Dr. Zein Obagi started the line in Southern California years ago.  As this article in Plastic Surgery Practice states “For 25 years … he has written and rewritten the book on healthy skin.”  He does not judge skin based solely on the Fitzpatrick System (looking at white to black skin, and judging it on how it responds to UV light). 

He instead wants to base classification of skin based on a more “clinical classification” looking at five things:

• color
• thickness
• oiliness
• laxity
• fragility

He describes life stages of the skin: 

• Under age 10.  Properly clean and hydrate your skin.  Apply sunscreen.  He recommends antioxidants to prevent early damage from free radicals (**I am not sure how I feel about this.  I don’t know any research has been done on safety of antioxidants in young children.  Remember whatever you put on the skin can be absorbed through the skin. But I think it is an interesting concept and makes sense.)
• Age 10, the skin needs to be cleansed properly. If there are issues with sebum production (ie acne), you need to cleanse with a specific cleanser for oily skin and do a nonirritating scrub to prevent whitehead formation.  He recommends an astringent to decrease the sebum deep in the pores.  If needed, he also recommends hormone balancing.  The best you can do with acne scarring is to PREVENT it.
• After age 25:  He calls this the “inactive phase.”  Most cells making collagen and elastin become lazy.  This leads to aging.  So we should stimulate these cells.  The most effective agent to do this is Vitamin A- Retin A and retinol.  I agree with this statement.  Retin A products are well studied, their positive effects on the skin are well known, and it has been the workhorse of skin care for 20+ years.  I carry both Retin A and retinol in my office.  ***These products are NOT safe during pregnancy or breast feeding.  So if you are starting to think of babymaking, stop these 6 months before you start trying for your baby.

Other interesting pearls…

97% of the public gets skin care products from department stores and not physician offices.  This number surprised me.  The cost is usually similar (and for my personal line, my products are sometimes less).  Don’t pay for advertising and packaging.  Get a medical grade product.

Guidelines and safety in our industry:  He had an entire page dedicated to “unqualified doctors doing procedures.  We have board certified doctors who have worked hard in their training and worked hard to get the best results.  And we have a lot of other doctors who are not as well trained, who are doing it just for the money.  The dilemma is very big.  I think the future is not in creating more devices.  It is to create guidelines, to create standards. … I think the consumers really need to do their homework and go to board certified specialists and ask for a second opinion on a procedure.”  I agree. 

I saw a patient of mine recently who had a breast augmentation done in her 20s who is  now pregnant with her first child.   And she thanked me for my advice when she got her breasts done.  Why?

When she had her augmentation, she was unsure of what size to pick.  I knew she wanted to have kids some day.  So when she was trying on sizers, I urged her to be a little conservative when she had narrowed it down to the last two.  The common wisdom is to “go a little bigger than you think because most women wish they had gone larger.”   I agree with this.  It is the most common comment I hear from patients if they wish their size was different (though most are happy and did pick the right size).   It is likely a bit of the whole diamond effect- a diamond looks huge when you first get it but “shrinks” with time. (And no ladies don’t worry- they aren’t actually shrinking, you just got used to it.)

BUT if you are young, don’t max out with your first augmentation.

Why? Hint one: you are young.  You likely jog, wear tiny tops without bras at times, and have not had kids.  You will age (oh no!) as time goes on.  Gravity and activity and babies- pregnancy, breastfeeding, etc- are going to act to stretch out your skin.  It is great to leave yourself some room to upsize to tighten and lift things down the road.  Hint two: this is your first augmentation.  A good lifetime for an implant is 15-20 years.  Expect you will have a second surgery at some point.  Again, it is good to be able to go a hair bigger to tighten and lift. 

If you maxed out your breast implant volume at your first surgery, then you will age more with time and gravity.  You will become super huge when you are pregnant and breastfeeding.  And then you will droop.  Droopy is not a term you want associated with your breasts.  To fix droopiness, you can go larger in volume or you have to lift.  If you are maxed out, then you shouldn’t go larger on size.  You need to lift.  To lift involves cutting out more skin and is a bigger scar.

So be little conservative with your first breast augmentation when you are young.  Think of your lifetime.  My goal is your breasts stay as pretty as long as they can.  Don’t go too small- I want you to feel like you “did this.”  But don’t do larger just to go larger.  You can always wear a push up bra on a Saturday night for the little extra oomph.  Your breasts will age better and give you more options down the road if you do.

1. Exercise.  A healthy body does better with pregnancy.  A lot of the women I see with great figures after pregnancy had them before pregnancy.  So improve your muscle tone, particularly your core muscles (especially the rectus muscles and oblique muscles which you use to do pilates/the plank/sit ups).

2. Healthy skin.  The “rosy skin” of pregnancy sounds great. And many women do get it.  They also get a lot of pigmentation.  The sun spots, age spots, freckling- call it what you will- worsens with pregnancy.  So prior to pregnancy, try to reverse any skin pigmentation you have.  Hydroquinone and Retin A are great for pigmentation, but they are NOT baby safe.  There are products with Vitamin C and E which are okay while pregnant and breast feeding.  And the key to pigment? SUNSCREEN and the big floppy sun hat. You should apply sunscreen daily.  Try to find a moisturizer or makeup base with sunscreen in it.  When doing activities in the sun, apply sunscreen 20 minutes before going outside, reapply every 45 minutes in water, reapply every 2 hours regardless, and use sunscreen less than a year old.  I am a fan of the clear zinc based sunscreens.  They are mechanical blockers, not chemical, so they are likely less absorbed in the skin.  Very effective and thought to be a little more baby safe.

3. Ideal weight.  You will gain weight with pregnancy.  (Oh my!? shocking.) The amount of weight you gain varies, but the usual recommendation is 25 pounds.  There is a correlation with weight gain and body changes- stretch marks, loose skin, diastasis, and higher post pregnancy weight.  There are studies which link obese children to mothers who were obese before pregnancy.  (The amount of weight gain has been revised to 11-20 pounds for women with a BMI of 30 or more.)

4. Stop smoking.  I could go on for ages on this one.  It affects every body system; increases your chance of heart attacks, stroke, and cancer; along with sun exposure it is the biggest ager of the skin, and does things I can’t fix with products and peels; no surgeon will do a tummy tuck or a breast lift on a smoker, so you might as well stop now; it is expensive; you can’t do it in restaurants; it yellows your teeth.

The health effects on the baby: it lowers the amount of oxygen they get in utero, increases heart rate, and increases rate of miscarriage and low birth weight.  There are other studies indicating after birth these babies have issues with asthma, behaviorial issues, and higher SIDS. For more information go to: http://cerhr.niehs.nih.gov/common/smoking.html.

5. Surgeries. The one surgery I like before pregnancy is liposuction.  If you have a discrete problem area, like “my outer thighs,” or are an exaggerated pear or apple shape, your shape will not improve with pregnancy.  Particularly for those women who are teeny tiny up top and carry all their weight in their thighs/hips, when you put on baby weight it will all go there.  Fast forward: you are now 10 years older and have stretched that skin more, for a longer time, and your skin is older- it won’t bounce back after liposuction like it would at age 25. Skin tone is key to liposuction, and young skin is better.

I do not like to do abdominoplasty (tummy tuck) or breast surgery right before babies.  If your breasts really bother you and you will not have babies for 5-10 years, then it may be worth it to do now. But pregnancy and breast feeding affect the belly and the breast the most.  If you can, wait to fix up those areas until after you have kids.

So,

Exercise. Wear sunscreen. Eat well/be your ideal weight. Don’t smoke.  Sounds simple, eh?

Now go get practicing to have that baby.