Botox during pregnancy: what you need to know

Botox during pregnancy is generally postponed when the treatment is cosmetic. UK pregnancy guidance recommends avoiding cosmetic botulinum toxin during pregnancy because the available safety evidence is limited and the treatment can usually wait.

This does not mean that having Botox before you knew you were pregnant automatically means harm has occurred. If you have already been treated, do not arrange another cosmetic treatment for now. Find out which product and dose were used and discuss the exposure with the healthcare professionals involved in your pregnancy.

On this page, Botox refers mainly to cosmetic treatment with botulinum toxin type A. If you receive botulinum toxin for a medical condition, the decision can be different because the risks of delaying treatment also need to be considered.

If you first want an overview of the treatment itself, read more about Botox treatment.

Can you have Botox during pregnancy?

Cosmetic Botox is generally avoided during pregnancy. There are not enough human pregnancy data to establish that botulinum toxin treatment is risk-free, and UK product information for commonly used botulinum toxin medicines advises against or restricts use during pregnancy.

Because wrinkle treatment and other cosmetic uses are elective, treatment can normally be postponed until after pregnancy rather than accepting an uncertain risk.

Why is cosmetic Botox usually postponed?

Botulinum toxin is injected locally into specific muscles. This limited local administration does not, by itself, prove that treatment is safe during pregnancy.

UKTIS notes that significant exposure throughout the body is not expected when botulinum toxin is administered according to the manufacturer's instructions. However, human pregnancy evidence remains limited.

For cosmetic treatment, there is therefore little reason to accept uncertainty when treatment can be delayed.

Does ‘not recommended’ mean Botox is proven harmful?

No. ‘Not recommended during pregnancy’ does not mean Botox has been proven to cause harm to an unborn baby.

Available human exposure data have not established a clear pattern of adverse pregnancy outcomes, but the evidence is too limited to rule out an increased risk with confidence.

The practical distinction is important:

• planned cosmetic treatment can usually be postponed;

• accidental previous exposure does not automatically mean that harm has occurred.

Is there a safe trimester for cosmetic Botox?

There is no trimester in which cosmetic Botox should routinely be presented as safe or recommended.

If exposure has already happened, the timing is useful information for the healthcare professional assessing your individual circumstances. It should not be used to decide for yourself that exposure was either safe or harmful.

What if you had Botox before you knew you were pregnant?

If you had Botox and later discovered that you were pregnant, do not assume that the treatment has harmed the pregnancy. UKTIS states that, where there have been no systemic side effects, fetal risk following inadvertent botulinum toxin exposure is expected to be low.

You should still give your healthcare professional enough information to assess the exposure in the context of your own pregnancy.

Ask the clinic or practitioner for:

• the exact botulinum toxin product used;

• the treatment date;

• the number of units given;

• the areas that were injected;

• the batch number if available;

• the name of the practitioner who performed the treatment.

Also note whether you experienced any unusual symptoms after treatment and when they started.

Do not arrange another cosmetic botulinum toxin treatment while you are pregnant. Discuss the previous exposure with your GP, midwife, obstetrician or another healthcare professional involved in your pregnancy.

What should you do in your situation?

The appropriate next step depends on whether you are already pregnant, could be pregnant, are trying to conceive or receive botulinum toxin for a medical reason.

You are pregnant

Postpone a planned cosmetic Botox treatment.

If you have already been treated during the pregnancy, collect the product, dose and treatment-date information and discuss it with the healthcare professional involved in your pregnancy.

You might be pregnant

Tell the clinic before your appointment and postpone the cosmetic injections until you know whether you are pregnant.

You may still be able to have an information-only consultation, but make it clear that you may be pregnant and that you do not want treatment during that appointment.

You are trying to conceive

Tell the practitioner before considering treatment.

Advice differs slightly between botulinum toxin products. For example, current UK BOTOX product information does not recommend treatment in women of childbearing potential who are not using contraception.

There is no single waiting period before conception that should be invented and applied to every botulinum toxin product. Ask which product is being proposed and what its current product information says about pregnancy.

You are having IVF or other fertility treatment

Tell both the cosmetic practitioner and your fertility team that you are considering treatment.

Do not alter fertility medicines, egg collection, embryo transfer or another part of your fertility treatment because of cosmetic Botox advice from an aesthetic clinic. Decisions about your fertility treatment belong with the healthcare team responsible for it.

You receive botulinum toxin for a medical condition

Do not stop or postpone prescribed botulinum toxin treatment on your own.

The clinician responsible for the treatment can assess why you receive it, whether alternatives exist and whether the possible benefit of treatment outweighs the uncertainty during pregnancy.

More information about Botox and pregnancy

Cosmetic Botox or botulinum toxin for a medical condition

Cosmetic Botox and medically prescribed botulinum toxin should not automatically be treated as the same pregnancy decision.

Cosmetic Botox

When botulinum toxin is being considered solely for an aesthetic change, treatment can normally be delayed. There is no untreated medical condition that becomes worse simply because a cosmetic wrinkle treatment is postponed.

This is why UK pregnancy guidance advises avoiding cosmetic botulinum toxin during pregnancy.

Botulinum toxin for a medical reason

Botulinum toxin is also prescribed for medical conditions. In these situations, a clinician needs to consider what could happen if treatment is delayed or stopped.

The decision may depend on:

• why you receive treatment;

• which product is used;

• the proposed dose;

• where you are in your pregnancy;

• previous response to treatment;

• other medicines or health conditions;

• whether an appropriate alternative exists.

For example, if botulinum toxin is prescribed for migraine, the decision should be made with the clinician managing that condition. Read more about Botox for headache for information about that treatment indication.

When should you seek medical help after Botox?

Most readers searching for Botox and pregnancy do not need a complete complications guide. However, certain symptoms following botulinum toxin treatment require prompt attention whether or not you are pregnant.

Rarely, the effects of botulinum toxin can spread beyond the area where it was injected.

Seek urgent medical help if you develop:

• difficulty breathing or shortness of breath;

• difficulty swallowing;

• difficulty speaking or slurred speech;

• unusual or widespread muscle weakness.

These symptoms can occur after cosmetic or medical botulinum toxin treatment and may develop some time after the injections.

For more detailed information about adverse events, read about Botox treatment complications.

Botox and breastfeeding

Pregnancy and breastfeeding are separate questions.

Current UK product information for several botulinum toxin medicines remains cautious about breastfeeding. For example, BOTOX states that use during breastfeeding cannot be recommended, while Azzalure also says use during lactation cannot be recommended.

Do not assume that advice for one product automatically applies to every botulinum toxin medicine.

If you are breastfeeding and considering cosmetic treatment, tell the practitioner before treatment is planned and ask which product would be used and what its current product information says.

Do not stop breastfeeding solely to make a cosmetic Botox appointment possible without discussing your circumstances with an appropriate healthcare professional.

How long should you wait for Botox after pregnancy?

There is no single waiting period after giving birth that should be applied to everyone.

The relevant considerations include:

• whether you are breastfeeding;

• which botulinum toxin product is being considered;

• your health and recovery after pregnancy;

• medicines you currently take;

• the reason for treatment.

If you are no longer pregnant and are considering restarting cosmetic Botox, a practitioner can review these factors before treatment is planned.

When comparing practitioners for a future treatment, you can read what to consider when choosing a Botox doctor.

Frequently asked questions about Botox during pregnancy