When is treatment postponed?
Treatment is usually postponed until healing if there is an active infection, open wound, cold sore, acne flare or eczema at the treatment site. A feverish illness can also be a reason to wait.
Any procedure that passes a needle through the skin carries a chance of carrying bacteria into deeper tissue. Injecting while there is active infection or inflammation in the area can increase this risk and make healing more difficult. If you often get cold sores around the mouth, it is important to mention this before treatments such as lip filler; your doctor may suggest a preventive approach where appropriate. Treatment can then be rescheduled once the skin has settled.
Some doctors may also suggest a short delay after recent dental work, a vaccination or a feverish illness. Practice varies between doctors and treatments. If you develop a new health problem before your appointment, letting the clinic know in advance helps avoid unnecessary risk, which is especially useful if you are travelling for treatment. Postponing is not a setback but a normal part of planning treatment safely.
Which conditions need extra care with Botox?
In disorders that affect nerve-to-muscle transmission, such as myasthenia gravis or Lambert-Eaton syndrome, botulinum toxin is generally not recommended or needs very careful assessment. Some medicines can also alter its effect.
Botulinum toxin works by temporarily reducing the signal from nerve to muscle. In neuromuscular disorders where that signal is already impaired, the effect may be stronger than expected and unwanted muscle weakness can occur. For this reason these conditions are usually listed among the warnings and contraindications in product information. If you have a diagnosed neurological condition, you should describe it, along with your medicines, in detail at consultation.
Certain medicines, including some antibiotics and muscle relaxants, are known to be able to increase the effect of the toxin. If you have recently had toxin treatment for another reason, such as migraine or muscle spasm, that is also important to know. A previous allergic reaction to botulinum toxin or to other ingredients in the product may mean treatment should not go ahead. Without this information, dosing and planning cannot be done safely.
Can I have Botox or filler if I take blood thinners?
Taking blood thinners is not in itself an automatic bar, but it can increase bruising and bleeding. Do not stop these medicines on your own; discuss them with both your aesthetic doctor and the doctor who prescribed them.
Anticoagulants, painkillers such as aspirin and some herbal supplements affect clotting and can increase bruising after injection. Most of these medicines are taken for heart, circulation or clotting conditions, and stopping them without advice can pose serious health risks. It is therefore very important not to stop any medicine for an aesthetic treatment without first speaking to your doctor. Your aesthetic doctor can adapt the treatment plan to take these medicines into account.
If you have a known bleeding disorder such as haemophilia, whether treatment is possible and what precautions are needed should be assessed together with the relevant specialist. In some cases, technical choices such as using a cannula or fewer entry points may help reduce bruising, but this decision is individual. It is also worth listing supplements such as fish oil, vitamin E and ginkgo alongside your medicines at consultation.
How are autoimmune conditions and allergies assessed?
With an autoimmune condition, treatment is assessed according to whether the disease is active and what treatment you receive; it is usually postponed during a flare. An allergy history is considered against the product's ingredients.
In autoimmune conditions such as rheumatoid arthritis, lupus, scleroderma or inflammatory bowel disease, the immune system may respond differently to injected products. Some treatments may be planned during a quiet phase and with input from your specialist, while procedures are usually postponed during a flare. Medicines that suppress the immune system are also considered separately in terms of infection risk and healing, so it is important to mention every treatment you receive.
If you have ever had an allergic reaction to a filler, a local anaesthetic, a medicine or a product ingredient, you should always say so. Some fillers contain lidocaine, and some biostimulators and polynucleotide products contain ingredients derived from different sources. Your doctor will choose products with this in mind. Permanent fillers or fillers of unknown content injected in the past can also affect planning, so please share whatever you remember.
Why are expectations part of suitability?
If there is a clear gap between what a treatment can realistically achieve and what is hoped for, not treating can be the safe decision. Discussing expectations openly can reduce dissatisfaction and unnecessary procedures.
Aesthetic injections and device treatments produce change within certain limits. Hoping for a surgical result, a lasting transformation from a single session or someone else's face can create expectations beyond what a treatment can do. At consultation your doctor should explain what is possible, what is not and when another approach might be more appropriate. Sometimes this conversation ends with a recommendation not to treat, which is a legitimate outcome.
For people who feel intense, persistent concern about their appearance, seek new treatments at short intervals or feel dissatisfied after every procedure, a doctor may prefer to talk this through openly rather than offer another treatment. This is not a judgement but an approach that puts your wellbeing first. Where appropriate, support from another specialist may be suggested. The aim is a plan that is meaningful and sustainable for you.
Frequently asked questions
I have diabetes. Can I have Botox or fillers?
Diabetes is not in itself an automatic bar, but how well your blood sugar is controlled matters for infection and healing. Your doctor will assess your overall health.
Can I have Botox while taking antibiotics?
Some antibiotics can increase the effect of botulinum toxin, and the infection being treated may itself be a reason to postpone. Let your doctor know which medicine you are taking.
Can I have lip filler with a cold sore?
Injections in and around the lips are usually postponed until an active cold sore has healed. If you get cold sores often, mention this at consultation.
I have had permanent filler before. Can I have new filler?
The type and position of previous filler can affect planning. Sharing what you remember, and any records, helps your doctor decide whether further assessment such as imaging is needed.
Does this page cover every situation?
No. The examples here are general information and are not exhaustive. Whether a treatment suits you is decided by your doctor after taking your health history and examining you.
I have Hashimoto's or another thyroid condition. Can I have Botox or fillers?
Well-controlled Hashimoto's thyroiditis or another thyroid condition is not usually, on its own, a reason to avoid Botox or filler. Because Hashimoto's is an autoimmune condition, your doctor will ask whether it is stable and about any related autoimmune conditions. While thyroid levels are unsettled, facial puffiness or weight change can occur, so judging volume for filler may make more sense once levels have stabilised.
I am having cancer treatment or have just finished it. Can I have aesthetic treatments?
During active chemotherapy, radiotherapy or immunosuppressive treatment, elective aesthetic injections and device treatments are usually postponed. Infection risk may be higher, healing may be slower and blood counts can fluctuate during this time. Whether and when aesthetic treatment suits you after cancer treatment is decided with your oncologist's input, and areas that have received radiotherapy are assessed with particular care.
I tend to form keloids or thick scars. Which treatments need extra care?
A tendency to form keloids or thick (hypertrophic) scars calls for particular care with treatments that create controlled micro-injury in the skin, such as microneedling radiofrequency, laser and deep peels. With Botox and filler injections the needle entry points are very small, so this risk is generally considered lower. Your keloid history, and where the scars formed, still shapes the choice of method and area.
I have high blood pressure or a heart condition. Can I have aesthetic injections?
Well-controlled high blood pressure or heart disease is not usually, on its own, a firm bar to aesthetic injections; what matters is whether the condition is stable and which medicines you take. Blood thinners can increase bruising, and the lidocaine in some fillers is assessed separately for heart rhythm problems. With an implanted device such as a pacemaker, some energy-based treatments may not be suitable.
Sources (3)
- U.S. FDA / Allergan: BOTOX Cosmetic (onabotulinumtoxinA) for injection: Highlights of Prescribing Information (2024)
- EMA: Nuceiva (botulinum toxin type A): Annex I, Summary of Product Characteristics (2024)
- Goodman GJ, Liew S, Callan P, Hart S (Australasian Journal of Dermatology): Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes (2020)
This content is for general information and does not replace a personal medical assessment.