Is Botox Bad for You? A Dermatologist Explains

In case you missed it, Botox isn’t just for celebrities and influencers anymore. If you haven’t received the botulinum toxin (Botox is a brand name) injectable yourself, you probably know someone who has. For anyone who is new to the aesthetic procedure, there’s a lot to be curious about, but mostly: Is Botox safe or is it bad for you? That’s where Nazanin Saedi, MD, a board-certified dermatologist whose specialties include cosmetic procedures, comes in. Here, she breaks down what you need to know about Botox side effects and how it impacts your health. 

Is Botox bad for you?

No, Botox is not bad for your health, says Saedi. That’s as long as it’s administered in the correct doses by a licensed provider. 

Botox was first approved by the FDA in 1989 to treat two eye disorders. But you may primarily associate it with cosmetic use, which it was approved for in 2002. Now, “we have [about] 20 years of safety data out for it, just for its cosmetic use,” says Saedi. That doesn’t even cover the many other medical issues Botox has been shown to treat, including migraines, muscle spasms, bladder issues, and excessive sweating. It’s “the jack of all trades,” but it is a toxin, after all, says Saedi, “So people are so afraid when they see that.” 

Featured expert:

Nazanin Saedi, MD - A board-certified dermatologist and clinical associate professor at Thomas Jefferson University.

How does Botox work?

Botulinum toxin works by relaxing targeted muscles, says Saedi. It stops the release of acetylcholine — a neurotransmitter that contributes to muscle movement — so that those specific muscles can’t contract. That’s what ultimately smooths out lines and creases, and may help slow down the development of wrinkles in the future. Botox is commonly injected around the forehead, mouth, or eyes as a wrinkle relaxer.

You can get Botox treatment as often as every three months, says Saedi. But the frequency won’t be the same for everyone. “Some people are really lucky, and it lasts six months,” she says. “Some people who have fast metabolisms just tend to break [Botox] down [faster].”

Another important note: “It's not something you have to do forever,” she says. “You can stop whenever you want.” 

Are there any side effects of botox?

“For the most part, it's really safe and well tolerated,” says Saedi. But just like any medication, there are potential Botox side effects, such as “bruising at the site of the injection,” she says. Some people may also get headaches that last a day or two after treatment.

A less common side-effect is “a heavy forehead or heavy lids,” which may happen if Botox in the forehead or between the eyes migrates to an unintended muscle. That’s typically temporary and goes away in a few months as the toxin is wearing off, and in some cases there are options to combat it, such as prescription eye drops that help open up the eyelid, says Saedi. 

Even though Botox is considered safe, it does pose some risks to certain individuals who should avoid botulinum toxin injections.

Who shouldn’t get Botox?

If you’re interested in getting Botox, your doctor or dermatologist should be your first stop. Not everyone is a good candidate. “People who have [certain] neuromuscular diseases like myasthenia gravis or Eaton-Lambert syndrome … shouldn't get it because they have problems with their neuromuscular junctions,” says Saedi, and Botox could worsen problems associated with muscle weakness.

Saedi doesn’t advise getting Botox while you’re breastfeeding. While some studies say it may be safe, there hasn’t been enough research to say if botulinum toxin passes through the breastmilk to the baby. “I don't think it's worth the risk,” she says. Similarly, Botox while pregnant is definitely not recommended, as there is no definitive research done on pregnant women to potential risks to the fetus. Instead, she recommends some types of chemical peels as Botox alternatives to help reduce fine lines. 

In small doses, Botox is safe and effective for a variety of uses. But before you make an appointment, run it by your dermatologist first to make sure it’s safe for you.