Botox for an Anal Fissure: Do I Need to Delay Conceiving?

The use of Botox during pregnancy is avoided and should be if you're trying to conceive regardless of the indication.  If one is not pregnant, nor trying to conceive, then as long as the units of botox used for the anal fissure is not approaching the limit of safety, then elective cosmetic treatment of crow's feet can be done without a negative effect on the eyelid wrinkle treatment.

Generally, it is not advisable to have cosmetic botox once conception has occured.  There is just no safety information on this procedure.  However, it has been used off-label for medical reasons during pregnancy.  I suspect that while its use for the anal fissure might be deemed a reasonable risk, that for the crows feet being purely cosmetic with no medically beneficial purposes will not be recommended.  It is reasonable and appropriate to minimize exposure to agents during pregnancy that could potential cause harm, even if the risks are relatively low.

It is not known how Botox would affect pregnancy or the fetus if at all, because the company is absolutely right in not undertaking testing Botox for safety in pregnancy.

We all use medications in pregnant women when absolutely necessary.  We try as best we can to use pregnancy category B medications that we know are safe.

Since we have no data about Botox safety during pregnancy, I strongly recommend against using it for cosmetic procedures while you are pregnant. 

Use of Botox is contraindicated during pregnancy. Period. Therefore it should never be used for as an elective treatment for cosmetic purposes while you are pregnant. Regarding your statement that the Botox toxin is already in your body anyway, at this point it should not pose a risk to a future pregnancy. This is because within 20 to 90 minutes after it is injected, botulinum neurotoxin type A can be detected inside the motor nerve endings. Therefore the muscles and nerve endings take up the Botox very quickly before it can spread far from the injection site. Within a few hours after the injections the reaction is complete and there should be no risk of Botox travelling to other locations in your body in the future.