Blooming Beauty: Nurturing Your Skin During Pregnancy with Dr. Michele Hakakha

Blooming Beauty_ Nurturing Your Skin During Pregnancy with Dr. Michele Hakakha

Trina Renea  0:07  

Hey everyone, welcome to Facially Conscious. I'm Trina Renea – a Medically Trained Master Esthetician here in Los Angeles, and I'm sitting with my rockstar co-hosts, Dr. Vicki Rapaport – a Board Certified Dermatologist with practices in Beverly Hills and Culver City, Rebecca Gadberry -our Resident Skincare Scientists and Regulatory and Marketing Expert, and Julie Falls – our Educated Consumer who is here to represent you. We are here to help you navigate the sometimes confusing and competitive world of skincare. Our mission is to provide you with insider knowledge on everything from product ingredients to medical procedures, lasers, fillers, and ever-changing trends. With our expert interviews with chemists, doctors, laser reps, and estheticians, you'll be equipped to make informative decisions before investing in potentially expensive treatments. It's the wild-west out there, so let's make it easier for you, one episode at a time. Are you ready to discover the latest and greatest skincare secrets? Tune in and let us be your go-to girls for all things facially conscious. Let's dive in.

Dr. Vicki Rapaport  1:26  

Good morning to everybody on this wonderful day.

Julie Falls  1:30  

Good morning

Trina Renea  1:31  

Doing good, excited about this episode. 

Dr. Vicki Rapaport  1:36  

We have a good one for you today.

Rebecca Gadberry  1:37  

It was inspired or was prompted by my cousin who is expecting a little boy in July. She's the winner because she's a producer at National Geographic and we were talking, I said send in a question. And that's how this whole thing got started. So, we are now sharing with everybody.

Dr. Vicki Rapaport  1:57  

We're going to be tackling pregnancy and skin today because we are with the fabulous Michele Hakakha. And she is a board-certified OBGYN in private practice in Beverly Hills. And I'm going to give you guys a little bit of highlight on her education because it's kind of amazing. Okay. She was the valedictorian of her high school class, which is amazing. And she then proceeded to go into medical school at the University of Hawaii. She graduated with honors, and then she attended the prestigious OBGYN residency at Cedars Sinai in LA. She started her private practice in 2002, where she expertly sees her patients in a safe and comfortable state of the art office, which is very important when you see OBGYN patients. I personally think that her surgical skills are to be envied by any OBGYN. And she penned the book called Expecting 411 with a pediatrician colleague. She's a mom of two beautiful and very, very wise daughters. And she is my very good friend. And she's joining us today to talk about pregnancy and skin. So welcome, Michele. Very nice to meet you. 

Dr. Michele Hakakha  3:10  

Thank you. Nice to meet you, too.

Dr. Vicki Rapaport  3:11  

You know, it's funny, we were all sort of past having the baby stage. But when this question came up, it was like yeah, of course we need to talk about pregnancy and the skin. Estheticians get questions, dermatologists get questions, you know, I'm imagining OBGYN obviously gets getting questions and I'm not sure if you field all of them or if you sort of say you got to see your dermatologist, but can you tell us kind of an overview of what happens to the skin during pregnancy?

Dr. Michele Hakakha  3:40  

I can. So, most women think that they're going to get a glow and they're going to get shiny hair and beautiful skin and there are a lucky few that that that happens too. But for a lot of people what happens to the skin is more blood vessels, more oil gland activity and a lot of acne and more melanin and a lot of staining of different parts of the skin. So, Melasma and Linea Nigra and darkening of moles and I'm sure we'll talk about all of that. So, there's a lot going on because of all the hormone production.

Dr. Vicki Rapaport  4:17  

And cosmetic questions come up you know unfortunately in LA pretty quickly when somebody is pregnant what they can and can't do so you know generally speaking are most cosmetics off limits when you're pregnant and we're going to go through like an ingredient list of what is and isn't okay, so you don't have to go through that right the second but cosmetics I know is a big question on people's minds.

Trina Renea  4:40  

When you say cosmetics, do you mean, what do you mean by that?

Dr. Vicki Rapaport  4:43  

Injections, lasers, Botox fillers, services, not a topicals.

Trina Renea  4:49  

Cosmetic dermatology, right. So, can they still get Botox and fillers and lasers and all that?

Dr. Michele Hakakha  4:56  

This is a great question and I get it so often that there's a chapter in my book called ‘The spa treatment’ because everyone wants to know the answers to this. So no, you cannot have any injections, you can't have Botox, you can't have fillers, nothing that we don't have testing on. And the problem with pregnancy is we cannot take 100 women and say, let's see if this affects your baby. So, we don't have studies on a lot of this stuff. The problem with lasers is that your skin is extremely sensitive. And sometimes because of the melanin production, you can get hyperpigmentation with a lot of the lasers. So, a lot of things that Vicki does are off limits during pregnancy.

Dr. Vicki Rapaport  5:41  

Yeah, and the laser companies don't want any liability. So even if it's hair removal, you know, in somebody who's like blond hair, blue eyed, or freckly redhead who won't get necessarily hyperpigmentation, but it really is sort of considered contraindicated when you're pregnant, because God forbid, something happens to your pregnancy, the laser companies just don't want to be liable, which make sense.

Dr. Michele Hakakha  5:59  

We're the only ones liable. 

