A Wrinkle in Time

Can I use Botox while breastfeeding? — Spare Me The Lecture

Dear Spare Me,

The folks who make Botox state clearly that women should not use Botox if they are pregnant or think they are pregnant but regarding breastfeeding mothers, they say "Only your doctor can decide if BOTOX Cosmetic is right for you." In other promotional materials for Botox the language is similar, "every situation is different, so talk to your doctor."

So, the first part of the answer is: "only your doctor can decide." The second part of our answer is: only you can decide which doctor to go to. We’re fairly certain that you can get the answer you want to hear, though it may take a tour of several dermatologists’ offices.

The fact is, there has been no research on the effects of Botox on breastfeeding mothers and their breastfed babies. This scenario is the same with so many drugs that might be used during pregnancy and breastfeeding for a reason: testing on pregnant and lactating women is difficult, and some say, unethical.

We do know that although Botox is a serious toxin, only tiny amounts reach the bloodstream. It’s unclear whether any of it gets into the breast milk and if it does, what that would mean. Given the lack of concrete data, the tendency is to err on the side of caution. The standard approach for weighting the benefits and risks for drugs during pregnancy and breastfeeding usually goes something like: "Do I need this right now for my health and the health of the baby?"

The implication is that treatments for non-medical reasons don’t make the cost/benefit cut. In this spirit, Dr. Hale — a well-known expert in medications and lactation — posted on a professional message board: "I have some preliminary data that [Botox] does not penetrate into milk." He then goes on to say: "I do not recommend it for cosmetic reasons in breastfeeding mothers . . . they should wait until they finish breastfeeding. However, it is also commonly used for rectal tears. In this case it is probably justified."

You don’t specify why you’re interested in the treatment, but we’ll assume you don’t want to inject it into your butt to keep it from bleeding. A case could certainly be made to support the value of a youthful appearance to career, personal life, self-esteem, and probably a pile of other things. Whether that value trumps an unknown, if unlikely, effect on your baby is something for you and your trusty dermatologist to decide. And hey, if your baby needs a little help interpreting facial expressions later on, you can always get a highly theatrical babysitter.

Have a question? Email parentaladvisory@babble.com.au