, you might have a rapid loss of fluid or rapid loss of blood. And so you have that ability to pump that.

extra fluid that you've been storing back in circulation to help, um, you know, physiologically survive. Um, you know, now we have plenty of IV fluids, we got plenty of blood, we don't need it as much, but our bodies don't know that, you know, we still think, you know, oftentimes that we're, you know, out under a tree or, you know, in a field or something, you know, so, and that's kind of still 

prepping, right?

Yeah, exactly. You know, I noticed that with my, um, like my sinuses.  They're definitely inflamed. And when I go to take like a deep breath through my nose, I, it's not the same, 

but 

yeah, the perioral dermatitis has been so frustrating. I just started, um, metronidazole cream. 

Okay. 

Um, um. But only three days in, but yeah, it's, it's hard to treat.

I was moisturizing like crazy. I think the weather doesn't help. 

No. Yeah. Yeah. We, we, you know, we go from, uh, you know, 40 degrees and then it's minus nine with wind chill today. So, you know, that doesn't help. 

Yeah. Yeah.  But 

Jonathan's got a full on, you know, sweater and everything. Oh my God. It's my, my office is like two degrees in here.

I 

saw a fire before.  

You'd think you were in your, um, your front yard, John. Well, 

I have a heater underneath my seat right now, too. It's just cold in this room. I don't know what's going on. My dermatitis is going to be flared up very shortly, especially with 

that heater. 

Oh yeah. 

Hey guys, just popping in. If you're enjoying our podcast, please subscribe.

And don't forget to follow us on Instagram, Injector John and Aesthetic Nurse Nicole. On top of like sensitivities, like dermatitis, you see a lot of acne sometimes too, right? Right. 

Oh yeah. Very common. So I'll actually see like 50 50 with acne. So, you know, because there are a lot of women out there whose acne might be hormonally mediated to begin with, you know, because they might have PCOS or they might have excess.

estrogens, excess androgens. And so a lot of times you'll see women who have, um, you know, uh, especially in the first and second trimester, their acne will get a lot worse. Um, and then sometimes in the third trimester it can get worse. So it's really person to person dependent, but I kind of see it go either way.

And then also you have like a, um, your sweat glands, um, they, Will increase and they'll be more, um, just, uh, like you'll get hyperplasia and increased amount of your Ekron and African plans. And then the sebaceous glands as well. Um, they can go up and, uh, cause increases in acne. And so any hormonal changes, right.

You know, we talk about oil, more oil, more congestion. Yes. A hundred percent. And, uh, to, you know, a lot of people change their routine. Um, and you also, um, we ramped down.  immune system. So your barrier immune system, so skin, hair, those things actually, you know, get turned up from all of this excess fluid. But your learned immune system, things like, um, immunity to, uh, viruses and such gets turned down.

So when you're talking about, you know, problems with your mucous membranes, et cetera, um, that can play a part of it as well. 

Mhm.  

Yeah. And it's tough because like you said, you got to change your routine. So you got to take out that retinol if you're using it. Right? Yes. 

Retinol is not. That's one that we know, um, is not good in pregnancy.

We don't do a lot of studies on pregnant women. We don't have a lot of people signing up.  So a lot, a lot of these studies, um, you know, are retrospective. They're after yeah. Things have come out and the possible repercussions of them. Um, but so retinol is one that that's fairly common, you know, it's common out there and we typically recommend having a reliable form of birth control.

Um, if you're on retinol products, especially because, you know, many of the people that are on it are young, young women or young people, 

right? Especially, um, any form of oral retinol to like any kind of Accutane. I've done Accutane in the past many years ago. Um, but anything like that, you have to be so careful with. 

The pregnancy glow that's related to an increase in oil too, right?  

So, you know, my, my thoughts on pregnancy glow. So, so you have high estrogen, right? You've got hyperpigmentation of his skin. You've got increased, um, you know, fluid volume and hydration, you know, you're good. You're going to look like you're glowing.

Most people are walking around, you know, their estrogens low. Um, they're, they're dehydrated. They're not feeling good. Yeah. You know, and then you add it, you know, pregnancy. Oftentimes people can be very happy about pregnancy, but it's definitely, you know, I think you guys probably a lot of the products that you guys use a lot of the treatments are aimed at hydrating skin, right?

And so physiologically, I mean, you're, you're giving patients extra hormones and then you're making sure they're well hydrated. And I think, you know, half the time when I see patients in my office, I'm telling them, I'm asking them, you know, what color is your pee? You know, these are things we talk about it, you know, and I'm like, because I can tell, like, are you hydrating enough?

And you know, and that's one of the big things. 

Yeah. It's so funny. Cause normally I'll get up like five times a night to pee. And last night I slept through the night and I'm like, I did not drink enough water yesterday.  

A 

hundred percent. That's an indicator.  

Well, it's so funny. We're talking about right now because there's, um, like a, she's an esthetician, but she's an influencer on social media.

And she talked about Nicole, like how she's used  retinol during pregnancy. She did her own research and things like that. Like I won't name her name and it's fine, but she publicly talks about it, um, how she did it through her pregnancy. Um, it says that, you know, she thinks it's safe and it's fine. Um, but I don't 

know. 

I don't. Yeah. 

Yeah.  I mean, so, you know, like  babies are resilient, right? Like we as a species have been propagating for the beginning of time. We, we want to survive, you know, and our bodies are constantly trying to self regulate, constantly trying to fix it, you know, but if we do enough to mess it up, we can, you know, we can, um, we can mess it up.

And so, you know, retinol has been, you know, associated with like, uh, heart problems with cleft palate, um, with CNS problems, deafness. blindness, hydrocephalus. So, so there are a lot of things and again, everything is probably, you know,  

but I guess my question is, it's like what percentage of the topical retinol is actually making it, you know what I mean?