Trina Renea  6:02  

And also like during pregnancy when you get some melasma or hyperpigmentation like it goes away after pregnancy sometimes. I mean, I see people with a go down like when they get that pregnancy mastering pregnancy. Once they're done, hormonally breastfeeding and all that and everything kind of settles, a lot of that can go away. And you always used to say Dr. Vicki to wait till after your pregnancy to do anything or to treat anything with pigmentation until after you're totally done.

Dr. Michele Hakakha  6:39  

Well, you know, what's interesting is that a lot of it does go away. So, the Linea Nigra, which is that black line, or the darkened line up and down the belly, the Ariels, the nipples, the lips, the moles, that often goes away. Melasma, I find that it can fade, but then sometimes it comes back again with sun exposure or birth control pills or something else that stimulates that same reaction. 

Dr. Vicki Rapaport  7:04  

Agreed. I think with melasma it's so tricky. It's so hard to treat. So, yes, when somebody does develop melasma during pregnancy for the first time, I just recommend you know, sunscreen and sun avoidance and maybe some brightening agents that are over the counter like vitamin C, but I do not go aggressively treating the melasma during the pregnancy because it can get worse and worse. And obviously their ingredients are contraindicated. And then once they're done breastfeeding, then we can address the melasma.

Rebecca Gadberry  7:30  

Well, what do you think about, I think the best of the skin brighteners right now for melasma are Mandelic Acid and Tranexamic Acid. Are those safe for pregnancy?

Dr. Vicki Rapaport  7:43  

Tranexamic. I would leave that up to Michele, what do you think about that one?

Dr. Michele Hakakha  7:47  

It's interesting because we use that now for postpartum hemorrhage. Right. So, that’s a different indication that that we do use it for at the end of pregnancy. Topically it hasn't been studied yet. So we're back to that same place of we don't know exactly. It's probably okay. But no one's going to say it's fine to do unless we have a good study.

Dr. Vicki Rapaport  8:11  

But if somebody does have like, it's a 4% Tranexamic product, would you tell them to stop using it?

Dr. Michele Hakakha  8:17  

I probably would.

Trina Renea  8:19  

So, if a patient comes to you, and they're like – ‘Oh, my skin's breaking out, I'm getting hyperpigmentation, help me, what do I do?’ What do you tell them?

Dr. Michele Hakakha  8:29  

I mean, breaking out is a whole another issue, right? So that you can use most everything that we tell people to use now, you can do topical benzoyl peroxide, you could do topical salicylic acid. You could do any sort of face wash. We just don't want it left on your face overnight. Is that you're making the face because that was the one you were talking about? 

Dr. Vicki Rapaport  8:50  

Michele, you broke my mind when you said that.

Trina Renea  8:56  

I thought you can't use salicylic acid because it's made from aspirin.

Dr. Michele Hakakha  9:00  

Well, yes, but we give people baby aspirin, 81 milligrams every single day for a lot of new things now so women over the age of 35, IVF pregnancies anyone at risk for preeclampsia or growth restriction gets an ad one milligram oral baby aspirin every single day till the day of delivery. So certainly, a little bit of salicylic acid on the skin is fine. 

Dr. Vicki Rapaport  9:22  

Okay, that's huge.

Trina Renea  9:24  

Because there was really, in my mind only two ingredients that we weren't allowed to use during pregnancy and that was salicylic acid and vitamin A. Yeah. So, that's really amazing. So, you tell your patients that they can use salicylic acid?

Dr. Michele Hakakha  9:43  

I do, yeah.

Trina Renea  9:48  

This changes everything for me because this is the first time I'm hearing this. So, there's so many products on my shelf that I can have pregnant people use now that had salicylic acid in them.

Dr. Vicki Rapaport  10:00  

And back to the acne question, Michele, you know, obviously I all see somebody who has very severe acne. But what do you do if somebody you know, has minimal acne that you're managing? Can you give us some tips and our listeners some tips on that.

Dr. Michele Hakakha  10:14  

I mean, when I do it, it's very basic. So, it's, have a good facewash and make sure that you're not sleeping in your products and make sure that you're using topical benzoyl peroxide, topical salicylic acid. And if it gets beyond that point, although we do say Proactiv is okay, and really severe cases, if it does get beyond what I'm recommending, then I would send to a dermatologist and then have them recommend what they would like to try and I ‘Okay’ it. So that's often what we do is OBs as we'll send out to the end or send out to the dermatologist. They'll tell us what they'd like to use. And we'll say yes, yes, no. 

Julie Falls  10:50  

Is it common for patients to develop acne for the first time when they're pregnant? 

Dr. Michele Hakakha  10:57  

It is actually. Yeah, I would say probably 40% of patients get pretty severe acne, particularly in the first trimester when your hormones are skyrocketing.

Rebecca Gadberry  11:06  

Does it make a difference whether it's a boy or a girl?

Dr. Michele Hakakha  11:09  

No. Okay, good question.

Trina Renea  11:12  

So, I mean, a lot of pregnant people, you know, when they come into an esthetician or a dermatologist or anywhere and they ask us for advice will say, you know, talk to your OB, the OB has an ultimate power over that. Do you find that, that gets tricky answering questions, because like, what if something happens to the baby and they try and blame it on whatever word you said, during the whole pregnancy?

Dr. Michele Hakakha  11:45  

You know, that's a tough question. Because I think we take responsibility for the entire pregnancy, we take responsibility for a healthy baby coming out, but it takes a lot to really cause a birth defect. So even in women who are inadvertently using Retin - A, and they don't know they're pregnant and inadvertently drinking and they don't know they're pregnant. It's really rare for us to see a birth defect because of these things. And we just tell women once they know they're pregnant to stop doing, you know, XYZ.

