Face
Can I Get Botox or Fillers When I'm Pregnant or Breastfeeding?
In this 2020 recording, Dr. Smith recommends postponing elective cosmetic Botox and fillers during pregnancy and breastfeeding because of limited safety information. Darren M. Smith, MD, a plastic surgeon in New York City, explains the reasoning behind that precaution and distinguishes cosmetic treatment from treatment of a medical condition. Updated evidence is summarized separately below.
In this episode.
Episode summary
In this 2020 recording, Dr. Smith recommends postponing elective cosmetic Botox and fillers during pregnancy and breastfeeding because of limited safety information. Darren M. Smith, MD, a plastic surgeon in New York City, explains the reasoning behind that precaution and distinguishes cosmetic treatment from treatment of a medical condition. Updated evidence is summarized separately below.
Key takeaways from the episode
🔎 Botox and fillers work differently.
Botulinum toxin products reduce selected muscle activity; the hyaluronic acid fillers discussed in the episode add volume.
⚠️ A familiar ingredient does not establish safety in pregnancy.
Hyaluronic acid occurs naturally in the body, but that alone does not answer whether an injectable product is appropriate during pregnancy or breastfeeding.
💬 Elective and medical uses raise different questions.
Dr. Smith mentions uses such as migraine and muscle spasticity. A decision about an ongoing medical treatment requires its own assessment.
🔎 The recommendation in the audio is precautionary.
It should not be interpreted as evidence that every exposure causes harm, or as a statement that all products and uses have been studied equally.
Questions this episode answers
Why does Dr. Smith recommend waiting for cosmetic injections?
He weighs an elective appearance benefit against uncertainty about pregnancy and breastfeeding safety. The recording's recommendation is to wait rather than assume that a small dose or a naturally occurring filler ingredient settles the question.
Does this episode provide a treatment plan for migraine or spasticity?
No. Dr. Smith mentions these medical uses but does not give an individualized treatment plan. The clinician treating the condition should assess the relevant benefits, uncertainties and alternatives.
ℹ️ Current context for this 2020 recording
The FDA does not recommend cosmetic botulinum toxin injections during pregnancy or lactation. The FDA also states that dermal filler safety during pregnancy and breastfeeding is unknown.
Lactation evidence has developed since the recording. The September 2026 LactMed review describes limited human data on onabotulinumtoxinA and notes guidance supporting its use for chronic migraine during breastfeeding. Those findings do not establish safety for every toxin, dose or indication, and breastfeeding evidence does not establish pregnancy safety. Discuss your specific treatment and circumstances with your prescribing and obstetric or lactation care teams.
🔗 Related information
Explore Botox treatment information, dermal filler information, or request a consultation with Dr. Smith in New York City.
Originally released July 6, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.
Original show notes
Who doesn't like a little Botox here or a little filler there? Board certified New York City plastic surgeon Dr. Darren Smith explores the safety of these almost ubiquitous treatments during pregnancy and breastfeeding.
Read the conversation.
[00:08] I'm board certified New York City plastic surgeon, Dr. Darren Smith, and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures, news about trends in aesthetic medicine and candid sessions with industry insiders. We hope you enjoy today's episode. Can I get Botox or fillers when I'm pregnant? Let's start this one off by looking at exactly what Botox and fillers are. So Botox is one of several medications in the class that we refer to as neurotoxins or neuromodulators and Botox is actually the trade name for a formulation of botulinum toxin which may sound familiar because it is in fact the same botulinum toxin that is responsible for the paralysis associated with the medical condition called botulism. Now of course the botulinum toxin that we're using for aesthetic purposes is minutely dosed such that it is extremely safe and you know we don't go around causing botulism to get rid of wrinkles and fine lines. What's interesting though is that one of the famously dangerous things about botulism is the paralysis associated with the condition. And it is this same property of botulinum toxin that we take advantage for aesthetic purposes. But again, we're using extremely small doses and we are using botulinum toxin in the context of aesthetic medicine.
[01:52] to, in a very controlled way, slow down the movement of some of the muscles of facial expression so that they are less apt to cause wrinkles or fine lines in the face when they're moving to cause facial expression. And specific examples of this are we often use Botox on the forehead to prevent those horizontal fine lines. And when we're doing that, we're actually slowing down a muscle called the frontalis. And when we use Botox to eliminate the 11 lines between the eyebrows, we're using Botox to slow down the motion of muscles called the corrugators. And when we're using Botox next to the eyes to eliminate crow's feet, we're using the Botox to slow down the contractions of the muscle that goes around the eye called the orbicularis oculi. So on the one hand, while we know that Botox and other neuromodulators or neurotoxins are extremely safe when they're used properly and in an appropriate dosage for aesthetic purposes. We really don't have great data on what Botox or other botulinum products might do in the case of someone who's pregnant or breastfeeding. And the common sense indication is that such small doses of a medication like this would probably be harmless. However, since we don't have the data, and we probably never will because I can't really imagine anybody ethically doing that study, the recommendation is that you steer clear of Botox and other neuromodulators while you're pregnant or breastfeeding. Interestingly, Botox and these other neuromodulators do have clinical uses outside of cosmetic medicine.
[03:45] For example, they can be used to treat migraines and they can also be used to relieve joint spasticity in patients with paralysis and there actually have been studies on botulism in these patient populations when Botox was being used for medical rather than aesthetic purposes and there were no detectable reproductive effects, but these studies were extremely small and I'm certainly not comfortable generalizing their results to the use of Botox for cosmetic purposes. So for me, and I think for most board certified plastic surgeons and dermatologists, the answer to, can I use Botox when I'm pregnant or breastfeeding would be no. Now let's go ahead and look at fillers.
[04:29] and I'm going to focus on the fillers that I use primarily in my practice and those are the fillers that are based on hyaluronic acid and these are products that you might know by the name of Juvederm or Restylane or Voluma or Velour and products of that nature. So like I said these are made of hyaluronic acid and hyaluronic acid is a molecule that's found naturally in the human body. So it really should be pretty safe in the context of pregnancy and breastfeeding. But again, this just has not been studied. So again, unfortunately, the answer to can I use fillers when I'm pregnant or breastfeeding is also probably going to be no for most practitioners that you ask. And again, I'm speaking specifically about hyaluronic acid fillers here, but I'd imagine that most people would give the same answer for pretty much any kind of filler because when it comes to something like pregnancy or breastfeeding, it's always better to be safe than sorry. And these are cosmetic procedures that we're talking about. So to put a positive spin on all this, let's just add Botox and fillers to the list, along with champagne and sushi of things that you can look forward to after you deliver.
[05:45] And if you're breastfeeding, you've got to wait a bit longer for these things as well. But you'll just love your Botox and fillers that much more when you do get to have your treatments. Thanks for listening, and don't forget to subscribe, share the show, and head over to DarrenSmithMD.com for more real world plastic surgery talk.
Sources and context.
Original Captivate episode. Original release date: 2020-07-06. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.
Behind the conversation.
Darren M. Smith, MD, FACS