And yeah, you don't have to say,  

like everything is dose dependent, right? You know, so a lot of these studies, like, um, for instance, how many people are out there and are on a product like this and then find out they're pregnant and then just continue it. And so, you know, the overall number of birth defects associated with this is going to be fairly low, but we do know that it puts you in that higher risk bracket, you know, for developing those things.

And so, you know, we would say stay away from them because there is a chance. of those things happening. And again, it's probably going to be dose dependent. You know, if you're someone using it every day, and then for the entirety of organogenesis, which we're talking about five to eight weeks, you know, pregnancy where the most of the organs are developed.

Yeah. You're, you're probably going to see, you know, a higher percentage of birth defects or problems with that. So, um, you know, I know this is for, A lot of entertainment purposes, but stay away from retinol. And if you're thinking pregnant,  there's no safe lot. Like a lot of things, there's, there's no safe amount.

Less is less is better.  Probably. 

And more obviously, you know, Botox is an apple. Absolute. No, no. When, if you're pregnant, um, now, but when you're breastfeeding, you know, we have so many patients that after they pop that baby out, they're like, I need my Botox. Like, you know, I don't care if I'm breastfeeding, I'll just pump and dump for a couple of days.

I have so much milk stored. Like, what are your thoughts on that? Cause I know there's been like recent literature that just came out too. 

Yeah. recent study. Yeah. 

So, you know, the thing about Botox is so there's a lot. First off, let's talk about the physiology of Botox, right? You know, so first off, Botox is something that you're probably not using every day, you know, in, in your, you know, in your field, you're using it probably 1 injection time, you know, and then.

Maybe, you know, you're not something that you're using on a weekly basis. You know, it's something that you're doing maybe quarterly, let's say. And so again, um, in there's been a couple anecdotal studies and a couple, um, you know, just retrospective looking back on people who've gotten pregnant, especially when it's Botox for migraines, because there's a, um, a lot of data on that.

And then, um, there haven't been any adverse  outcomes based on those retrospective studies. Um, and so now with breastfeeding, um, there hasn't been a tremendous amount of literature, right? We have, I did see, um, one study that was on PubMed that you guys had shared with me before, um, you know, where it said that there was, I think it was four lactating women with 16 samples, um, and they had eight, um, had a detectable amount of Botox in breast milk.

It was well below, you know, what would affect the fetus. So, I mean, based on that, um, we would probably say, yes, is it detectable in breast milk to some extent, probably, is it going to be enough that's going to affect the infant? Probably not. So, but what would the safest thing be to not use it? Because it would be detectable in breast milk to wait until you're done breastfeeding, um, you know, and then it would be probably a good study would be how long does it stay?

Detectable and breast milk, you know, that would be the next thing so that we can get because there's a lot of medications whether you're getting contrast or something, you know, if we could safely have a, you know, a well studied time frame that says it's detectable and breast milk for 24 hours, it gives us a great recommendation for people to say, you know, what's safe and what's evidence based.

Based, you know, I think right now, um, especially with the litigious nature of, um, OBGYN, uh, you know, giving birth, we, we don't want to do anything. That's going to jeopardize baby, right? You know, it's everything. Um, we want to look back and we say, say that we didn't do anything to harm anybody, but this is something that is very common.

And so it's, we should be getting a much larger data set over the next years as Botox is more readily available. As more people get pregnant or are pregnant and getting Botox and didn't realize it, you know, I didn't realize they were pregnant before they were going in. We should get some more data on that.

Um, and we should also, you know, have more studies available and say, how is this, is this transmitted in breast milk? How long is it present in breast milk and what levels? Because, you know, like every other. medication out there. We do a fairly good job of investigating these things. I think it's probably, you know, well worth the time and effort to find that out because it's becoming more and more common, right?

You know, so I think it would be great. Um, my, um, disclaimer would be that, you know, as of now. We don't have the information so that so the answer is always going to be, you know, the safest thing would be to avoid the safest thing would be to abstain. But that doesn't mean that that won't change once we get more data and I hope that we do, because, you know, the accumulation of data in these scenarios, all of these, um.

It's asking the questions about these things. There's going to give us better answers over time,  right? 

Right. Yeah. And I was so excited to see this study and then I saw it was only four participants. I'm like, Oh, 

I know, you know, we have so many people lactating out there, you know, like we could, I feel like we could fund this study.

We definitely could. 

Give me some samples, everyone. Give us, uh, send us some emails.  That'll be my next study. But yeah, I, I read that and I was like, Ooh, I don't know, as a expecting mother myself, if I would be comfortable knowing that there is trace amounts, you know, being, yeah.  in the milk. So it's a tough decision.

Yeah. The other thing with that was that they, they monitored on lethal dose. So lethal dose of infant is a lot of Botox. So I hope, you know, I hope they're not trying to titrate 

that one. Oh my 

God.  

Isn't it like 3, 500 units for adults? I think 

for adults. Yeah. So it's probably, I can only imagine what it is for infants, but probably 

half that. 

Yeah. Yeah. But I think another question too, that we get a lot of the time along with, um, Breastfeeding and Botox is if I'm doing like IVF or if I'm trying to get pregnant, I always say, if you're trying to get pregnant, I think it's honestly, it's fine. You're not currently pregnant, but IVF treatments.

What is your thoughts on that? 

So it depends. So IVF gets. Gets really complicated because what happens is you have a lot of, um, a different spinning variables, right? Um, and so it depends really where in that process. You are, um, if you're in the process of egg. Retrieval and harvesting. You know, it's probably the best to stay away from it at that point.

But again, these are short time periods. You know, if you're actively taking injectable medications to stimulate egg retrieval, I would probably recommend trying to eliminate as many variables as possible.  Um, but again, this is a very short, you know, a short time in the IVF process. Um, if they've already, You know, taking your eggs if they're, um, you know, getting ready for implantation again, you know, it would be talking to that reproductive endocrinologist getting their thoughts.

I mean, I don't see a lot of contraindications that if they, you know, if, you know, but again, there's, there's so many different parts and moving parts and a lot of these, um, you know, it would really depend on where it is and when it is. 