Dr. Vicki Rapaport  12:15  

Yeah, I mean, Trina, I'm sure you had some wine, some champagne, maybe even a cigarette before you knew you're pregnant.

Trina Renea  12:21  

Oh yes. I mean, I quit smoking when I found out I was pregnant, but I had been pregnant for like seven weeks. 

Rebecca Gadberry  12:29  

I smoked through my pregnancy.

Trina Renea  12:32  

People smoked in their pregnancies. My OB told me it was fine to drink wine during my pregnancy, and I did.

Dr. Michele Hakakha  12:39  

I mean, I had a few Apple martinis, which really dates me because nobody drinks those anymore.

Dr. Vicki Rapaport  12:45  

Oh, that sounds really good right now actually. Actually, you know, my silly story with that is that I went to coincidentally, Rebecca, meet with the lab in New York who does a lot of our medications. And I had met him for the first time I didn't know I was pregnant, went to the sushi bar. Saki Ban, I even actually did I'm sorry to say I did actually have a cigarette that night. This was 23 years ago. And, literally two weeks later, you know, first pregnancy ever, and I really was worried. But you know, Michele is right. Like, a little bit of alcohol at the beginning of pregnancy is not going to, luckily for me did not cause massive problems with my pregnancy. 

Trina Renea  13:26  

What my doctor told me was that your baby doesn't actually attach and start like taking blood from you until 10 weeks or something, if I remember, is that not right? 

Dr. Michele Hakakha  13:40  

It's actually three weeks. So, conception happens two weeks after a last period, and then seven days until the embryo implants. And the most critical time is between five weeks and 10 weeks.

Trina Renea  13:53  

What? So, then that’s when we're all drinking and don't know a lot of the time?

Dr. Michele Hakakha  14:01  

I mean, unless and we don't recommend it. But most of us have done something that we wish we didn’t.

Julie Falls  14:06  

I mean, I went home from my amnio with Dr. Kadner. And he said, go home and have some wine.

Trina Renea  14:12  

I know, I mean, the doctor told me it's fine to drink some wine in the beginning, don't be scared of it. Literally said the baby doesn't attach until 10 weeks and so that is not going to hurt them in those first 10 weeks. Don't freak out about it. Maybe he just said that because I was super, like upset or something.

Dr. Vicki Rapaport  14:40  

Well, you know how you can get. Anyway, back to the skin. Okay, so Michele, I have a very specific question. What are some of the most outrageous things you've seen your patients do instead of Botox during pregnancy, since of course we can't do Botox during pregnancy.

Dr. Michele Hakakha  14:53  

That’s off limits and well, you know, it's interesting. Most women just suck it up because they're pregnant and They're young, they're 20. They're 30. They're not 50 where it lasts for two weeks. Vicki, can I come back in again? So, they ask, they all ask, I once had a patient come in with a prescription from another doctor and said I needed to cosign it in order for him to do it. And I said, I'm not co-signing this, this says, this says Botox, and you're pregnant. So, people will try. But ultimately, you know, when you're 20, 30, early 40s having a baby, it's not as devastating to miss it.

Rebecca Gadberry  15:33  

Correct. I remember, I wasn't allowed to get perms back in 1978, which everybody had a perm. 

Trina Renea  15:43  

I'm actually surprised that another doctor was like, get your OBS permission on a signature, and I'll do it.

Dr. Vicki Rapaport  15:51  

Because we're still ultimately responsible and should know the science behind doing Botox or not doing Botox in a pregnant woman. So yes, yeah, it is sort of unbelievable. Like, like Michelle says, you'll deal with a wrinkle for nine months, like no big deal. You know, protecting that child is much more important. Do you have a favorite pregnancy book for listeners to read about all-things pregnancy? And is there something that we could chat about on that front?

Dr. Michele Hakakha  16:23  

So, I actually love it's called “Girlfriends Guide to Pregnancy.” And it's written by Vicki Lovine. It is not a medical book. But it is funny, and it will make you laugh. And you have to go through pregnancy with a little bit of humor. So that was one that I loved. And then when I had a one-year-old, and a four-year-old, I was approached to write a book, and I decided I was going to read all the other books out there, and I was shocked. I mean, a lot of the number ones best sellers and pregnancy are scary for people to read. And that's what I would hear from patient to patient that we're trying to look up. If we can have sushi and we find out we might get preeclampsia. So, So, I ended up co-authoring, Expecting 411 with a woman who had written Baby 411 and Toddler 411. And it's easy, and it's fun, and it's we make jokes, but it's we're physicians, and we have, you know, evidence-based medicine backing what we're saying. And we are now in our fourth edition.

Dr. Vicki Rapaport  17:27  

I saw that, Michele, congrats on that. Can you eat sushi when you're pregnant?

Trina Renea  17:31  

Can you eat sushi when you're pregnant?

Dr. Michele Hakakha  17:32  

If it's cooked, sushi, tempura roll, that's all fine. I get that question all the time.

Rebecca Gadberry  17:45  

I have a burning question that I know a lot of our listeners have, what do we do about stretch marks? Can we prevent them from happening? Or is that something we have to take care of with Dr. Vicki later?

Dr. Michele Hakakha  17:58  

You can try to help minimize them. But stretch marks, you know, the classic thing is people are 36 weeks pregnant. So, they're a month from their due date. And they say, oh, look, Dr. H, I don't have any stretch marks. And in my head, I'm thinking, ‘well, here they come.’ Yeah. So often, they happen at the very end. I mean, they happen there breaks in the dermis, right? So, they happen as you rapidly grow. And if someone gains a lot of weight quickly, or at the very end of pregnancy, when the belly just really expands, it can happen. But women also can get them on their breasts and they can get them on their thighs. And the only thing I think we could try to tell them is to gain weight gradually, and to moisturize your skin as much as you can. But genetically, if you're going to get them, you're often going to get them and then we send them to Dr. Vicki.

