Botox is a beloved in-office skincare treatment thanks to the way it temporarily freezes facial muscles and practically erases the appearance of fine lines and wrinkles. Nowadays, the popular neuromodulator is even used to combat headaches, slim jawlines, and prevent underarm sweating. All this is to say, the more we uncover about Botox and its applications, the more people of all ages turn to it as a solution for their cosmetic and medical needs. The problem is, given Botox is a cosmetic treatment, it’s impossible to say that there are absolutely zero risks associated with it. As such, the question arises as to whether or not it’s safe to get Botox during pregnancy. To get to the bottom of the often-discussed debate, we chatted with a few dermatologists and one OB/GYN for everything there is to know about getting Botox injections during pregnancy, as well as how to approach the injectables post-pregnancy. Keep reading to brush up on the controversial subject.
Meet the Expert
- Kelly Culwell, MD, MPH, is a board-certified OB/GYN and women’s health expert.
- Dendy Engelman, MD, FACMS, FAAD, is a board-certified dermatologist and Mohs surgeon based in New York City. She primarily works at Shafer Plastic Surgery in Manhattan.
- Robert Finney, MD, FAAD, is a board-certified dermatologist and Mohs surgeon based in New York City.
- Michele Green, MD, is a board-certified cosmetic dermatologist based in New York City.
Is It Safe to Get Botox While Pregnant?
The FDA has set categories in which it labels drugs for use during pregnancy. Broken down by letter, the categories range from A (safe to use) to X (potentially fatal). As "Dr. Lady Doctor" Kelly Culwell, MD, points out, Botox is considered a Category C drug by the FDA. “This indicates that a risk cannot be ruled out,” she explains. “In general, Category C means the benefits to the woman need to outweigh the potential risk to the fetus in order to recommend use of the medication. If using Botox for conditions like migraine headaches, that might be the case, but it is not generally recommended for cosmetic purposes.”
From a dermatologist’s perspective, Dendy Engelman, MD, says that most derms won’t give pregnant women Botox given the uncertainty surrounding how it can potentially affect the baby.
“There have not been sufficient studies done on this subject and it is almost certain there will never be,” Engelman explains (that’s because most pregnant humans won’t want to risk joining a study trial if it means harming their child). “The good news is, when you are pregnant, there is often overall soft tissue edema (swelling), so it can sometimes look like you’ve just had injections done!”
Possible Complications of Getting Botox While Pregnant
Because Botox during pregnancy hasn’t been widely studied given pregnant people’s unwillingness to participate in a potentially harmful study, it’s hard to clearly point to what the complications may be. That said, Culwell says the main concern is Botox’s potential to cause birth defects in the fetus. “Just as with anyone receiving Botox, if the toxin spreads beyond the area of the injection, you could develop botulism, which can be a life-threatening condition,” she warns, even though that’s a much more rare side effect of Botox.
How Soon After Giving Birth Can You Get Botox?
If you’re willing to hold off on Botox during pregnancy thanks to the notion that you’ll be able to get injected soon after delivering your baby, proceed with caution. According to dermatologist Robert Finney, MD, recommendations will typically vary, but Botox injections are generally permitted so long as the breastfeeding patient pumps and dumps for 24 hours following the injections. Of course, if you have a newborn, this could be difficult to align with their feeding schedule. Because of that, Culwell says that Botox is best avoided during breastfeeding if its sole purpose is cosmetic. “This is again due to the lack of large studies supporting the safety and the potential for some small amounts of the toxin to pass through breast milk,” she explains. “If botox is being used for non-cosmetic purposes, women should talk to their doctor about the risks versus the benefits of treatment while breastfeeding.”
Pregnancy-Safe Alternatives to Botox
As much as we wish there was a topical ingredient or pregnancy-safe in-office treatment that perfectly mimics the magical results of Botox, that’s simply not the reality. That said, there are a handful of treatments and ingredients that can help diminish the appearance of fine lines and wrinkles in the interim before Botox is back on the table. Find out what they are, below.
- HydraFacial: Michele Green, MD, touts the HydraFacial as one of the best pregnancy-safe cosmetic treatments thanks to its ability to boost the overall complexion of the skin in a gentle three-step process. “Hormonal acne can be problematic for many during pregnancy, and it can be challenging to treat when there are so many restrictions surrounding what to use,” Green explains. “The HydraFacial exfoliates, cleanses, and nourishes the skin to deliver a radiant, glowing, beautiful complexion. This procedure is completely safe during pregnancy and can help with maintaining healthy skin in a sensitive and special time of life.”
- Chemical Peel: Green says that in-office chemical peels are another option for pregnant people. That said, it’s best to talk with your dermatologist to determine if your skin is in a state that can withstand the deep exfoliating treatment that they offer.
- Vitamin C: One of the best ingredients you can add into your daily skincare routine is vitamin C. Engelman points out that it’s one of the most potent antioxidants for repairing and protecting the skin against sun damage, as well as working to ward off premature signs of aging. “I recommend layering vitamin C under your SPF every day,” she says, noting that Wander Beauty’s new Sight C-er Vitamin C Concentrate ($42) and Glo Skin Beauty’s Hydra-Bright AHA Hydrator ($48) are two of her favorite vitamin C products.
- Bakuchiol: Since retinol is pretty much off the table during pregnancy, Finney recommends bakuchiol, a safe retinol alternative. “Bakuchiol is a plant-based ingredient that went head-to-head against retinol in a clinical trial and performed just as well from an anti-aging standpoint,” he explains. “I frequently recommend this ingredient even to non-pregnant patients who want to optimize their anti-aging skincare regimen because it is also better tolerated than retinols, which frequently cause irritation.” His favorite bakuchiol serum is the ISDIN Isdinceutics Melatonik Overnight Recovery Serum ($160), which also has vitamin C, melatonin, and other ingredients that act as antioxidants to help with inflammation and redness.
- Glycolic Acid: If you love the idea of exfoliation but aren’t sure about an in-office chemical peel, opting for an at-home serum filled with glycolic acid is a wonderful alternative. The alpha-hydroxy acid is known for gently sloughing away dead skin cells to reveal brighter, smoother, clearer skin beneath. And, according to Finney, it’s totally safe during pregnancy and breastfeeding.
- Humidity: Last but not least, we have humidity. While not technically a topical or treatment, Engelman says that adding a humidifier to your pregnancy skincare routine is incredibly beneficial. “Even if your skincare routine is perfect, dry air in your home or environment could be sabotaging your efforts to achieve firm, hydrated, glowy skin,” she explains. “To address this, I love using the Canopy Humidifier ($125)—it’s an effortless way to help maintain skin’s hydration and prevent transdermal water loss at night. As a bonus, it is also compatible with essential oil aromas, which are perfect for helping mothers-to-be and new mamas and babies relax!”