Yeah. Yeah. And like you said, like, there's already so many variables.

Why add another one? Yeah. I always say if you're on IVF, when people ask me, I'm like, it's better to just hold off in my opinion. 

Yeah. So like, you know, like I said, they're probably the safest thing is to stay away. You know, we're trying, we're always, whenever a patient is having. Infertility, or a couple is having infertility.

We're trying to eliminate as many variables as possible. And a lot of medicine is, is just that, you know, the process of elimination, right? You know, do we have good eggs? Do we have good sperm? Do we have a, a good cavity? Do we have any medications or, you know, stressors or, and all of these things and, and.

We also need a little luck, right?  So we're trying to eliminate variables and not try to happen. 

Yeah. Yeah. And I'm sure you get that all the time, John, too. Like people asking, well, we're trying to get pregnant, but we're not pregnant yet, but they're not doing any kind of, you know, IVF or anything like that.

And then I'm like, okay, now you're good. 

It's all the time, all the time. And my big thing is, like you said, like, if you're not, If you don't know that you're pregnant, it's okay. And I can't tell you how many women are actually testing. I mean, they're testing like every other day, if not once a week, if they're pregnant, if they're actively trying.

So usually like I'll have someone who's saying, Oh, I took a pregnancy test this morning. I was negative. You had an opening. I'm in. 

Oh 

yeah.  Um, I want to go back to the hair changes because I feel like this is a big topic to, um, During pregnancy, your hair gets thicker  and then after we, we start to lose a little bit of hair. Yeah. Like, 

yeah. So, um, one of the biggest things. So, um, with hair growth and pregnancy, um, you have, Like I said earlier, high estrogens, and when you have very high estrogens, it actually floods the estrogen pathway.

And so some of those estrogens actually get converted to androgens, and this is what we see in women with PCOS, right? PCOS is not because they have high estrogen. Androgens overall, it's because their estrogen is so high. And so like I tell many patients, I say, when there's too much traffic on the bridge, people start to take the tunnel.

And so when they do, um, you get that secondary hair growth. So here on your lip here on your chest, um, you can also have, um, here on your face, legs back, like anywhere that might, um, be, you know, when you think traditionally of testosterone. And so, and for many pregnant women, they'll get that hair growth like on their belly and new places.

Um, the good news is a lot of those, as those estrogens go down, a lot of those hairs go away. Um, for some women, you know, it might stay and you might have like terminal hairs that kind of, you know, take take, uh, take root. But a lot of times, you know, we'll say, you know, like, uh, laser treatments, et cetera, you know, for those, um, after pregnancy usually.

Um, but then postpartum,  what happens is that we, uh, we take all that estrogen away. And so then you have this hypo estrogenic state, and that also could be exacerbated by prolactin. So prolactin, um, which is generally the hormone that helps. with lactation and creating, um, you know, breast milk will actually override ovulation, override estrogen and progestin.

And for some women that can make them feel like they're menopausal. It can make them feel like they have vaginal dryness. It can have their, you know, their hair can get really thin in the front. Um, you know, that pregnancy glow, it kind of You know, we take it away. And that is another biologic function of, you know, um, I don't have enough resources to produce another child at this point.

But, you know, in doing so, you know, for many women, it can make them not feel very great. Um, and so you can have that, like I said, frontal hair loss and thinning, um, you know, associated with that, just lower estrogen. 

And that's more of just a waiting game to kind of giving your, your hormones time to level out.

Yeah. For a lot of women, you know, and that can be, like I said, exacerbated by term breastfeeding, um, you know, but a lot of times it'll normalize after, you know, three to six months.  You know, you know, not a lot of women don't want to hear, you know, we're hoping your, your hair gets better in three to six months, but it usually does.

And it usually goes back, 

uh, to where I love seeing it. Like I'll be like doing their frontalis injections and all of a sudden I'm like, Oh, look at these little baby hairs just coming in, sticking 

right up 

and they're like, thank God this needs to grow quicker. You know? So.  

Yeah. 

I'll tell them there's hope.

Yeah.  I was thinking after the fact PRP injections might be beneficial. Sure. Sure. You know, kind of, if, if you're trying to supplement the area, give it as much as you can, 

you know, Dr. Simons, I wanted to bring up to the GLP ones. Um,  yeah, so there's a lot of patients obviously that are on them for weight loss with our or for PCOS and things like that.

And it's helping them tremendously, but they're also finding that they're getting pregnant easier on them. Oh, this is  

a huge thing. Yeah. 

Yeah. Do you want to add anything 

about that? There's so much. Where do we start? All right. So, um, I, I do, I do prescribe, uh, uh, describe, uh, prescribe GLP ones. I do use them off label for PCOS.

Okay. I have many women who come in with abnormal periods and you know, they're on that spectrum for PCOS and we talk about, you know, the main goal for them, um, is in treating their abnormal periods or their symptoms is often weight loss. And these are women who have been not. Not lack of trying, you know, they're, they're eating right there, exercising, and a lot of times they just need that little bit of nudge to get over, you know, and then start that metabolic process where they start losing weight.

And I really seen a lot of pregnant or not pregnant women. Um, a lot of women have a lot of success in regulating their periods with weight loss, as well as their symptoms of PCOS, including abnormal bleeding, including increased androgens, um, and hair.  Now they're also getting pregnant because they become super pro.

So that reduction and, um, so  let me start back that that extra estrogen and excess androgens, um, acts as a birth control. And so it is preventing ovulation for many of them. And as soon as we get rid of some of that, we, as soon as we get rid of, you know, metabolic resistance, yeah. And they're, they're. 

Super ovulation. They're, they're fertile myrtles all of a sudden . No, they really are. It's, it's wild. My 

husband's a, uh, board certified family medicine doctor, and he does, um, the GLP ones at my office. I know, uh, Nicole, you have Meg at your office. Mm-hmm . Who does that as well. And, um, there's obviously so many off-label uses for GLP ones and he's got, my husband's got a few patients that have PCOS and their, their periods are becoming more regular and they're losing weight.