Rebecca Gadberry  18:45  

What about what shea butter, and cocoa butter, those have been traditional, and I've never found them to be very beneficial.

Dr. Michele Hakakha  18:55  

I tell people, anything that will last on your skin. So oftentimes mixing an oil with a moisturizer, moisturizer is going to last on your skin longer than just a moisturizer. So cocoa butter probably lasts a little bit longer.

Dr. Vicki Rapaport  19:11  

Okay, and then I tried to give an analogy to patients when, I mean everybody already sort of knows and does it but the analogy I like to give is like – If you had two leather purses, and you oiled a leather purse over the years, and you oiled it and you weld it and the other one just sat out and didn't get oiled, you know, and maybe was even in the sun, it would crack it would break. So, you know, oiling our skin, which isn't really leather, but in a sense, it really does protect the integrity. But Michele is right, between 36 and 40 weeks is the time where you rapidly expand and it's devastating for people. As soon as they get a stretch mark, what are you going to do? There's not much you can do other than just get it taken care of as soon as you can after delivery. And when I say get it taken care of. They're not easy to 100% cure, right you can laser them to do I'd bring back elasticity and bring back collagen with these resurfacing lasers or these like hybrid resurfacing lasers, but they're not perfect. They get the read out.

Julie Falls  20:08  

Are they genetic. I mean, the stretch marks?

Dr. Vicki Rapaport  20:12  

Michele, do you agree that there are genetic? 

Dr. Michele Hakakha  20:15  

Yes, they are. I see them a lot in women who say, Oh, my mom had them, yeah.

Rebecca Gadberry  20:19  

Are they connected to anything else like diabetes or any other disease or disorder in the body?

Julie Falls  20:29  

Even something that would make you more susceptible.

Dr. Michele Hakakha  20:31  

Well, I mean, if you're gaining a lot of weight, right. So, if you have gestational diabetes, and you aren't taking care of your diet, and you're gaining too much weight, they can happen. But in my particular field, they're not connected to anything I know, I'm sure, Vicki, she'll talk about cortisol levels and different things like that.

Dr. Vicki Rapaport  20:54  

Yeah, well, in people who either are lifting weights really aggressively and have increased muscle mass, men will get in the front of their shoulders. So, and yes, diabetes, patients who aren't really monitoring themselves can gain a lot of weight. And also, topical cortisone use, you know, really aggressive topical cortisone use. I've seen it way too many times in my practice where somebody was given either a super potent cortisone or was given bad instructions about, how long they should and shouldn't use it. And they develop horrible stretch marks. So topical steroid can also cause them besides pregnancy, so men can get stretch marks.

Trina Renea  21:33  

But can people really, like what are your treatments for stretch marks? Like, when can a pregnant person like start treating their stretch marks? Do you have to wait till after breastfeeding? Can you do it right away? And what do you do for that?

Dr. Michele Hakakha  21:52  

So, unfortunately, there's nothing we can do while someone is pregnant, we just tell them to keep oiling and keep moisturizing. Usually stretch marks start out you know, purpley, red, and then over time, they slowly fade to like a grayish silvery color. And that's part of what the lasering can do is kind of help a little bit with the tissue underneath and change the color. But we usually don't recommend people do that until they're at least six months after having a baby. Because the other thing is they're rapidly then losing weight, and any kind of tension on the skin. We want them to be back to their normal weight before they start doing things like that to their body.

Dr. Vicki Rapaport  22:30  

I agree. I think the best results are three to six months after when people have lost. Hopefully you have lost the other weight, and their lasers and the lasers typically, you can either do micro needling or you can do lasers, and the lasers that will basically make these micro injuries to stimulate your collagen to basically build and build and build to fill in those area of loss volume, those crevices of lost volume and tear of the elastin and the collagen. The redness is actually quite easy to get out, as Michele was describing, they can be purple, they can be red, the laser can actually get that out pretty quickly. And sometimes that's all you can do. And then you still have these creases, and you could feel them and they feel kind of cool, but they're not as obvious because they're not discolored anymore. 

Julie Falls  23:14  

If you're nursing and you get stretch marks on your breasts, then we're going to imagine you're not going to laser while you're nursing because your breasts are going to change. 

Dr. Vicki Rapaport  23:26  

Exactly. Michele, what about leg veins do we love and do we hate them? What's up with those?

Dr. Michele Hakakha  23:36  

So, there's two types there. They're the Spider Veins which are the really superficial, they look like spiders and they're on the surface and those happen due to elevated estrogen levels. Those are actually easier to treat after a pregnancy ends and those often go away after a pregnancy ends or get a lot smaller. The larger, deeper Varicose Veins are, you know, due to… I always give this analogy in my office, you have a garden hose and you have a bowling ball and you put the bowling ball on the garden hose and the water is going to have a really tough time getting back past the bowling ball. So, you have your uterus sitting on top of all of the veins in the lower extremities. And over time the progesterone dilates the veins and the pressure of the uterus kind of opens up those valves, so the valves actually burst sometimes. And that's why women will get varicose veins in the lower extremities, not in their arms. They'll get them around their rectum, which is hemorrhoids. They sometimes get them outside the vagina which is you know vulvar varicosities and those can get smaller after people deliver, but they often come back really quickly in subsequent pregnancies because those valves have already been damaged.

