Botox and Pregnancy: Is It Safe?

There’s nothing like pregnancy to make you think twice about everything you put into your body.

There’s a wealth of information available about what to eat and drink while pregnant. You know to avoid alcohol. To take your prenatal vitamins faithfully. To keep your caffeine intake low.

But there are some gray areas, too.

Like what about your regular Botox® injections? (Or Dysport®, Xeomin® or your botulinum toxins of choice?)

Are they safe during pregnancy?

These purified proteins help improve the appearance of fine lines and wrinkles. Some also use botulinum toxins to treat chronic health issues.

To provide you with some guidance, plastic surgeon James Zins, MD, answers commonly asked questions about Botox and pregnancy.

Is Botox safe if you’re pregnant?

The U.S. Food and Drug Administration (FDA) identifies botulinum toxin as a category C drug.

“That means botulinum toxin hasn’t been shown to be dangerous,” Dr. Zins shares. “But it also hasn’t been shown to be safe if you're pregnant.”

For that reason, Dr. Zins recommends erring on the side of caution and avoiding Botox during pregnancy whenever possible.

“Anytime you ingest anything or inject a substance into your skin, you need to consider the effect it may have on healthy fetal development,” he emphasizes. “The challenge is that we don’t always know the long-term effect. So, we can’t assume it’s safe during pregnancy.”

What if you unknowingly use Botox while pregnant?

If you already got Botox injections before you realized you were pregnant, Dr. Zins says you can take a deep breath. The overwhelming likelihood is that it won’t pose a risk.

“We use very small doses of botulinum toxin for aesthetic (cosmetic) purposes, especially in cases of baby Botox,” he explains. “It’s not absorbed in the bloodstream. It’s just absorbed locally, in the area where it’s injected.”

One study reviewed nearly 400 pregnancies that involved exposure to botulinum toxin during the three months before or after conception. Those pregnancies had the same percentage of birth complications as the general population.

But that’s a small sample size to know for sure. So, while you don’t need to stress about an injection you got before you knew you were pregnant, it’s better to not keep them up later on.

What if you use Botox for a medical condition?

Botox isn’t only used to smooth out your forehead and laugh lines. It’s also used as a treatment for a range of health conditions, like:

• Bladder incontinence and spasms
• Hyperhidrosis (excessive sweating)
• Migraine headaches
• Temporomandibular disorders (TMD or TMJ)

“If you typically use Botox for a health issue, talk to your provider about safer, alternative treatments during your pregnancy,” Dr. Zins advises. “They can help you weigh the risk versus the benefit of continuing that treatment.”

Dr. Zins adds that in some cases, your condition may improve during pregnancy. To the point that you might not even feel a need for the injections.

“Migraines, for example, may improve during pregnancy. So, you and your healthcare provider may decide to stop treatment until after the baby is born,” he points out.

Should you get Botox while breastfeeding?

If you decide to breastfeed (chestfeed), it’s a good idea to wait until your child weans off your milk before resuming your Botox regimen.

“Botulinum toxin is not likely to be found in breast milk, but there’s always a potential risk,” Dr. Zins says. “It may be best to avoid it, especially if you are using it in a totally elective situation.”

Discuss the issue with a healthcare provider. They can help you figure out the best solution for your needs.

What happens to your skin if you stop using Botox during pregnancy?

If you’re used to a regular regimen of injections for wrinkles, it’s natural to wonder what you’ll look like after going some time without them.

Dr. Zins says that temporarily stopping a Botox regimen won’t affect your appearance long term.

Botulinum toxin weakens or paralyzes the muscles that cause wrinkles. Without Botox, the muscle regenerates. This makes the effects of Botox temporary.

When you stop getting injections, yes, you may see some wrinkles come back.

The good news: If you choose to start Botox injections again later, you’ll regain the effects you saw pre-pregnancy.

“It’s not like you’re losing a cumulative effect and have to start from square one,” Dr. Zins confirms. “After your first post-pregnancy Botox session, you should be right back where you were.”

What are some Botox alternatives during pregnancy to keep wrinkles away?

So, if you shouldn’t use Botox during pregnancy — and experts don’t recommend using retinol because it can be toxic for the fetus — what can you do?

To keep your skin looking as smooth as possible, Dr. Zins recommends some pregnancy-safe remedies.

Protect your skin

Sunscreen and moisturizers are safe during pregnancy, so use them daily.

Keeping your skin moisturized and safe from the sun’s harmful rays can help prevent further wrinkles.

What’s more, hormonal changes during pregnancy may even promote healthy skin.

“During pregnancy, your estrogen and progesterone levels change significantly,” Dr. Zins notes. “Those changes can benefit the quality of your skin.”

Use topical vitamin C

Using topical vitamin C benefits your skin in several ways:

• Encourages collagen production. Collagen is a protein that keeps your skin elastic and strong so it wrinkles and sags less.
• Improves the effects of your sunscreen. Vitamin C and sunscreen are a powerful duo. Sunscreen helps block the harmful ultraviolet (UV) rays, and vitamin C protects your skin from any UV rays that get through.
• Makes you glow. Vitamin C can even your skin tone and brighten your complexion.
• Protects your skin. As a powerful antioxidant, vitamin C keeps your skin cells safe from the damage caused by environmental factors.

“It’s always best to be on the safe side during pregnancy,” Dr. Zins advises. “When it’s time, your provider will be there for you, ready to help you safely get back to your regular treatments.”