They're feeling better. Their s  m's improving and, yeah. They're just overall so much happier.  Yeah, 

it's, it's great. And, you know, we're trying, trying to use them, um, or I'm trying to use them, you know, more often and create more accessibility to them,  you know, there's a lot of, 

yeah, there's this doctor. I don't know if, you know, I'm Dr kilts.

Do you know Dr. Keltz? He owns CNY fertility, which is in Syracuse. I think he's got a New York clinic. I think he's got, he's got a bunch of clinics and he has this book that's called plants will, plants will kill you. Um, he's, he's very much like a keto, like carnivore diet. Like he believes in like meat, cheese, butter.

He wants you to put a half a stick of butter in your coffee in the morning. You know?  I mean, yeah, you'll end up on the cardiac cath table, but, um,  He's basically saying by eating, doing a more keto diet, it will decrease inflammation and then help hopefully get you pregnant more. And he's a very big firm believer of that.

But I, I, I mean, with the GLP ones and right, like there's a more peripheral uptake of glucose, right. With, with that. So it's helping to regulate giving people more glycemic control, um, and all that. So I think it's helping with decreasing inflammation systemically too.  

Yeah. It's really, you know, um,  I've had so many patients that have started their journey coming in saying, you know, I'm, you know, I know I'm overweight.

My periods are irregular and I want to get pregnant. And, um, you know, I think in the past. It was like, uh, well, you know, we're going to try to do one thing at a time. You know, I'm going to look at this and I'm going to prescribe you a birth control, I'm going to refer you to a bariatric surgeon, and, you know, then we're going to get you on, you know, oculation induction with clone it or something, which increases your chances of multiple, so a lot of these things.

And now it's like looking at it from a completely different light. Yes. You can do all of those things, but it's like. No, let's, let's get you, you know, on a path where we're kind of going to treat all of these things all at once. And, you know, and we're having such success with it. Um, that it's really, I mean, for me, it's been really awesome and very, very fulfilling too.

Yeah, because I feel like in the past for PCOS too, it's been like, okay, here's a birth control, try this one or try the next one. So that's kind of like you're treating that but getting so many other benefits as well.  

Absolutely. And you know, you, you see all different, um, you know, again, PCOS is a similar, spectrum.

And so you see lots of different patients along that spectrum somewhere, and not all of them, you know, are going to be, you know, not all of them are going to have a super high BMI. It might just be slightly elevated, but that might just be enough biochemically, you know, or hormonally, you know, to prevent them from ovulating correctly.

And so it might be just, you know, a little bit, it might just be a little bit off and maybe they just need a little bit of a reduction of BMI. And so, you know. It's, it's been working really well. 

It's amazing.  With weight loss. I feel like to a big question I get all the time is the stretch marks. And is there like a true, is there a true way to prevent the stretch marks?

Are they just hereditary? 

So, so stretch marks for those of you, you know, guys who don't know about them. So like they're, um, very common, you know, they've happened. Usually around six to seven months. Generally, you know, it'll be around the abdomen, but you can also get them in the upper legs. You can get them in the breasts as well.

Um, not a good way, um, to get rid of them once they're there, but there is some prevention. Okay. And, and so when we talk about prevention, you know, the biggest risk factors are gonna be a, like if you're have, um, a history of a lot of abdominal or breast surgeries before mm-hmm . If you have a high BMI, um, and or if you have using chronic.

Topical steroids or corticosteroids, um, you know, the like thinner skin because exacerbated by rapid weight gain. Um, and then also, um, if you have a larger pregnancy, so multiples, if you have polyhydramnios, which is an abundance of fluid inside, um, the amniotic sac. And so you can do risk reduction, you know, to help prevent those things, right?

Mm-hmm . So we have a gradual healthy.  Weight gain and pregnancy. We don't want, you know, I get pregnant and then I gain 40 pounds, right? Mm-hmm . Because your, your skin only has so much elasticity, right? You know, and so if you have a rapid gain gaining of weight, if you have, you know, a lot of pressure on that skin, it's gonna cause, you know, some stretch mark.

Works. Um, if you, so I tell patients, I say, you know, make sure you're watching what you're eating. Make sure you're exercising. Make sure that you know, if you're prone to diabetes, that you're eating the right things at the right time, you know, and that we do your glucose tolerance test. Um, because also being non-diabetic, you know, even though many patients can't help it in pregnancy, but better controlling that sugars is gonna lower their risk of polyhydramnios.

And so less tension. on that skin, less tension, you know, overall. And so, um, there are lots of studies of this, you know, different creams, cocoa butter. I, I hear that a lot, um, you know, lotions and things that can help prevent that.  Sure. You know, and the bottom line is, is, is treat your skin. Well, right. You know, you make sure it's not dry, make sure that you're using lotions that you're using good.

safe products and keeping good hydration to prepare your skin. Cause you're, you're going to have some stretch, you know, it's, you're going to get big, you're going to have a baby in there. Um, and so, you know, don't, don't beat yourself up. Yeah, it's going to happen, you know, and so we just got to try to be as healthy as possible and some patients will avoid it.

And I've seen it, you know, again, both ways I've seen patients that are. have two, two babies in there and they got 12 pounds of baby in there and polyhydramnios and they don't get any stretch marks. And then I've seen patients with a, with a tiny baby, um, that gets stretch marks. So, you know, sometimes you, you get Delta hand, um, genetically and you gotta, you gotta play that hand too.

So some people, I think 

that's what it is too. I think it's the ethnic background too. And you know, you 

get like, so I tell patients all that all the time. You know, you get. Some patients get dealt a really good hand and you know, you can eat, you know, whatever you want all the time and that your heart looks great and you're ripped and you know, and other patients, we got to like work at it and eat right and take medicine.

It's the worst. It's not fair.  

Life's not fair, right? 