Dr. Vicki Rapaport  24:55  

So, when somebody plans on having multiple children and say they have spider veins that can be treated by the dermatologist. Do you recommend waiting until all the pregnancies are finished? Or do you recommend them doing in between the pregnancies? What's your take? 

Dr. Michele Hakakha  25:09  

Spider Veins we recommend, I mean, they often believe it or not go away or they're really faint after let's say pregnancy number one, and I do recommend people wait until they're done having children to do all this stuff. There are some people who are very impatient and don't mind spending money each time they have a baby but ultimately you want to wait until you're done to do that stuff.

Dr. Vicki Rapaport  25:31  

That's fair. Yeah, I like that recommendation. Also, it calms them down so they don't feel like every little cosmetic thing has to be taken care of. 

Trina Renea  25:42  

Can you share with our listeners what you do for those varicose veins or spider veins?

Dr. Vicki Rapaport  25:48  

I don't treat varicose I send those to the vascular surgeon because they usually use like either they actually surgically remove them or they inject detergent things that ingredient that we don't use in dermatology. But for the spider veins, we use two different things. Hypertonic saline, which is high doses of salt of salt solution, it's like 23.9% Normally it's point 9%. Like if you get a saline injection into something or you get a bag of saline, it's point 9% were injecting 23.9% or 23.4%. And it collapses the veins and the veins sort of gets the walls inside the vein gets sticky and it sticks to itself and even a vein needs blood flowing through it to survive. So, when you collapse a little tiny spider veins with the saline, they die and it takes about six weeks for your body to break them up and make them disappear. So, we inject them it's called Sclerotherapy. There's also something called Sotradecol, which is actually like a detergent that does the same exact thing and it doesn't burn the way the saline burns but that one can hyper pigment. So, it's an injection. Lasers don't work as well for like veins. Lasers work better for facial veins. But there are people that do leg vein lasers, it's okay. But there's also a really cool situation where a pregnant women will get all these broken blood vessels on the chest. And it's all as Michele was saying it's an estrogen influence on the blood vessels. They just break. And those disappear sometimes in the delivery room. Right, Michele, like once the baby has been delivered, those vasculature on the chest just literally disappear. Have you ever seen that?

Dr. Michele Hakakha  27:26  

I had it. I knew exactly where mine were, I'd be like, here, here and some of my face too.

Dr. Vicki Rapaport  27:31  

Then did those disappear after delivery?

Dr. Michele Hakakha  27:33  

I think most did. I came back to you for two of them.

Julie Falls  27:38  

This was kind of a little bit getting off topic. But if estrogen can cause those, what about like hormone replacement therapy, people who are on birth control, or they also can be a culprit for the leg veins, the spider veins?

Dr. Michele Hakakha  27:55  

Typically, not because pregnancy estrogen levels are dramatically higher than birth control pills and birth control pills are higher than hormone replacement therapy. So, at lower levels, we don't see that what's interesting is we do see the same situation often in Alcoholics because in Alcoholics the liver actually is making estrogen because of all the damage that's going on and if you think about an old man who's an alcoholic with all the red here and kind of the cheek sometimes have the spider veins, it's the same process. We don't typically see that with pills and then hormone replacement therapy. 

Dr. Vicki Rapaport  28:33  

Okay. But I liked the topic of hormone replacement therapy eventually to talk about that.

Julie Falls  28:38  

I’m trying to find something to blame my spider veins on my family, besides my mother and grad mother.

Rebecca Gadberry  28:43  

How about that line of ancestors that leads directly into them.

Julie Falls  28:48  

The ones who are trying to escape Russia with like poultry on their shoulders.

Rebecca Gadberry  28:52  

It's the chickens.

Trina Renea  28:56  

I was a jazz dancer growing up and my stepmom used to tell me to wear really tight tights to keep you by leg veins from bursting or whatever. And I used to hate wearing them because they were so tight. And I have leg veins all over my legs. So, I had to not work and I had to suffer through those really tights.

Dr. Vicki Rapaport  29:14  

Well, I think like stretch marks or genetic you know certain like, propensity, so genetic. Michele, I have a list of topical ingredients that I would love to go through in rapid fire. And for you to say yes or no whether these are OBGYN approved during pregnancy. And if you don't know the answer, or I should say like, you know if you and I agree, disagree, let's chat about it. But if not, we're just going to do rapid fire. You're going to say yes or no and we're going to just go for it. What do you think? 

Dr. Michele Hakakha  29:47  

Sounds good.

Julie Falls  29:48  

Can I ask her one quick question before you do this. She grew up in Hawaii and why is her skin look like that?

Dr. Michele Hakakha  29:56  

I see Dr. Vicki all the time, but I also started college at 18. And I was indoors from 18 for four years and then medical school and then residency and I didn't go in the sun a lot there, but I did when I was little. 

Rebecca Gadberry  30:15  

It's her own personal suncare. 

Julie Falls  30:16  

It’s called academics. 

Rebecca Gadberry  30:20  

Yes. For those of you who cannot see her skin is amazing. It's beautiful. She's beautiful and wrinkle free. It's great. And I just heard that you've got a daughter going into college.

Dr. Michele Hakakha  30:32  

I have one daughter who just finished her first year in college and another who is a sophomore in high school studying next door for her finals.

Rebecca Gadberry  30:40  

So, we can get an idea of how old you are. So, you look wonderful.

Dr. Vicki Rapaport  30:45  

But as beautiful as she is she's even smarter. And you know, I'm just proud to say that she is my OBGYN as well.

