David W. Stepnick, MD

Botox binds to "acceptor sites" on motor nerve terminals, enters the terminals, then blocks release of the substance that triggers a muscle to contract. Once this has happened, the effect of Botox lasts, on the average, for several months. But, the Botox is not "floating around" in the bloodstream during this period of time.

Pharmaceuticals and and their relationship to "pregnancy" is always a "tricky" issue, because nobody (doctor or patient) wants harm done to a fetus. And, one cannot risk that a pharmaceutical might do damage to a fetus. So, many drugs, including Botox, are not recommended during pregnancy.

Theoretically, within hours or a few days after one has had Botox treatment, the material has been "absorbed" into the nerve terminals and is not available to sites elsewhere in the body. If the Botox is not available elsewhere in the body, it would not damage a fetus.

In your case, it has been almost two months since you've had Botox, so the risk should be pretty close to zero, if not zero. But, there is always the person who will have a child that has suffered some unrelated intrauterine insult who "blames" a certain event or drug for the problem when, in fact, the event or drug had nothing to do with it.

While I personally would tell a family member that it's safe to get pregnant 8 weeks after having received Botox, or to want to be even safer, to wait until the effects of the Botox have completely worn off, I am not sure it's smart for me to offer you that advice in a public forum like this.

Please review the information (below) taken from Allergan's package insert on Botox Cosmetic as you make your final decision, and if you want advice specific to you, ask the physician who did the Botox treatment! You paid for his or her expertise, not just a technical fee for Botox injections.

Pregnancy: Pregnancy Category C
Administration of BOTOX® Cosmetic is not recommended during pregnancy. There are no adequate and well-controlled studies of BOTOX® Cosmetic in pregnant women. When pregnant mice and rats were injected intramuscularly during the period of organogenesis, the developmental NOEL (No Observed Effect Level) of BOTOX® Cosmetic was 4 U/kg. Higher doses (8 or 16 U/kg) were associated with reductions in fetal body weights and/or delayed ossification.

In a range finding study in rabbits, daily injection of 0.125 U/kg/day (days 6 to 18 of gestation) and 2 U/kg (days 6 and 13 of gestation) produced severe maternal toxicity, abortions and/or fetal malformations. Higher doses resulted in death of the dams. The rabbit appears to be a very sensitive species to BOTOX® Cosmetic.
If the patient becomes pregnant after the administration of this drug, the patient should be apprised of the potential risks, including abortion or fetal malformations that have been observed in rabbits.


Carcinogenesis, Mutagenesis, Impairment of Fertility:
Long term studies in animals have not been performed to evaluate carcinogenic potential of BOTOX® Cosmetic. The reproductive NOEL following intramuscular injection of 0, 4, 8, and 16 U/kg was 4 U/kg in male rats and 8 U/kg in female rats. Higher doses were associated with dose-dependent reductions in fertility in male rats (where limb weakness resulted in the inability to mate), and testicular atrophy or an altered estrous cycle in female rats. There were no adverse effects on the
viability of the embryos.


Nursing mothers:
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when BOTOX® Cosmetic is administered to a nursing woman.

. . . a material that is used to fill in an area that is depressed, has lost volume, or considered a "wrinkle". Fillers can be naturally occurring substances (like fat) or synthetic. Before many of the fillers on the market today were available, some of these materials were surgically placed under the skin, and in thes cases, would be termed an "implant". Both implants and fillers are available today, and each have their own role in aesthetic surgery.

While most of the physicians responding to this question in this forum have either provided actual "numbers" or general information about pricing, beware of several ways that physicians can charge for Botox.

Some physicians will charge "by area" and will inject as much Botox as they believe will provide the result you desire. But, you really do not know how much Botox has been injected (unless you ask and are told). You may have achieved your goals, but you don't know if you found a "good value". These physicians will "argue" that your goal isn't about how much Botox you want to purchase, but about enjoying the result in a particular facial subunit.

Other physicians will charge "by the syringe". This is probably the least appropriate of the three ways of pricing, as the Botox can be diluted to pretty much any concentration. When the Botox comes from the manufacturer (to any physician), it comes as a "powder" that is reconstituted. While there are some standard dilutions, these dilutions can vary considerably.

I would agree that the best way for the consumer to know exactly "how much" Botox they are paying for is to know "how many units" the physician is injecting. But, also try to avoid trying asking the physican to inject fewer units than he/she feels is necessary (in a particular region) so you can save some money.

Ask how much the physician charges per unit. Discuss the areas you want to have injected. Find out the quantity your physician thinks will be required to achieve the intended results. Then decide if the cost is justified and compare.

Finally, though, recognize that everyone who injects Botox is not alike in their skill. Ultimately, it would be better to pay more and have the Botox injected by an expert than to get the Botox at a bargain price from someone whose specialty really is not focused on aesthetics. In this case, the saying "you get what you pay for" is true!

In many rhinoplasties, cuts are made in the bones of the nose (osteotomies) to resposition the bones. In a sense, until they are healed, one could consider them "broken bones". So, just as if someone had an injury and broke their arm (which is then casted to keep in in correct position to allow it to heal), the bones of the nose can be moved - at first, fairly easily, then with more and more difficulty.

I cannot assume that you actually had osteotomies, but if you did, and if you replaced the splint and squeezed "too hard", then you may indeed have displaced the bones from your surgeon's intended positioning. Tightness may or may not have been the issue, but the "bottom line" is that (as an unbiased physician answering your question) it sounds as if you did something that caused your nose to heal in an imperfect way.

Can it be fixed? Probably. Should you get a secondary rhinoplasty? Any decision for any surgery is made by evaluating the cost (not just financial, but also things like time "off" from work or school, pain and suffering, et cetera) versus the benefit. Only you can decide if it is work paying the money, taking time off, and enduring discomfort and healing to achieve the desired aesthetic goals.

A few points:

First, "in general" one must be careful about timing with respect to doing revision rhinoplasties. In your case, IF you were to have yet another procedure, this would be considered a "tertiary" rhinoplasty. The problem is that your nose is still healing, and in fact the tissues are VERY ACTIVELY going through the healing process assuming that May 4th was several weeks ago - 2009. So except for minor revisions, most surgeons would not consider performing your tertiary rhinoplasty (if needed) for many months.

Secondly, a "septorhinoplasty" is the procedure which corrects both the septum and the nose. If you truly just had a "revision rhinoplasty" and your septum previously had been crooked, then a "rhinoplasty" (without septoplasty) would NOT have straightened the septum. To best answer your query, a surgeon would really need to know more details than you are providing.

Thirdly, and finally, the RealSelf forum is a wonderful tool, but the nuances you are describing with respect to your nose probably cannot be accurately answered by anyone unless they actually examine you. I would strongly advise actually seeing someone "in person" so that you can review your concerns, and so that they can review details of your two surgeries and make appropriate recommendations.