Yeah.  

John too, after the fact, any stretch marks, we could always do microneedling 

as an option. Yeah, that's 

something that might be beneficial out there. 

Yep. And for those of you that don't know what microneedling is, it's just basically these little microneedles that we run over your skin and cause little micro injuries that stimulate Collagen and elastin.

So basically it helps us smooth those, you know, the scarring. We use a lot for acne scarring too, but we can use it for stretch marks as well. And it probably will require multiple treatments, you know, over time to improve.  

Um, I think now would be a good time to stem into like what's safe and not safe when it comes to treatments that we perform. 

Okay. 

Um, I definitely know, um, That so many people want to do everything while they're pregnant and you just, yeah, you can't. We already touched base on Botox. Um, fillers are in the same  ballpark, uh, again, it's just so 

many people that are like, it's hyaluronic acid gel. How is this going to affect my baby?

I'm like, because there's not enough studies, 

you 

know, it's, it's, it's, I still tell people all the time. Like, I, I don't know. . Yeah. It might do, something might not, you know? Right, right. There's, um,  lots of things. So, you know, the big thing that people look back on is DES, you know, when was that? The right, you know,  1940s, 1970s.

Mm-hmm . You know, and so the less, the less in pregnancy, probably the better. Um, but you know, in the biophysics of Botox and how that organ in fillers and things like that, it doesn. It's not things that are going systemically. So I think over time, we'll probably get a much larger, you know, um, sample size and we can start, you know, making some, you know, some jumps to real conclusions.

And for those 

that don't know what DES is, well, isn't that, that, It was that injection that was given to mothers to prevent a miscarriage. 

Yeah. It was, um, what is it? Diet ethyl still best. Yeah. So that was like 1940s to 1970s. It was a medication to prevent miscarriage and it was an estrogen based.

product, synthetic astrogen and did lead to increased  cancers, not only in the generation of those moms, but in their daughters as well, which we're actually still seeing because you're born with the eggs that, you know, those eggs. So it actually affected multiple generations. And so Yeah. 

Yeah. 

So there's, 

so there's actually a, um, foundation called Marines Hope in Syracuse, New York.

And it was founded based upon that. Um, it was, um, it's her sister who now runs the foundation, but her, her sister was, um, she passed away from one of those deadly cancers. Her mother had gotten that shot. Yeah. And then obviously gave birth to her, you know, the whole thing and it passed on to her. So yeah, crazy.

Crazy. Mm hmm.  Um, well, on that note, yeah,  

yeah, that's what a doubter, but, uh, I brought it up. I'm the worst. Um, but yeah, the thing  

people are gonna be like, what are D E S and I'm like, well, actually I know about it because  

that's a definitely, yeah, that's a med school question. They definitely. 

So your Botox, your fillers, but then you also have to stop your laser treatments, your laser hair removal.  And I think that there's two reasons for that, right? One would be the skin healing.  So you don't want to increase anything that could potentially increase your pigment, especially with that risk of melasma and things like that.

Right. 

Yeah. Yeah. Yeah. And also you can have any skin reacts very strangely in pregnancy. So, you know, I don't, I mentioned before that your skin, like it increases your physiologic resistance, um, with your barriers for your immune system. So the body, um, a pregnant woman's body doesn't want to recognize the fetus as an invader, a foreign invader.

So it dials down your learned immune system, but then dials up your barrier immune system. And so some of the things that we. see, you know, melasma and skin hyperpigmentation is probably also in response to that. And so you can also see patients who form like keloids that can get much worse in pregnancy as well.

Everything becomes hyper reactive and um, like itching, all everything, everything can affect people differently in pregnancy. I don't know if you, you know, if, if you react differently to different products. Now that you're pregnant, do 

you at all, Nicole, do you react differently? I 

never had to use moisturizer until now.

Wait. Oh yeah, cause you use Zio. Zio doesn't believe in moisturizer, right? 

Yeah. And I am now all my whole routine is just like six different moisturizers. 

Wow.  

So I'm definitely more of that. Like I became sensitive dry. Okay. Yeah. Yeah.  So I definitely did notice that, but the other thing with lasers, which I think again is more of a lack of research.

But they're concerned about, I guess, those wavelengths reaching the fetus. Uh, I feel like there's plenty of barriers in between, but again, there's a lack of research. So I don't know your thoughts on that.  

Yeah, I mean, so a lot of a lot of the studies, you know, when it comes to these things are things that probably.

That one, I don't think they're going to study, um, too well, you know, I know that we don't, we don't like to do lithotripsy for kidney stones on patients who are, um, are pregnant because, you know, we can scramble, scramble a little brain and we're trying to get a stone and that's probably a lot higher.

I've seen patients who've had lithotripsy when they're pregnant and they ended up fine. But again, like, we want to steer things away.  Honestly, a lot of the studies on radiation and things in pregnancy are based on, like, proximity to nuclear bombs in Japan. Like, there's, you know, there's not a lot of research on these things.

It's not, it's very antiquated.  I don't think we're getting any closer. What 

are we on? 

Yeah.  You know, but it's like the interesting things in the medical, you know, books when you look back and they're like, well, how do, how do we know how much radiation is safe? Well, you know, they said, how many miles did you live away?

from her ocean and you say, well, we're, you know, how'd you get radiation poisoning? And then that's, you know, that has stayed for many years. And so we need, you know, medical research and studies, 

right? Yep. Yep. But I think overall, right. Botox fillers and lasers, it's more of just, it's unpredictable outcomes too.

We don't want to put you at risk or have an issue with healing 

or anything of that 

nature. 

Yeah. And no one wants to say, you know, I wish I didn't. Do this, you know, one thing, right? Because a lot of times we look back, you know, things are either going to work out or they don't. And if something bad happens, we often as human beings, we want to look back and we want to say, this, this is the reason why, even if it had nothing to do with it, but it makes us feel better.

