In this 2020 recording, Dr. Smith recommends postponing elective cosmetic Botox and fillers during pregnancy and breastfeeding because of limited safety information. Darren M. Smith, MD, a plastic surgeon in New York City, explains the reasoning behind that precaution and distinguishes cosmetic treatment from treatment of a medical condition. Updated evidence is summarized separately below.

Key takeaways from the episode

🔎 Botox and fillers work differently.

Botulinum toxin products reduce selected muscle activity; the hyaluronic acid fillers discussed in the episode add volume.

⚠️ A familiar ingredient does not establish safety in pregnancy.

Hyaluronic acid occurs naturally in the body, but that alone does not answer whether an injectable product is appropriate during pregnancy or breastfeeding.

💬 Elective and medical uses raise different questions.

Dr. Smith mentions uses such as migraine and muscle spasticity. A decision about an ongoing medical treatment requires its own assessment.

🔎 The recommendation in the audio is precautionary.

It should not be interpreted as evidence that every exposure causes harm, or as a statement that all products and uses have been studied equally.

💬 Questions answered

Why does Dr. Smith recommend waiting for cosmetic injections?

He weighs an elective appearance benefit against uncertainty about pregnancy and breastfeeding safety. The recording's recommendation is to wait rather than assume that a small dose or a naturally occurring filler ingredient settles the question.

Does this episode provide a treatment plan for migraine or spasticity?

No. Dr. Smith mentions these medical uses but does not give an individualized treatment plan. The clinician treating the condition should assess the relevant benefits, uncertainties and alternatives.

ℹ️ Current context for this 2020 recording

The FDA does not recommend cosmetic botulinum toxin injections during pregnancy or lactation. The FDA also states that dermal filler safety during pregnancy and breastfeeding is unknown.

Lactation evidence has developed since the recording. The September 2026 LactMed review describes limited human data on onabotulinumtoxinA and notes guidance supporting its use for chronic migraine during breastfeeding. Those findings do not establish safety for every toxin, dose or indication, and breastfeeding evidence does not establish pregnancy safety. Discuss your specific treatment and circumstances with your prescribing and obstetric or lactation care teams.

🎧 Episode chapters

00:36 — What botulinum toxin does

02:49 — The original precautionary recommendation

03:45 — Cosmetic versus medical uses

04:29 — Hyaluronic acid fillers and timing

🔗 Related information

Explore Botox treatment information, dermal filler information, or request a consultation with Dr. Smith in New York City.

About the host — current biography

Darren M. Smith, MD, FACS is a board-certified plastic surgeon in Manhattan specializing in mommy makeover surgery, breast surgery, and body contouring. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.

Originally released July 6, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.

Full transcript and related resources