Dermatologists report common botulinum toxin use during pregnancy and lactation

A cross-sectional survey of 177 US board-certified dermatologists published in *Dermatologic Surgery* reveals a substantial gap between official product protocols and real-world clinical practice regarding botulinum toxin type A during pregnancy and lactation. For medical aesthetics clinicians, this data provides rare visibility into how peers actually handle these common off-label scenarios when managing their own lives and patients.

According to the findings, 75 percent of the 177 respondents reported either administering or receiving botulinum toxin type A while breastfeeding. Use during pregnancy itself was less frequent but still present across all stages of gestation, with 8 percent of respondents reporting use in the first trimester, 5 percent in the second trimester, and 7 percent in the third trimester. Across all reported cases of exposure, there were zero adverse effects or fetal complications recorded.

While these numbers are striking, the study authors caution that these exploratory findings should be treated as hypothesis-generating rather than definitive evidence of safety. The data highlights a distinct disconnect between current self-practice and the scarce formal safety data available, underscoring an urgent need for controlled clinical studies.

For practice owners and injectors, these insights are useful for contextualizing real-world safety profiles when discussing treatment options with pregnant or nursing patients. However, because formal guidelines remain unchanged and clinical trials are lacking, the most prudent approach remains to maintain conservative consent protocols and carefully weigh the lack of official safety clearance against these peer-reported experiences on a case-by-case basis.

Source: PubMed (Dermatologic Surgery), https://pubmed.ncbi.nlm.nih.gov/41499679/