And so we want to, like I said earlier, eliminate as many variables. Um, we don't want anything that could possibly hurt mom, possibly hurt baby. So we, you know, the answer is usually no, 

yeah,  

don't do it. It's 

going to be what you don't want to hear. Yeah, 

exactly. 

Um, microneedling. So microneedling is like little needles.

They create little channels across the skin. It's like the vampire facial. Um, There has been a few accounts on Instagram that have gone a little viral because they've said that they allow that procedure when pregnant. 

Uh, 

again, I don't know your thoughts on that. Like mine would be again, you're healing and you're, you're worried about the pigment.

And I don't know if it's worth causing injury to the skin.  But if that would be considered safe, there's also a topical lidocaine component that might have different forms of lidocaine that I don't know if is worrisome either. 

Sure. I mean, topical lidocaine we use, you know, pretty often and we use regular lidocaine in pregnancy.

So I don't think that would be, you know, a component at all. Um, you know, it probably depends when in pregnancy. Um, You know, and the patient's  comorbidities. And again, the answer is probably no.  You know, in being safe, does it really have a adverse outcome in effect? Probably not. But, you know, because we're causing micro trauma, could that stress, you know, over time in, you know, increase if it's very early pregnancy?

Theoretically, could you come to another conclusion that can increase risk for miscarriage? I, you know, I'm sure that there's someone out there that could argue that point. And so it's probably good. The answer for the meantime would probably be no. I think honestly, 

it just makes sense. I mean, I know the whole retinol thing, obviously that's not pregnancy safe, but just to think of things that are safe during pregnancy or like, um, thinking of things that your skin could react to, I mean, like retinols, vitamin Cs.

I mean, you know, big actives, like obviously lasers, microneedling, you just don't know how your skin's going to react. So you just, you better be safe than sorry and just wait until after  you're pregnant.  

You do have a lot of these changes that are transient because of pregnancy. And so if something is really bothering you, a lot of times we're telling patients, wait till after we know you want it now, but wait till after it's pregnant, after you're pregnant, because it might.

Just go away on its own. You might not need any, any of this. Now, you know, for a lot of these facials and things, people are doing those for wellness and, you know, to maintain their skin over time. So, you know, they want to, you know, keep doing these things. And I understand 

that. What about, um, red light therapy? 

I have not heard anything as, 

as adverse, you know, I actually, 

yeah. I'm pretty sure it's pregnancy safe. I mean, I know Nicole, you've been  religiously doing your Omnilux while you can't get Botox. 

Yes.  

That should be fine. It's just the light, right? 

Yeah. It's just like exposure to led light. Yeah. Colored 

light.

Yeah. We go out in the sun.  

We have so many people that ask that though. They're like, is it safe? Like, I, you know, I don't know what to do. You're not going to spend money on this if it's not safe.  

I posted that as part of my routine and I got so many DMs like, wait, can, can you do that? I'm like, I mean, it's just light, so  

it should be fine.

You know, I can't imagine, you know, again, from a, the, the media legal 

standpoint, 

if you ask someone, they're probably going to tell you, you know, stay away from it at all costs, you know, because it could be, 

If you look on like Omni Lux's website, I guarantee it tells you not to use it, but it's more of a liability thing.

Yeah.  

But like, and then again, like I have patients who are CrossFitters or MMA fighters and all that, you know, and, you know, the old adage was that, you know, there, there, We're telling people to be on bedrest, you know, now, now I tell people, no, go if you're deadlifting 200 pounds before you're pregnant and you don't have something that's preventing you to keep doing it, you know?

And so we, we have to use some common sense to in treatment of people, you know, we can't just say no to everything. 

Yeah. Yeah. Another question I had was IV hydration, um, IV therapy. So, you know, I know you Nicole, you do it in your practice. We do it in ours. We have, um, I get up and go, which is like, it's got some like amino acids that help with metabolism.

Sure. We have immunity. So, you know, zinc, vitamin C, all of that. And then we have Myers cocktail, the typical, you know, thing that you get in the hospital. So are, is IV therapy safe during pregnancy? Sure. Oh, 

good. I mean, I would say definitely because I mean, the 1st thing we do when you come into labor and delivery is pop, you know, pop and start pumping you full of fluid.

So I have so many women who, you know, who come in, who might be, um, you know, have an upper respiratory or kidney infection, or they've been on their feet. Working all day. They're dehydrated during the summer. You get patients, you know, the, the joke is when it's, you know, 95 degrees out, you know, I said, everyone's going to come in contracting later today because they're going to be, you know, and then they come in, they get IV fluids and typically, you know, if they're not in labor, they go home.

So I can't see as long as it's. You know, recommended IV fluids and not something weird or crazy. 

Well, 

and I would say too, like if you have as a business owner and I know Nicole, you agree with this. I, if someone who was like, was eight months pregnant and they were feeling, they had a diarrheal illness and they were dehydrated and they wanted to come in and get a Myers cocktail, I would do it.

Just make sure you check their blood pressure before and after just, you know, just to make sure they're, they're good. Cause if they have an elevated BP. Probably not too smart. 

Yeah. And I would say definitely call your doctor. Maybe go to the er, call your 

doctor first. Yeah.  Yeah. If, if they're dehydrated, having diarrhea at eight months pregnant, tell me, come on in,  sweetie.

Go see your ob gyn. Please, 

please go to 

the er. 

Don't see your aesthetic inject. Go  see your ob.  Yeah,  

it's too funny. Um, I was told because I was having a lot of a nausea in the beginning. So I was told that electrolytes and being like keeping a good hydration can actually help with that. Is that true?

Definitely. And you know, the, our first line treatment for nausea, vomiting of pregnancy is going to be vitamin B six and doxylamine. Um, and again, small you know, stable meals, nothing crazy, um, kind of all of those things. And it's keeping a good hydration status. Um, making sure that you're not overdoing it.

It's all of those things are very, a very safe for you, no matter what, you know, whether you're pregnant, not pregnant or anything. Um, but again, it just, just good advice. 