Julie Falls  30:54  

You're her doctor. I love it.

Dr. Vicki Rapaport  30:56  

Okay. Rapid Fire ingredients, Michele, here we go. Yes or no. Vitamin C. 

Dr. Michele Hakakha  30:57  

Yes. 

Dr. Vicki Rapaport  30:57  

Glycolic acid. 

Dr. Michele Hakakha  30:58  

Yes. 

Dr. Vicki Rapaport  30:59  

Botox. 

Dr. Michele Hakakha  30:59  

No.

Dr. Vicki Rapaport  31:00  

Filler.

Dr. Michele Hakakha  31:00  

No. 

Dr. Vicki Rapaport  31:03  

Retinol. 

Dr. Michele Hakakha  31:03  

Never. 

Dr. Vicki Rapaport  31:04  

Retin -A.

Dr. Michele Hakakha  31:04  

Never. 

Dr. Vicki Rapaport  31:05  

Hyaluronic acid. 

Dr. Michele Hakakha  31:06  

Yes. 

Dr. Vicki Rapaport  31:06  

Peptides. 

Dr. Michele Hakakha  31:07  

Topical peptide, yes.

Dr. Vicki Rapaport  31:08  

Topical growth factors.

Dr. Michele Hakakha  31:33  

Don’t know about that, I haven't had anyone asked me. 

Rebecca Gadberry  31:38  

Except for fibroblast growth factor. FDA says no.

Dr. Vicki Rapaport  31:42  

Okay. Well, the big expensive one on the market. TGF beta one. Yeah, that one. And I looked at it…So peptides. Yes. growth factors. Yes, unless its fibroblast growth factor. Sunscreen? 

Dr. Michele Hakakha  31:50  

Absolutely. 

Dr. Vicki Rapaport  31:50  

Lasers. 

Dr. Michele Hakakha  31:52  

No. 

Dr. Vicki Rapaport  31:56  

Salicylic acid?

Dr. Michele Hakakha  32:09  

Yes. 

Dr. Vicki Rapaport  32:10  

Okay, two more. Hydrocodone? 

Dr. Michele Hakakha  32:011  

No. 

Dr. Vicki Rapaport  32:13  

Benzoyl peroxide.

Dr. Michele Hakakha  32:15  

Yes.

Dr. Vicki Rapaport  32:16  

Wow. Okay, so yes to salicylic acid, and yes to benzoyl peroxide, no to hydrocodone and no to retinol, never to retinol or retin - A.

Dr. Michele Hakakha  32:35  

Vitamin A actually is a very, very well known to Teratogen meaning that it can cause birth defects. And we've actually taken vitamin A out of most prenatal vitamins now, because we found women were getting too much. And if you're eating a well-rounded diet, you're getting enough in your daily intake with food.

Rebecca Gadberry  32:53  

And it can cross through the skin’s barrier and very quickly, they get picked up by the circulation and because it can cross the placenta, it's can be very dangerous even on the skin. And

Trina Renea  33:08  

And why not Botox if it's just numbing a muscle in your face?

Dr. Michele Hakakha  33:11  

Because Botox hasn't been studied in pregnant women number one, and number two, I mean, it's botulinum toxin, right? And if you could potentially have any sort of dispersing of that into your body and into your bloodstream and across the placenta, and I don't think any of us would take that chance with a baby.What about

Rebecca Gadberry  33:33  

What about sunscreens like Octinoxate and your Benzophenone groups? A lot of companies are saying that they cause fetal abnormalities. Have you seen anything on that? You or Dr. V.

Dr. Michele Hakakha  33:50  

I mean, I ideally you are taking out as much that could be dangerous as possible. So, if you look at a unborn baby, there are over 100 chemicals in the blood of the umbilical cord before baby is even born in women that are taking good care of themselves. So, anything that you can potentially take out of your products that could be dangerous, like those two that you just mentioned? Yes. Ideally, you're doing the most natural things you can while you're pregnant.

Rebecca Gadberry  34:22  

So, for sunscreens, we're talking about titanium dioxide and zinc oxide, so your minerals. 

Dr. Vicki Rapaport  34:30  

The physical blocks have become my favorites overall in general, and we go hyper spastic on pregnant women so sure, why not? I have a funny story about Michele. We have a doctor group that we you know, friends, about four of us would go out to dinner. We used to try and do it like every couple of months, and now we do it like every couple of years, but I remember Michele had this bag, some fabulous, I don't know Chanel bag or something. And we were all gawking at it. And wow. And Michele is like, yeah, patient just gave this to me. And so, her patients love her so much. They give her Chanel bags and I'm wondering if on your website that Louie Vuitton bag that's like sitting in that photo by your desk, was not given to you by a patient?

Dr. Michele Hakakha  35:11  

It was actually.

Rebecca Gadberry  35:13  

I'm in the wrong business.

Dr. Michele Hakakha  35:17  

But she is another doctor and I didn't charge her so she got that.

Dr. Vicki Rapaport  35:21  

Of course, you didn't charge her because you're amazing. You are just a beautiful human being. Thank you so much, Michele. Does anybody have anything else for our fabulous Michele Hakakha?

Trina Renea  35:31  

So, is there anything we haven't touched on for pregnancy that you feel like we our listeners should know?

