David PerlmutterPresident,, Perlmutter Health Center · Board-Certified Neurologist | Functional Medicine Pioneer | #1 New York Times Best-Selling Author | International Speaker | Host of The Empowering Neurologist Podcast

Botox or No-Tox?

13 Feb 2026 · 1 min

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1:08

In this YouTube video, Dr. David Perlmutter discusses the safety of cosmetic Botox. He notes his early involvement as the second qualified practitioner in Florida to use Botox for neurological conditions, giving him a long‑term perspective. He states that the dosages employed for cosmetic purposes appear generally safe, with no data indicating significant risk. The primary scientific concern he highlights is retrograde transport—whether Botox can travel up nerves to the brain—a phenomenon observed only in animal studies that used doses far exceeding those used in typical facial cosmetic treatments. Perlmutter advises continued monitoring of the literature but does not anticipate major warnings. He recommends a cautious approach regarding treatment frequency and dosage.

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Botox or no-tox? That is the question. A lot of buzz now about whether it's safe to use Botox or not. And gosh, I began using Botox. I was the second person in Florida to actually be qualified to use Botox back in the day when we were using it for neurological problems. So I've been looking at this for an awful long time, and here's what we know and what we don't know. I think the dosages that are being used in for cosmetic purposes are generally safe. There's really been no data to indicate that there's any real risk. The concern has been this idea of retrograde transport. In other words, can Botox migrate up the nerves and get into the brain? That has been seen in animal models, but keep in mind, in those models, the dosage of Botox was a heck of a lot higher than is used routinely in terms of facial and other areas of cosmetics. So we'll continue to follow the literature. Right now, I don't see a huge warning coming your way as it relates to Botox from me. But I think by and large, you know, err on the side of caution as it relates to frequency and dosage.