Yeah. Yeah. Um, going back, cause you brought up the skincare before John, um,  I know. They say to steer clear of like salicylic acid, but to a certain degree, um, is it, is that true?

Or should you again, just try to steer clear salicylic altogether? 

Yeah. I mean, I don't have a lot of, a lot of, um, experience with, you know, salicylic acid, but you know, again, um, it's probably going to be no, no impregnancy  on anything, you know, if just, I would stick to, you know, your normal scrubs and stuff without active ingredients.

Is it, you know, a very, You know, is that topically absorbed where it's going to get to fetus at a high amount? Most likely not, but you know, again, I, I would stay away from any product that is controversial. Talk to your OBGYN, you know, and they'll, they'll tell, you know,  

you'll just get another no. 

Yeah. You ask them and they'll certainly tell you, you know, 

my next, my next two things on the unsafe list, um, were, were  microcurrent and certain chemical peels, um, microcurrent is gaining a lot of traction on like Tik Tok.

Uh, and things like that. I don't know if you've seen the new face. It's like a little device. You turn it on and it sends little waves to stimulate your muscles. 

Okay. 

Um, but again, it's a waste of money, my opinion.  

I've never heard of this. So 

yeah, they, they say that it can help tighten the skin or the area around the eye, things like that.

Um, but again, there's lack of research. And with the microcurrent, they're concerned that that current can travel throughout the body.  

Okay.  That one, I mean,  we could try it, um, you know, like, uh, but I mean, like, what do we do when we ultrasound and everything? Yeah. We use some, you know, we use some sound and waves.

And you know, when I have a baby that's not responding, you know, on Nst or something. I will tap them or you can take a coffee cup and you can go, Hey, what's going on? It's like vibro acoustic stimulation. Oh my God. I love that. Yeah. You, you could literally do that. If you don't have the, we, I mean, sometimes you take the button and you go,  and you can get them to wake up, but I'll just give them a shot.

I mean, it's still a baby. I'll just go. Hey, you wake up. 

Nicole, if your baby's not moving, I'm going to do it. I'm going to say move, bitch.  

Yeah. If you put the coffee cup on there, it'll amplify it. 

So all 

of 

a sudden you'll get a swift kick in the diaphragm.  

They were doing that during my anatomy scan. They were like, they were like,  making them cause he wouldn't move.

So they were just jumping on my stomach with that thing.  

Just, you know, they like, uh, give him a good couple shelves. 

Yeah. Chemical peels. Obviously they're going to be high ingredient. Yeah, 

I would probably avoid it. And that's more likely it's more because you don't know how people's skin is going to react.

Right. 

You know, I've had patients who are using products they've used their entire life and then they come in and during pregnancy and they break out in a terrible rash, um, because, you know, for something that they've used or a cleaning product that all of a sudden they're sensitive to. Um, and so, you know, Um, I would probably stick, you know, stay away from doing anything that's high, high intensity.

Yeah.  

Um, there's some chemical peels that I guess could be considered safe, like the aluminized peel. I don't know if you have that, John. It's just 

like 

that exfoliation, but not actually like a peel that's going to cause a reaction. Sure. But I feel like that would go more into just like your facials, you know, Maintaining skin that way,  

definitely, you know, and again, you know, if these, if it's fairly, you know, non abrasive, if it's something that is, you know, very hyper allergenic, and it's probably going to be safe, right?

Um, and, but, you know, with the caveat that everybody reacts differently. And, um, you know, if, um, someone's pregnant, their skin might just react to it a completely new and different way, you know? And so that's just like a little caveat for someone who even might be doing a hypoallergenic peel. And then I'd always tell them, Hey, if you're worried about something, call your OBGYN and they will tell you no.

Right?  And you'll hear that. No, again. 

So now to get into some safe stuff, your traditional, like you just said, the, the facials that aren't going to cause any kind of, crazy irritation with any high ingredients. No retinol, obviously. Uh, but definitely your diamond glows, hydra facials, things of that nature with the right ingredients.  Um, the led therapy 

glow to facial for those people that glow to facial is probably, you know, safe to 

do.

Uh, 

we talked about the aluminized peel derma planning.  Derma planning is, um,  Yeah, 

I mean, that should should be fine. Yeah, I can't I can't think of a reason why that would affect. I mean, you're literally just shaping up eyebrows and doing those things. Those things should actually. Be fine, 

right? You're not causing anything crazy. 

Get 

their haircut during pregnancy. They shave, you know, they shave their, we shave their abdomen before a C section or we clip it, you know, like normal things like doing, getting your nails done, dying your hair, these things. If you read a hair dye. You know, um, thing it says, don't, don't do any hair dye during pregnancy.

I think, you know, a common sense is that's probably not going to affect you in a way that's going to harm your pregnancy. But again, there, there's that standard no for everything. And so, you know, let's use it. You're a discretion. Talk to your OBGYN, but it doesn't make sense, right? It doesn't make sense.

Why painting your nails is going to have an adverse reaction when you're pregnant. Yeah.  you know? 

Yeah. And like,  doing it every day. You'r dyed every single day. It that's not happening. Exa acne, we just didn't touc  I know that the rosacea c flared a lot of the time. Sometimes the people  again, it's probably difficult to treat.

Yeah. You know, it's one of those things that you kind of, you tell them to avoid triggers with Rosacea and kind of, you know, I know there's some people who have actually done corticosteroids occasionally if they've breaking out, but we don't like to do those too much in pregnancy. 

Um, 

but, uh, you know, it's kind of one of those things that usually gets better.

Um, you know, it's usually people with Rosacea. generally have rosacea and then it's exacerbated by pregnancy,  you know, and so it's avoiding those triggers a lot of times. Yeah. Yeah. Yeah. 

Um, and I did actually have a question come through about a clinician being pregnant. Okay. on certain things that we offer, uh, specifically if you have Pronox in your practice, if you should be in the treatment room when the patient is utilizing the Pronox, if you're pregnant.