Dr. Michele Hakakha  35:39  

Actually, yeah, I think I think we should talk about two more things really briefly. Skin tags because they happen oh, yeah, pregnancy, and just the darkening of moles that happen. And I recently had a patient that was pregnant and developed a melanoma on her belly. And she brought it to the attention of her dermatologist and he was afraid to actually do anything during pregnancy. And the same rules apply. If there's something that's changing, even though a lot of it is normal, and a lot of you we will see darkening of moles and sometimes even growth of the mole. I always tell people to see their dermatologist to get it checked out. And the same rules apply. Like I said, if it's growing, and it looks abnormal, it should be removed.

Dr. Vicki Rapaport  36:23  

And Michele, when I do that on pregnant women, I always do lidocaine, no epi. How do you feel about that? That's fine, right? Why was that dermatologist afraid to take off a mole?

Dr. Michele Hakakha  36:33  

I have no idea. I mean, she was 36 weeks pregnant, but there's no excuse for that. I mean, melanoma of all cancers can actually cross the placenta, right? And so that's why we're so concerned about that one in particular,

Rebecca Gadberry  36:47  

Were they both okay? 

Dr. Michele Hakakha  36:49  

They were both okay. 

Dr. Vicki Rapaport  36:51  

Okay, just quickly back that melanoma so they diagnosed it, did she end up doing the excision like ASAP before delivery? Or did she wait?

Dr. Michele Hakakha  36:58  

Nope, she waited until after delivery. She didn't even tell me about it, actually. And then she went back to see her dermatologist when her baby was about six weeks old, and had a massive excision.

Dr. Vicki Rapaport  37:11  

Wow, not my favorite, but you know, take care of those as soon as possible. 

Trina Renea  37:15  

Yeah. Wow. And then the skin tags, that's a common thing to get as well.

Dr. Michele Hakakha  37:21  

Yeah, the skin tags happen a lot on the neck and wear the bra rubs and your breasts are getting bigger and sometimes between the breasts. Those often fall off after pregnancy and can very easily be removed by the dermatologist, if not.

Trina Renea  37:35  

Can they be removed during pregnancy? 

Dr. Michele Hakakha  37:40  

They can, I just tell people that you just wait because when you're done, you're going to have those little red marks taken care of and your spider veins and your skin tags and do it all in one thing, one visit.

Julie Falls  37:54  

Can pregnancy bring on things like melanoma, I mean, are just something getting exacerbated? And possibly, if something was kind of lying there, could it trigger it to come out? I mean, should you take more trips to the dermatologist while you're pregnant just to get checked? 

Dr. Michele Hakakha  38:19  

Not unless you have a history of anything where you would require frequent checks anyway. And, Vicki, you can comment on this too. Not to my knowledge, does pregnancy increase your risk of having melanoma develop.

Dr. Vicki Rapaport  38:33  

I mean, in genetically prone people. Yes. But it's a new, very unusual. melanoma is very unusual in general, but pregnancy in the wrong person who melanoma can be affected, the way melanin can be affected by estrogen, so can melanoma in the prone person, right. And that's probably the reason.

Rebecca Gadberry  38:52  

Person should get looked at.

Dr. Vicki Rapaport  38:55  

Genetically, you won't even know. Right? So, Michele is right. If there's a changing mole, growing mole, and your OBGYN says to go to the Derm, I would highly recommend you go straight to the Derm. You know, because removing something is not contraindicated when you're pregnant.

Trina Renea  39:09  

Yeah. Not at all right. Because it's just the skin you're removing. 

Rebecca Gadberry  39:13  

Yes. And it's a local anesthetic. Right. So, it's nothing that it's going to penetrate.

Julie Falls  39:19  

Yeah, leaving it on there. Like Michele said, my God. Not just dangerous to you, but your baby.

Rebecca Gadberry  39:28  

Well, on that high note. Michele, this has been wonderful. I've really learned a lot from you. And I haven't had a child for 44 years. Which you never know. No, I know.

Trina Renea  39:45  

Can you say the name of your book one more time?

Dr. Michele Hakakha  39:47  

Sure. It's “Expecting 411”

Trina Renea  39:52  

Okay. And I bet you have it in your office. 

Dr. Michele Hakakha  39:57  

I have in my office but we also can get it on Amazon. You can get it anywhere. 

Trina Renea  40:05  

Great. Okay. Well, we'll make sure to put a link to that in our “About” page for you. Fourth Edition. 

Dr. Vicki Rapaport  40:15  

Well, we appreciate you blowing our minds about salicylic acid and, you know, just all the enlightening things that you brought. I love your perspective, I just think you are so kind and generous and you know, helpful to your patients. I love your description on your website about having a safe environment for these people who are going to the gynecologist for the first time or having a baby for the first time or as you said on your website like transitioning from adolescence to adulthood like you are, you know, the, I think the most beautiful OBGYN that everybody should just emulate when they are going through residency. They should all be like Michele Hakakha.

Dr. Michele Hakakha  40:57  

Thank you. It was it was fun, you guys. Thank you. 

Trina Renea  41:00  

Thank you so much, Michele. And we'll talk to you again soon.

Dr. Michele Hakakha  41:06  

Sounds good.

Dr. Vicki Rapaport  41:07  

Bye.

Trina Renea  41:09  

Well, that was lovely ladies. We're going to have a follow up. I just want everyone to know. So, this was skin in pregnancy, and we're going to do skin and the end of your life as well.

Rebecca Gadberry  41:25  

No, wait a second. I went through menopause 18 years ago, I am still alive, not the end of life. It's the end of your ability to have baby.

Julie Falls  41:36  

We’re just better and stronger.

Rebecca Gadberry  41:39  

Our life is now our own. I'm not going further into that.

