Can Botox cause hair loss?

Question

My hair was stabalosed and slightly improving from the combination of 2.5mg oral min and 1 mg finasteride. I received Botox injections twice recently, once in early December and once in early September. After the December treatment I feel that I have lost a lot of hair around my temple points particularly in the last month. To me it feels like a pretty sudden change and I don’t see what else could have caused it. Is there anything I can do during the period while the toxin is not worn off to try and mitigate the damage? I am wondering if PROmight help but I’ve never gotten it before. I went to the dermatologist and he prescribed me a higher dose of OM, 5mg to alternate with the current 2.5 for 3 months and then switch to And the keto shampoo. Is there anything else I can change in my regimen? Should I add Dut once or twice a week? I am 29m. The only other thing I can think of is my dad died last April but this timeline does not seem to coincide with that.

Anna Chacon, MD, FAAD · Answer

I’m really glad you asked this, because when hair shedding increases suddenly, it’s understandably alarming—especially when you’ve been consistent with treatment and starting to see stability. Let me walk you through this carefully and realistically.

Botox itself is not a known direct cause of widespread scalp hair loss. It works at the neuromuscular junction locally where it’s injected and does not circulate in a way that typically disrupts hair follicles. In fact, in some small studies, Botox has even been explored as a supportive treatment for certain types of hair loss because it may reduce scalp tension and improve blood flow.

That said, there are a few important nuances:

If injections are placed near the temple or frontal scalp region, there can occasionally be temporary localized shedding related to local inflammation, needle trauma, or vascular changes — but this is uncommon and usually limited.

The timing you describe — noticing increased shedding about a month after treatment — is actually more consistent with a telogen effluvium–type shift, where hairs move into the shedding phase after a trigger. Common triggers include physiologic stress, illness, medication adjustments, emotional stress, or hormonal shifts. Even events from a few months earlier can show up as shedding later.

I’m also very sorry about your father’s passing. Emotional stress can absolutely influence the hair cycle, and the delay between the event and shedding can be longer than many people expect.

Regarding your current regimen:

Increasing oral minoxidil dose as your dermatologist recommended is a reasonable step if you’re tolerating it well.

Ketoconazole shampoo can be helpful as an adjunct for scalp health and inflammation control.

Finasteride optimization is usually preferred before adding or rotating to dutasteride. Adding dutasteride once or twice weekly is sometimes done in select cases, but that decision should be individualized based on response and side-effect tolerance rather than added automatically.

PRP (platelet-rich plasma) may help some patients, but results vary — it’s supportive, not a rescue treatment for sudden shedding.

What you can do while things stabilize:
Stay consistent with your medications — avoid stopping and starting.
Avoid aggressive styling or tension at the temples.
Make sure nutrition, sleep, and general health are supported.
Track shedding trends monthly rather than daily — day-to-day variation can feel worse than it is.

Ebru Soylemez, MD · Answer

There is no reliable scientific evidence showing that Botox causes hair loss. Hair loss is not a known or documented side effect of botulinum toxin in the medical literature.
In your case, there are other much more likely explanations. Changes in minoxidil dosing or consistency can commonly cause a temporary shedding phase. In addition, significant emotional stress &mdash; such as the loss of a close family member &mdash; can trigger a condition called telogen effluvium, which often appears several months after the stressful event.
The timing can make hair loss feel sudden, even though the underlying trigger occurred earlier. This type of shedding is usually temporary.
I would not recommend making multiple treatment changes at once. Continuing close follow-up with your dermatologist and allowing time for stabilization is the most appropriate approach.

Can Botox cause hair loss?

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