Since Botox is a Toxin, Can it Cause and Outbreak of My Herpes?

The botulinum toxin would not cause a herpes flare. Herpes simplex virus may be awakened from its dormant phase by stress, fatigue, illness, sunburn, trauma, laser resurfacing, chemical peels, dermabrasion, and the placement of needles (for fillers or Botox). 

If there is an area that is going to have Botox injected and that's the very area that you tend to get herpes outbreaks in, then you can ask your doctor about taking an antiviral medication before, during and after the injections.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Unless you're having your lips injected with filler or Botox around your mouth, the potential for you having an outbreak is very low. If you're overly anxious about the treatment in general, start an antiviral prior as a preventative measure.

This is highly unlikely especially if you are not having any treatment around your mouth. However, triggers for Herpes outbreaks are vaguely understood. Depending upon the frequency and severity of outbreaks, you could use antivirals around the time of treatment to minimize your risk. I hope this information is helpful.Stephen Weber MD, FACS

While it's unlikely for you to have a herpes outbreak after Botox injections, it's wise to be proactive. You can be prescribed Zovirax or Valtrex to be taken before your injections.

Treating your forehead and crow's feet with Botox would not cause an outbreak of your herpes unless you were very stressed or anxious about your treatment.  In that case, it would be the stress that caused the outbreak..  If you are concerned, start taking an oral antiviral medication such as Valtrex the day before your treatment and continue it for a few days afterwards.

It would be highly unlikely for Botox performed in the upper face to cause an outbreak of cold sore/herpes virus outbreak. If on the other hand you were getting Botox for the wrinkles around the mouth ("smoker's lines"), it is conceivable to have an outbreak of herpes and so I would treat with an oral antiviral such as valacyclovir or famciclovir the day before, day of treatment, and day after treatment (prescribed by your physician).

No. I assume this is a herpes outbreak involving the facial areas. The two most common triggers for herpes labialis outbreaks are stress and sun exposure. If you get really stressed out about getting your Botox treatment, that could theoretically be a trigger. Valtrex is FDA approved for treating herpes labialis 500 mg twice a day for three days at onset. It is very effective. I rarely use Famvir and do not really use Acyclovir anymore, since Valtrex and Famvir are 80 times more effective. If you have more than 6 outbreaks a year than you are eligible for suppressive therapy, which is daily treatment with an antiviral. You can have significant impact, however, if you are careful with your sun exposure and use judicious sunscreens or sunscreen containing lip balm to the areas infected.

I advise all of my patients with a history of herpes to take an antiviral, like Valtrex at least one day before and for 3-7 days after any injection of any sort or laser treatment.  The concern is more that anything that can cause an inflammatory reponse can trigger an outbreak rather than it being a toxin.  It is unlikely that Botox on the forehead and around the eyes would cause and outbreak, however it can cause some inflammation and it is better to be on the safe side.

I suggest anyone who is prone to herpes outbreaks take Acyclovir or another antiviral daily. This helps prevent breakouts from occurring at any time. With that being said, Botox won't "cause" an outbreak of herpes, but the stress of your first visit, any nervousness, and therefore any lip trauma that you cause yourself during a first time procedure, can definitely lead to an outbreak. Just like when you go to the dentist, I'd suggest you take an antiviral for at least a few days before your procedure and a few days after, but really, daily is your best bet to avoid outbreaks at all.