Is It Safe to Undergo Major Procedure After Botox?

What are the risks of a procedure under general anesthesia after Botox treatment?

Doctor Answers 8

There are no contraindications to having a surgical procedure after Botox

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There are no contraindications to having a surgical procedure after Botox. Botox cannot and should not be performed at the time of the surgery while patients are asleep under anesthetic because of the complication of the Botox drifting into the eyelid and orbital muscles. The Botox injections are done as a clinic procedure unrelated to any surgical procedure that may be done.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Verify this with your anesthesiologist

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We are not aware of problems with cosmetic botox and general anesthesia. Are you implying that the procedure will take place some days after the Botox? Every Botox treatment is different from patient to patient as the number of units can be significantly higher or lower. This may make a difference and you should ask your anesthesiologist.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

No problem

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I agree that there is no problem having Botox injections prior to surgery. As has been pointed out, though, you should be VERY careful about not having anyone apply any kind of undue pressure to the areas of injection for about 1 week after administration as there would be a small risk of unintended spread and migration. While this would pose to systemic risk to you, it may alter your ultimate results if the Botox were to spread into the muscles around the eye, for instance, giving you ptosis or a droopy eye.

Brian S. Glatt, MD, FACS
Morristown Plastic Surgeon
5.0 out of 5 stars 59 reviews

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BOTOX has not effect on the risks for general anesthesia

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Dear Helloroxie

BOTOX has absolutely no bearing on the safety of general anesthesia. The dose that is used for cosmetic BOTOX would have no bearing on safety. Even for someone receiving very high doses of BOTOX for medical reasons would not experience an increased risk from prior treatment with BOTOX. So not to worry.

Generally we find that it is not a good idea to mix facial surgery at BOTOX at the same time. The reason for this is that surgery in the same area as the BOTOX treatment can result in an unexpected drift in the BOTOX treatment. This can cause effects like smile weakness and eyelid drooping. BOTOX treatment should be separated in time from facial surgery by a couple of weeks for this reason.

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

Botox right before the procedure, no / At end of procedure, OK

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Do you mean that your surgeon injected Botox within hours of an operation or days before? If it is days, then as stated by my colleagues there should be no problem. If the treatment was immediately before the operation it is not a good idea.

Botox is intended to be injected directly into the muscle that one wants to weaken. Depending on where the injection was placed, if you lay down for any significant length of time after wards, the Botox could conceivably track in the tissues to affect another muscle group not intended to be injected. I tell my patients not to lay down flat for 2 to 3 hours post injection.

On the other hand, injecting at the end of an operation while still anesthetized is OK and is something I do often. After facial surgery, patients will have their head elevated anyway.

Leslie H. Stevens, MD
Beverly Hills Plastic Surgeon

No risks that I am aware of, but avoid pressure on the treated areas for one week

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I am not aware of any risks for general anesthesia  because you have had Botox.  Do ask the doctors to avoid pressure in the treated areas for one week after Botox.  the Botox will have set up by then and there should be no problems with migration.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Surgery after botox

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There is not any problem undergoing surgery, even major surgery after Botox.  There is little if any systemic absorption and the quantities used for cosmetic purposes are so small they are inconsequential. 

When and where will the Botox be placed prior to anesthesia.

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How long after and in what location?

Generally if the botox is placed a week before it is highly unlikely that anesthesia will have any effect.

However, if it is placed 1 hour before and in the area around the mouth, it is possible that the manipulation of the mouth area may produce some alteration in the effect.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 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.