# The Risk of Using Cosmetics and Cosmetic Procedures During Pregnancy
## 4 The Risks of Cosmetics and Cosmetic Procedures
### Dermatosurgical Procedures  
The most common minor surgeries include the removal of benign skin lesions, such as seborrheic keratosis, nevi, and hemangiomas, through methods like shave excision, cryotherapy, electrocautery, or radiation. These procedures have been used safely by doctors for many years in pregnant women [19]. Electrocautery is considered harmless to the fetus when used on the mother. However, precautions should be taken to reduce exposure to the smoke plume, which can be mutagenic and carcinogenic. This risk applies to both pregnant and non-pregnant patients, and, by extension, to the fetus. Masks are considered inadequate barriers against the plume; therefore, using a smoke evacuator is preferred to minimize smoke exposure [19].  
Sclerotherapy may be safe during pregnancy but should be avoided in the first trimester and after the 36 th week of pregnancy. Sclerotherapy and laser-assisted liposuction are not recommended for breastfeeding women. CO\({}_{2}\) lasers have shown good efficacy and a low complication rate in the treatment of human papillomavirus (HPV) genital warts and laryngeal verrucous carcinoma in pregnant women due to their coagulating properties, with no reported adverse effects on the fetus [20]. However, there are concerns regarding maternal exposure to potentially mutagenic airborne particles generated during laser vaporization. This risk can be mitigated using aspirators, fume extraction devices, and masks for both the patient and physician. Several studies support the safety of carbon dioxide lasers in treating genital warts in pregnant patients [21; 22]. Additionally, Nd:YAG lasers have also been used safely to treat genital warts during pregnancy [23].  
Laser lithotripsy during pregnancy has been shown to be safe. Another study reported the successful and safe use of a pulse dye laser to treat symptomatic violthiasis in a woman who was 20 weeks pregnant [24].  
Botulinum toxin type A (BTX) has both cosmetic and medical applications [25]. Current studies suggest, though they do not fully confirm, that the toxin does not reach significant systemic concentrations when properly administered intramuscularly or intra-dermal. Additionally, the size of the BTX molecule makes it unlikely to cross the placental barrier [26]. There are no clinical studies on the cosmetic use of Botulinum toxin type A during pregnancy. However, two cases were reported by [PERSON] (2006), in which BTX was used cosmetically during the 6 th and 5 th weeks of pregnancy without adverse effects on the fetus [27]. Two studies have shown the safety of botulinum toxin A for the treatment of achalasia in women who were pregnant. The first study reported the administration of an intradose injection of BTX during the 14 th week of pregnancy without negative effects on fetal health and a successful childbirth outcome. The second study described a similar case in which BTX was administered during the 33 rd week of pregnancy to treat persistent esophageal spasms and subsequent malnutrition, with no adverse effects observed at five days postpartum [28]. [PERSON] and [PERSON] also reported the safe use of BTX in the 18 th week of pregnancy to treat migraines, with no issues noted in the infant for 6.5 years following birth [29].  
A study of 900 doctors revealed that only 12 had performed accidental BTX injections in 16 patients during pregnancy. Only one of these patients experienced a miscarriage after the injection [30]. Concerns have been raised that high doses of BTX are associated with cases of systemic weakness. However, the doses used in cosmetic procedures for pregnant women are typically much lower. If pregnant women choose to undergo BTX treatment, they should provide informed consent before the procedure. Procedures that are absolutely contraindicated during pregnancy include fillers, sclera therapy, and liposuction [19].