Botox Before Pregnancy

I am hoping to try for another baby and I want to know, how long should I wait after having the Botox? I had it at the end of March.

Doctor Answers 7

Botox Before Pregnancy

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If you wish to conceive and have had Botox recently, most of us would suggest you wait a period of time before conceiving. This is because we want to have zero risk for the developing fetus. Having said this, the risk to your child if you were to conceive while having Botox in your face is virtually zero percent.

We believe that when the medicine is absorbed into the muscles, the effect is done and that should be enough for many; but because there have been no clinical trials with Botox and conception, we usually will recommend that you allow the toxin to wear off then go ahead with your family plans.

As always, consult a board-certified dermatologist or plastic surgeon for all these concerns.

Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 reviews

Botox Before Pregnancy - How Long?

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Hi Caro.  We all wish we had a more definitive answer for you, but there is very little information to go on.  With that said, the effects of Botox last 3-4 months, so we would suggest not trying to conceive until after this period has passed.

There is not enough data to confirm any of our recommendations, but given the localized nature of Botox injections, it is unlikely to have any effect on a new fetus at four months post injection.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

A Sticky Question: Botox and Pregnancy

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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.

David W. Stepnick, MD
Cleveland Facial Plastic Surgeon

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Safest recommendation is to not have cosmetic Botox

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Dear Caro50

There is very little information available to guide an informed decision on this issues.

There are a couple of studies that suggest that BOTOX may slow muscle growth in developing fetuses but the effects on bone development of rabbits that were the subject of this study was less clear.

When it comes to humans, there is even less information. There are a couple of very small studies following pregnancies of woman who happened to get treated while pregnant. No adverse events were reported. This is no the same thing as a green light to have BOTOX when you are pregnant.

The safest recommendation is to not have cosmetic BOTOX if your are pregnant or are planning to become pregnant. There is absolutely not evidence to believe that a pregnancy should be terminated because BOTOX was done at the time of conception or during the pregnancy.

The question you are asking is even harder to be definitive about: How long should I wait before becoming pregnant. However, it is likely that if you had BOTOX in March it is safe to go forward with a new pregnancy now three months after the fact. You might also check with your obstetrician to see if they have a position on this matter.

Dr. Steinsapir

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox and conceiving

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Thank you for your question. I would not worry too much if you had Botox and now you are trying to conceive. Botox works locally where it was injected and the dosing is very small. I do recommend that you stop any future injectable treatments once you find out you are pregnant until either the baby is born or until after breast feeding.  If you want to be extra cautious, then I would wait 3-6 months for the Botox to be fully out of your system.

Botox Before Pregnancy

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Ideally you should wait 3-4 months for the Botox to be eliminated from your system prior to conceiving.

4 months after your last Botox injection

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Botox Cosmetic is Class C medicine, based on animal pregnancy studies. There are no adequate and well-controlled studies of BOTOX Cosmetic in pregnant women.

Botox becomes most active within 2 weeks after injection. Cosmetic results from Botox are typically 4 months, while some patients may have longer aesthetic benefits.

The recommendation is not to have any elective procedure, including Botox, if you are pregnant or about to become pregnant, or breastfeeding. If a patient becomes pregnant after injection the potential risks, which have only been observed in rabbits, include abortion or fetal malformations.

A safe answer would be 4 months after your last injection. Speak to your Ob/Gyn about your concerns.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.