Botox in Pregnancy & Breastfeeding

Botox is one of the most popular aesthetic treatments in the country and certainly one of the most common non-surgical cosmetic treatments that I perform. For a quick review, Botox is a formulation of botulinum toxin (a molecule produced by the bacteria Clostridium botulinum) that is produced for pharmaceutical use. Botox is used to flatten out “dynamic” wrinkles on the face, those lines that appear when you are activating your muscles of facial expression. (By contrast, fillers like Vollure are used for “static” lines that are present when the face is at rest). Botox works its magic by weakening the action of facial muscles.

Remember that voluntary muscles (like those that control your muscles of facial expression) contract when your brain sends a message to them via nerves. Botulinum toxin interferes with signal transmission between the nerves and the target muscles, leading to weakened muscle contraction and smoother overlying skin. The doses used for cosmetic purposes are minute and generally very safe. However, since botulinum toxin is, in fact, a toxin, it is a good idea to steer clear of Botox during pregnancy and breastfeeding. In fact, this is precisely the reason parents are advised not to give their children honey during the first year of life: the potential presence of Clostridium botulinum spores with, you guessed it, botulinum toxin that the newborn’s immune system is not yet capable of neutralizing.

While there is some data that Botox is safe during pregnancy when used for medical purposes (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117417/) I, and most other board certified plastic surgeons I’ve spoken to about the matter, agree that it is certainly not worth taking any chances for an elective cosmetic procedure while pregnant. It is simply not known if Botox poses some small risk to a developing fetus, and the risk just is not worthwhile. The risk of passing the toxin to a fetus through breast milk is probably even lower. However, there is again a lack of data here. Absent strong evidence that Botox for a breastfeeding mother is completely safe for her nursing infant, the risk of a problem is not justified. There are many other options for facial rejuvenation that are perfectly safe during pregnancy that we would be happy to discuss!

As always, we encourage you to join the conversation in our Facebook group: https://www.facebook.com/groups/askaps

Author
Office of Darren M. Smith, MD

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