Can I Get Botox Before FFS?
Publication date: 8/2026
Many women arrive for their facial feminization surgery consultation already on a Botox routine, such as treatment to the forehead every few months to soften lines or lift the brow, and they want to know whether they must stop before surgery. Typically, stopping is not necessary.
While Dr. Paul Mittermiller rarely finds that prior Botox interferes with surgical planning or surgery, there is one key scenario where he recommends pausing it. When performing a brow bone reduction, Dr. Mittermiller prefers his patients to have stopped forehead Botox far enough in advance of surgery to evaluate facial nerve function prior to and after surgery.
Can I Get Botox Before FFS?
Yes, you can. Prior Botox almost never causes problems with planning or executing facial feminization surgery. Botox acts on the muscle. Gender-affirming FFS works primarily on the bone and deeper facial structures. FFS often involves reducing the brow bone, reshaping the jawline, bringing the chin into balance, and refining the nose (rhinoplasty). A few units of neuromodulator that relaxed a forehead muscle months ago are not going to affect those procedures.
Limiting the use of Botox is primarily to allow your surgeon to assess facial nerve function. Skipping Botox for a short while before FFS allows your surgeon to check the facial nerve immediately after surgery and follow healing if there is any temporary weakness. If you want a wider picture on preparation for FFS, Dr. Mittermiller walks through these logistics in his guide on preparing for facial feminization surgery.
Why Botox Rarely Interferes with FFS Planning
Botox is botulinum toxin. Botox injected into the target muscle blocks the signal that tells the muscle to fire, so the muscle relaxes and stops moving and the skin over it smooths out. The effect doesn’t last. It sets in over a day or two, peaks in the first few weeks, and fades after about three to six months as the muscle wakes back up.1
Facial feminization surgery reaches deeper than that. The masculine features most patients want softened are often skeletal (e.g. a heavy brow bone, a wider jaw, a stronger chin). Many transgender women are interested in reshaping these areas, which means operating on the facial skeleton itself. Relaxing the muscle for a few months does not dramatically affect the shape or size of the bone.
Since facial feminization surgery is often booked months in advance, there is commonly plenty of time to allow Botox to fade prior to surgery. Injections done around the time of a consult have time to disappear by the surgery date, leaving nothing to interfere with nerve monitoring.
The Facial Nerve Consideration
The forehead muscles are controlled by the frontal branch of the facial nerve, which is protected during brow and forehead work. If the nerve is injured, the forehead can move unevenly, or an eyebrow can stop lifting.
If the neuromodulator Botox is already weakening those same muscles intentionally, it will be difficult to know if the associated nerves were injured during the operation. Holding off on Botox for a stretch beforehand gives Dr. Mittermiller a clean read on how the face moves on its own and allows him to determine whether the nerves are all functioning appropriately. This matters mostly for brow bone reduction, orbital contouring, and brow lifts where the dissection occurs in close proximity to the facial nerve. Neither using nor avoiding Botox makes the surgery riskier, it simply keeps the monitoring clean.
When to Pause Botox Before Surgery
If you want one simple rule, let your last treatment wear off before surgery so the forehead muscles are back to their baseline. If you’d rather keep up your injections closer to the date, the usual advice is to avoid Botox for 2 weeks prior to a procedure so you don’t show up with bruising or swelling near where the surgeon is about to work.
The number of days matters less than being upfront with your surgical team. Tell your surgeon what you’ve had done and when it was received. Dr. Mittermiller will review any relevant injectables during surgical planning and tailor his advice for the FFS procedures being considered.
Botox After FFS: When Can I Restart?
Most patients get back to Botox a few months after surgery. In the first few weeks, the face is swollen and tender. Most patients prefer to reach a comfortable state before starting with additional injectable treatments. If there is any weakness after surgery, Dr. Mittermiller prefers to see the nerves and muscles working normally before any neuromodulator is used, since Botox would hide any improvements in motion. The timing for restarting treatments is a decision that should usually be made in conjunction with the surgeon.
Planning with Dr. Mittermiller
Dr. Paul Mittermiller is a plastic surgeon with specialty training in craniofacial surgery and facial feminization surgery, based in Los Angeles and serving the broader Southern California area. He plans each procedure around every individual’s face, so details like recent Botox or filler are part of the conversation from the initial visit. If you’re mapping out FFS and wondering how your injectable routine fits in, schedule a consultation to go over your history and build a plan around your goals.
FAQ
Can I get Botox 3 days before FFS?
It’s best to avoid Botox for at least a few weeks prior to FFS. Botox itself won’t put the surgery at risk, but injecting a few days prior to surgery can leave bruising or swelling where the surgeon will be operating. Recent Botox injections will also erase the natural baseline used for facial nerve assessment. If you’ve already undergone injections close to your surgical date, tell Dr. Mittermiller so he can factor it into planning and monitoring.
Does Botox affect facial feminization surgery results?
Botox does not affect FFS results. FFS reshapes bone and soft tissue. Botox only relaxes muscle for a few months. It doesn’t change your surgical outcome or the healed contour. Where it matters is short-term planning and keeping forehead and brow movement easy to read before and after surgery.
Should I tell my surgeon about recent Botox or filler?
You should always tell your surgeon about any recent Botox or filler injections. This is useful to know during planning, especially around the forehead, brow, cheeks, and jaw. Dr. Mittermiller uses this information to evaluate your face and follow your healing. To go over your injectable history and map out a plan, you can schedule a consultation here.
Dr. Mittermiller is a plastic surgeon with specialty training in craniofacial surgery and facial feminization surgery. His office is located in Los Angeles, California.
Contact us today to schedule a consultation.