What facial changes can occur during pregnancy?

Facial Changes During Pregnancy

Pregnancy causes several facial changes due to hormonal fluctuations, including spider angiomas and palmar erythema related to the hyperestrogenic state, which typically resolve postpartum. 1

Common Facial and Skin Changes During Pregnancy

Vascular Changes

• Spider angiomas (telangiectasias) - Small, dilated blood vessels that radiate from a central point, appearing primarily in white women 2
• Palmar erythema - Redness of the palms, often associated with burning sensations 2
• Facial edema - Firm swelling that may develop on the face in the final months of pregnancy 2

Pigmentation Changes

• Melasma ("mask of pregnancy") - Hyperpigmentation appearing as brown patches on the cheeks, forehead, and upper lip 3
• General hyperpigmentation - Darkening of the skin, particularly in areas already pigmented such as the areolae, nipples, and genital areas

Structural Changes

• Facial fullness - Due to fluid retention and weight gain
• Nasal edema and enlargement - Due to increased blood volume and hormonal effects
• Gingival changes - Including gingivitis, gum hypertrophy, and sometimes pyogenic granuloma (a vascular growth on the gums) 2

Timeline of Facial Changes

Most facial changes begin during the first trimester and progress throughout pregnancy:

1. First trimester: Initial vascular changes may appear
2. Second trimester: Pigmentation changes become more noticeable
3. Third trimester: Maximum expression of most changes, particularly edema and vascular phenomena

Clinical Significance

These changes are primarily cosmetic and do not typically indicate underlying pathology. However, they can cause significant distress to pregnant women 4. Research has shown that facial attractiveness ratings decrease throughout pregnancy, with nonpregnant women being perceived as most attractive 3.

Management Considerations

1. Reassurance - Most changes are temporary and resolve postpartum
2. Monitoring - Any changing or concerning melanocytic nevus during pregnancy should be evaluated clinically (optimally with dermoscopy) 1
3. Biopsy considerations - If a nevus is worrisome, biopsy should be performed as in standard practice 1
4. Sun protection - Appropriate sun-protective measures should be similar to those for nonpregnant patients to minimize pigmentation changes 1

Special Considerations

• Melanocytic nevi - Evidence is lacking that melanocytic nevi darken or enlarge during pregnancy, except for those on the breast and abdomen that may appear larger because of skin stretching 1
• Facial recognition systems - The significant facial changes during pregnancy may impact facial recognition technologies 1

Postpartum Resolution

Most pregnancy-related facial changes regress spontaneously in the postpartum period 2. However, some pigmentation changes, particularly melasma, may persist in some women.

Understanding these normal physiologic changes is important for healthcare providers to appropriately counsel pregnant women and distinguish benign changes from potentially pathologic conditions.