Trina Renea  41:48  

Well, okay, so we have a listener’s question today that I wanted to throw out there. This is from Terry, and she's asking – Do I need to exfoliate and why? Okay, that's a loaded question. Because I mean, I'm going to say as the esthetician, my little tidbit, it depends on your age, really. When you're cells are turning over naturally, when you're younger, I don't think you need to exfoliate that much because your cells are naturally.

Rebecca Gadberry  42:17  

Like the age of under 30 or…?

Trina Renea  42:19  

25-ish, I would say you can start dabbling in exfoliation after 25 they say that's when your cells start to go downhill. That's what I've heard anyway. 

Rebecca Gadberry  42:33  

So, now our bodies are going down with menopause and your cells go downhill. You're just taking everybody down that hill?

Trina Renea  42:42  

No, but I think exfoliation is really a depends on so many things. How thick is your skin? How much acne do you have? What type of exfoliate the exfoliant? How old are you? How deeply are you wrinkling? You know, there's scrubs, there's Alpha Hydroxy Acids, there's enzymes. There's Retinols, Retin - A. There's so many different ways, buff puffs.

Rebecca Gadberry  43:11  

Okay, that should never be experienced, please. No, no, no, no, no, no, no, no, no. Don’t even get me going above?

Dr. Vicki Rapaport  43:20  

Do they still exist?

Rebecca Gadberry  43:22  

I don't know. I was just going to ask it. I haven't seen a buff puff in decades.

Trina Renea  43:26  

Imagine if people do loofahs to their face?

Rebecca Gadberry  43:31  

Don’t even, and if you have sensitive skin. You shouldn't be.

Trina Renea  43:33  

Rosacea, I mean, it really depends on so much. So, should you exfoliate? That is a question for your esthetician or your dermatologist to give you and I wouldn't just say everybody in the world. Yes, you should exfoliate. Why? Because whatever. It's really, really, really person dependent.

Rebecca Gadberry  43:51  

If we talked about exfoliation yet. No, but we can have an episode on all we should do a deep dive on exfoliation.

Dr. Vicki Rapaport  43:58  

Oh, thank you for influencing us, Terry. Is that right? 

Trina Renea  44:01  

Thank you, Terry.

Rebecca Gadberry  44:04  

We'll go into that in depth because I think the answer to this is much more involved in complicated so many variables.

Julie Falls  44:09  

So many variables.

Trina Renea  44:11  

It is very complicated to know. And there's so many exfoliation products out on the market and you can hurt your skin if you aren't careful. And one way to know if you're over exfoliating is if your skin feels sensitive, even when you put anything on it, even cleanse it or you're putting on some gentle serum and it's burning. That's a way to know that your skin is sensitized, irritated like that, that you should like slow down on whatever exfoliation you're doing because you're irritating.

Rebecca Gadberry  44:45  

And I know that there's a lot of doctors out there right now who are saying you should never exfoliate. I disagree with that, but we'll go into the reasons why at a later date. What do you think, Dr. Vicki?

Dr. Vicki Rapaport  44:56  

Terry, thank you for the question. I think it's skin dependent, not age dependent. So yeah, somebody who's 16 who has terrible Comedones, they need to exfoliate. I like Retinol. I like Retin - A, I like Sal and glycolic acid pads. But yeah, somebody who's 16 and has KP on their face and his eczema and I would never tell him, KP – Keratosis Pilaris, very sensitive skin. And then somebody who's 50, their cell turnover is slowing down. Yes. Exfoliate. Somebody who's 50 has rosacea? Ah, yeah. If you want to exfoliate a little bit with Mandelic, but I wouldn't go crazy. So, I don't I hate always saying check with your esthetician and check with your dermatologist, because that's probably a reason why they're listening to this podcast. Yeah, they don't have access to that. So, I think it's really up to your skin. You'll know if your skin can handle it. If you want to do it, give it a try. If it works, amazing. If it doesn't work, please stop.

Rebecca Gadberry  45:48  

And we’ll talk about the benefits of exfoliation too. And different types of exfoliants. And products out there, and the tools that are exfoliating too.

Dr. Vicki Rapaport  45:58  

Can we send our answer straight to Terry?

Trina Renea  46:03  

Yes, I can contact Terry and we can have a consultation. Okay, well, excellent. Thank you for the question. We will have a deep dive for you soon. And then I'm going to end with the takeaway today. My takeaway of the day is – I just heard from an OBGYN that it's okay to use salicylic acid when you're pregnant, which is new information to me. Wow. So, that's excellent news for so many people to know that it's okay. I had a client one time that told me that she didn't know that and she was pregnant. And she used salicylic acid through her whole pregnancy and said her baby was fine. So, I'm like, well, hi. I don't know.

Rebecca Gadberry  46:58  

My takeaway now is that when Trina learned something new that knocks your socks off? You better get the smelling socks.

Trina Renea  47:05  

Whoa, I'm blown away. I mean, because there's always only ever been two ingredients you can't use vitamin A and salicylic acid. So now there's really just the one. So that's amazing. All right. Thanks for listening.

Get ready to stay in the know with Facially Conscious - The Ultimate Guide to navigating the overwhelming world of information. We're your trusted co-host bringing you the latest and greatest on all things facially conscious. Have a burning question or idea you want to share? Don't hesitate to email us at info@faciallyconscious.com, we'd love to hear from you. And if you're itching to share your own experience with our audience, contact us and we just may feature you on an upcoming episode. Stay tuned for even more insights and inspiration on our website www.faciallyconscious.com, where you can catch up on blog posts and past guest interviews.