Can I get Botox if I'm still breastfeeding?

I'm starting the weaning process with my eight month old because I'm getting antsy about getting more Botox on my forehead and eyes. It's been a long time since I've had to wait this long between treatments. Because I'm weaning my son, I've got breast milk saved up. Do I have to wait until I've completely stopped using my breast milk before I can resume treatments or is it not that bad to get Botox and still be breastfeeding, especially mainly weaning with pre-pumped milk?

ababab

F, 35, Nebraska

I understand your frustration. After already going on a nine month Botox hiatus during pregnancy, the additional "no Botox" requirement of the breastfeeding phase can feel interminable to many nursing women.

Nevertheless, most doctors agree that breastfeeding women should avoid cosmetic Botox and Dysport injections.

While the effects of botulinum toxin type A are primarily local, a 2016 study indicated that the toxin may be able to spread to far off areas of the body. The effects in these areas (muscle stiffness, muscle weakness, headaches, nausea, difficulty walking, difficulty breathing), far from the treatment site, often resemble botulism poisoning.

To date there isn't enough research to say with any degree of certainty whether Botox makes its way into breast milk, but given its ability to spread systemically, breastfeeding women should avoid getting their frown lines and crow's feet injected with Botox and opt instead for mild facials and scrubs until the breastfeeding phase is over.

If your Botox use is for medical conditions or a non-cosmetic purpose (like treating migraines, muscle spasms, severe underarm sweating), or reasons other than simply preserving a youthful appearance -- you should discuss alternative treatment options with your dermatologist or plastic surgeon.

The official medical stance on Botox and breastfeeding is that there's not enough data to know for sure whether some small amount of the botulinum toxin ever reaches the breast milk. While it may well be perfectly safe, the reality is we simply don't know.

Although Botox generally stays within the muscle into which it’s injected, there are rare reports of side effects occurring in completely unrelated areas of the body. This opens the possibility that some amount of Botox may be reaching sites far from the treatment area.

A major 2016 study confirmed that a small amount of Botox toxin could theoretically travel on neural pathways throughout the body. While unlikely to reach the milk glands in your breast, when it comes to breastfeeding mothers, our mantra is to err on the side of caution.

Keep in mind that just because you're breastfeeding doesn't mean you have to ignore your facial treatments. There are other options besides Botox, and many of them are fine for breastfeeding mothers.

Some clinics may tell you that it's "probably safe" or that they’ve "never had a problem injecting breastfeeding mothers". But do you really want to take that chance? I strongly advise you to wait until you’ve stopped using breast milk before resuming your Botox treatments. And if you are considering a Botox treatment while breastfeeding, I strongly advise you to consult directly with a proper board-certified plastic surgeon or dermatologist before doing so.

According to the US Food and Drug Administration (FDA), the effects of Botox on breast milk are still untested and unknown.

Unfortunately, when it comes to something as important as the safety of an infant, we will continue treating Botox as unsafe for nursing mothers until such time as clinical tests prove otherwise and we can be assured there’s no chance of botulinum toxin ever reaching the child.

In our clinic we have a strict policy about pregnant women and nursing mothers when it comes to which treatments we will and won’t provide for them.

If you are looking for an interim treatment to fight off fine lines and wrinkles in the meantime, you should ask your dermatologist about a gentle facial or a light peel with alpha hydroxy acids like glycolic acid.

Whether Botox while breastfeeding is safe or not is open for debate. The truth is we just don't know what the effects of Botox injections are on breastfeeding -- or whether some small amount of botulinum toxin can make its way into breast milk.

Likewise, Allergan, the makers of Botox, are similarly clear about this unknown/gray area in the text of their in-package Drug Safety Information document:

"There are no data on the presence of BOTOX® Cosmetic in human or animal milk, the effects on the breastfed child, or the effects on milk production."

So while no one can say with any precision whether or not it's dangerous, until we have reliable data Botox treatment while breastfeeding should be off-limits.

Aside from the issue of Botox and breastfeeding, one thing we do know is that recent studies have shown Botox does sometimes migrate from the injection site, potentially causing muscle weakness, blurred vision, difficulty speaking and even trouble breathing. With adverse effects reported so far away from the injection site, it's certainly conceivable that this migration could reach mammary glands and potentially lead to Botox toxin in breast milk.

You noted in your question that you were weaning with "mainly" pre-pumped milk. Unless you can use exclusively pre-pumped milk, I strongly advise you to wait until your infant is fully weaned.

This doesn't mean you can't have any cosmetic procedures while you're breastfeeding though. There are many facial treatments that are fine for pregnant and breastfeeding mothers. You should ask your plastic surgeon or dermatologist about which procedures he or she advises.

I can't give you any specific medical advice without a personal consultation, but gentle facials and even some non-ablative laser treatments are usually fine while breastfeeding. I would avoid ablative laser treatments, which could lead to infection, and also any treatment that requires a painkiller as a pre-treatment. It's also best to avoid dermal fillers until you’ve finished breastfeeding.

Always remember to only consult with board-certified dermatologists or plastic surgeons for both your safety and the best results.

I imagine the risk of medical problems is very very low. I would say if it can wait, however, then it should wait until you are done with breastfeeding. Congrats!

There has been no conclusive research on the effects of Botox on breastmilk. However, nursing mothers should err on the side of caution of this uncertainty and refrain from Botox treatments until they stop breastfeeding. Botox makers are not sure on the effects of Botox on lactation and unclear whether the tiny amounts of Botox toxins do in fact get into the bloodstream. Given this air of uncertainty, it is always wise to be cautious when it comes to breastfeeding.