Aesthetics In Pregnancy: Can I Do BTX/Neurotoxin If I’m Pregnant?

by Dr Wan Chee Kwang
January 27, 2021

Pregnancy is a time filled with lots of changes — both mentally and physically. During pregnancy, many women are blessed with a pregnancy glow. But others may also experience acne outbreaks, wrinkles, dull, saggy-looking skin and pigmentation due to hormonal changes. For regular non-pregnant individuals, these skin problems can easily be treated with procedures like lasersHIFU and fillers.

But what about BTX/Neurotoxin, a cosmetic treatment that’s been around for a longer time — it should be safe, right? The short answer is we don’t know, because there are not enough conclusive studies on the effects of BTX/Neurotoxin during pregnancy. For that, I would say no.

How BTX/Neurotoxin works

BTX is a brand name for a neurotoxin produced by Clostridium bacteria. You might have heard of other brand names like Dysport and Xeomin, but BTX is more prominent as it was the first type of US FDA-approved botulinum toxin to treat lazy eye and uncontrollable blinking. In its original form, Clostridium botulinum is deadly, but it is very safe for commercial use as it is produced under a very strict extraction and purification process. This final safe-for-use product is what we know as BTX. 

When injected into our facial muscles, BTX helps those muscles relax and eventually slim down. As a result, horizontal creases or wrinkles previously caused by the movement of those muscles also improve. In many countries including Singapore, BTX is commonly used for treating wrinkles and for achieving a slimmer, V-shaped face. Cosmetic purposes aside, BTX is also used for conditions like bruxism, migraines, hyperhidrosis (excessive sweating) and an overactive bladder.

BTX/Neurotoxin during pregnancy

Is BTX/Neurotoxin safe during pregnancy?

If BTX/Neurotoxin can treat so many conditions listed above, why is it not recommended for pregnant and breastfeeding women? To begin, most studies done on the safety of BTX/Neurotoxin or botulinum toxin have been conducted on normal people. While animal studies show that botulinum toxin is safe on pregnant animals, which usually suggests that the results will be the same for humans, we must still remember that animals aren’t human and we must leave a degree of error. This error, in my opinion, is way too risky to take especially if there’s a foetus involved. 

Two separate studies on botulinum toxin on pregnant women proved inconclusive results too. In both studies, the women received botulinum toxin for various reasons. Not 100% had normal live births — we don’t know if this was due to other factors, and till more conclusive research is done, most medical professionals including myself do not recommend injecting botulinum toxin in pregnant and breastfeeding women. If for any reason a pregnant patient requires those injections, the benefits must outweigh the risks.

Risks of using BTX/Neurotoxin during pregnancy

Pregnant or not, a potential risk of BTX/Neurotoxin is the spread of the toxin beyond the original area. If the toxin spreads, it can cause botulism, a potentially fatal condition that attacks the body’s nerves. Patients with botulism experience: 

  • Muscle weakness 
  • Difficulty speaking or forming words 
  • Difficulty breathing 
  • Blurred vision 
  • Difficulty swallowing 
  • Loss of bladder control 

With a pregnant woman, what we don’t want is the toxin crossing the placenta. That is something we cannot control, and while there’s not a lot of evidence that proves such a risk will happen, as always, it’s better to err on the side of caution. 

The same goes for breastfeeding — if you’re planning to breastfeed, I would highly advise you to avoid doing BTX/Neurotoxin as it’s not yet known whether BTX/Neurotoxin passes into breast milk.

What are some safer alternatives to BTX/Neurotoxin?

I’ll be honest: if you’re looking for an alternative that will give you the same results as BTX/Neurotoxin injections, there isn’t any. But don’t be disappointed; there are still ways to look your best. Use this time to get a medical facial or glycolic and lactic acid peels — these treatments are safe for pregnant women. A good facial session can help you destress and soothe those hormonal changes too. I’d also recommend drinking plenty of water, moisturising regularly and exfoliating a couple of times a week to ensure hydration to minimise fine lines. Don’t forget lots of sleep for yourself and your baby too!


Your aesthetic treatments might have to take a pause for now, but surely no amount of looking good would supersede the safety of you and your baby. If you’re unsure on the procedures that are safe for pregnancy, feel free to drop me a line.


  1. Brin, M. F., Kirby, R. S., Slavotinek, A., Miller-Messana, M. A., Parker, L., Yushmanova, I., & Yang, H. (2016). Pregnancy outcomes following exposure to onabotulinumtoxinA. Pharmacoepidemiology and drug safety25(2), 179–187.
  2. Morgan, J. C., Iyer, S. S., Moser, E. T., Singer, C., & Sethi, K. D. (2006). Botulinum toxin A during pregnancy: a survey of treating physicians. Journal of neurology, neurosurgery, and psychiatry77(1), 117–119.

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