Okay. What's Pronox? So nitrous oxide is actually  It's fine. Okay. So, so nitrous oxide is actually, you know, the rest of the world is used as labor analgesia, um, in many, many different countries. So it's like, um, 1 of the 1st line, um, and a necessary.  Analgesia is for labor, actually. Um, and so, yeah, you know, as long as they're not making big decisions.

So 

where 

I trained, where I trained in Michigan, we offered nitrous oxide, um, and, and, uh, for labor pain. Oh, yeah. And so you would get the whole, you know, the thing and they would sit there and they'd be like, Oh 

my God. Yeah. They would have the mask and they'd take 

a big deep breath in while, you know, while they're right before they were pushing or right before the contraction.

Oh my God. So cool. Yeah. It was super cool. And then they'd be like,  they'd be like, Alright.  I want an epidural , please.  This, they're like, I'm in a tremendous amount of pain,  , but I don't 

care as much, but I don't care. Yeah. 

Now I happy  

I was gonna say, if you miss that window, the epidural, that, that ox would be nice.

The nitrous. Yeah. 

Yeah. We would, we would wheel it in. It would come like on its own standard cart with I'm dying, you know, attached. Yeah. It, it was great. Wow. A lot of, a lot of places, um, offer it not around here. Yeah. But 

yeah, yeah, I think it is starting to gain a little bit more popularity because I am hearing it more now being pregnant just from other people, but I don't know like exactly what hospitals offer it.

Yeah. You know, it's a call ahead.  

Yeah. Double check that one.  Um, I did have some off topic questions. I'm not exactly sure what this person meant, but they put opinions on vaginal rejuvenation and I'm not sure if they meant like surgical versus like  We have those, what's that seat know Lisa? Yeah. Like the, like things you can do Laser C2 therapy.

Yeah. Yes. Yeah. To tighten 

things up and Yeah. Like your, 

they just asked your opinion on that, like when to start that kind of stuff. 

Is it Sela? 

I can't Pronou. Yeah. Sela. That's what I was thinking. Yeah. Yeah, yeah. So I, so it's just the nature of my practice. Um, I, I don't do a lot of cosmetics because  mm-hmm

There are so many mm-hmm. Many  . OBGYNs who just do cosmetics, who are excellent, um, for doing labiaplasty and for doing, you know, cosmetically, um, driven procedures. Um, and, and so I am, I'm a big proponent of if you are uncomfortable during sex, if you're having a problem, a physical problem, or if there's something that's physical, physically unappealing or something that you want taken care of.

Go for it. You know, go get it taken care of. Um, I just don't have enough volume in my practice where I'm, you know, if I'm doing something, um, I want to be doing it every day or doing it, you know, all of the time. And so there are providers who have devoted their entire practice to that. And I'm all for it.

Um, and it's really just based on. Patient preference, right? We're talking about cosmetic procedures. You know, if we're talking about improving, you know, appearance of vagina appearance of vulva, um, or, you know, function during sex, um, then yeah, you should, you should have all of those things, anything that you want.

But, um, you know, I do refer out to providers for that generally, um, you know, because it is it is a tough field. You want cosmetically for everything to be up to the patient standards. You want them to have good outcomes. I do a lot of  besides obstetrics. I do a lot of minimally invasive gynecology. So I'm robotically trained.

So I work on the da Vinci. That's what I was doing this morning  before I got on here.  

So I do 

a lot of hysterectomy and  minimally invasive surgery, but, um, yeah, like I kind of, you know, do OB. So I do, I have a lot of pregnant patients and I do my, you know, minimally invasive gynecology. So I have a lot on my plate already, you know, 

it'd be, do you, um, offer hormone replacement therapy at your practice?

Yeah. Yeah. That 

was actually another question. Sure. Um, your thoughts on bioidentical.  HRT was the exact question. 

Okay, so the problem so bioidentical HRT, the two problems with it are number one. How do we determine, um, what is bioidentical for a patient? And so what's the standards are those? And then the second is then, um, how are we regulating them?

And so you With bioidentical hormone therapy, you need, um, good partners at your, you know, your compounding therapy. You need to have systems to figure out what to do for people. And then it's like, how do we determine what's good for a patient? So the, the adage for hormone replacement is we use the lowest dose, um, for the low, shortest period of time, you know, and that's kind of the, you know, cover your ass. 

program for, you know, not causing any harm. But, you know, one of the things with, you know, hormone replacement is that, um, it's easy to standardize dosing and then move up in order to get your patient satisfaction. So I personally don't do bioidentical hormone therapy. However, I, I don't have really access to it.

And so, you know, for me, the cheapest thing and the most available to my patients is usually. you know, using a standardized regime so that this way I can move it up. I can move it down based on their reactions. Um, and so, you know, it's tough with anything bioidentical, you know, it's going to be difficult to achieve those standardized success and also things that are accessible for vision.

So  it's, uh, I usually, I go with the standardized hormone therapy.  

Perfect.  So I think that was everything. That's all my questions. We went through all the myth busters. We went through do's and don'ts. Lots of don'ts. 

Yeah.  The answer is no.  That should be the title of today's podcast. The answer is no. And when in doubt, ask 

your OBGYN.

Don't ask. I mean, you can ask your injector. We're well versed on everything, but ask your OB and just go based on that. 

It's yeah, it's always going to be back to your OB. Exactly. Yeah. All right. Well, thank you so much for joining us today.  Yes. Thank you. Amazing. You're 

back on 

next pregnancy. 

All right, guys. Well, thank you so much for tuning in to another episode of the Fill Me In Podcast. I'm Injector John. 

I'm Aesthetic Nurse Nicole. 

And this is Punk Rock OBGYN,  Dr. Simons. Thank you so much for joining us today. All right. Thanks for having me, guys. It was a pleasure. 

Yes, thank you. All right.

Bye, guys. All I 

want. All I want. Me 

and you. Me and you. Been so long.