Question Summary:
Is it permissible to practice give Botox injections, facial peels, dermabrasions. Mostly, its done for patients to look younger and good looks. How about for medical sickness?

Question Detail:

I am a general practitioner in UK . My question is it permissible to practice give Botox injections, facial peels, dermabrasions. Mostly done for patients to look younger and good looks. I am mainly thinking of doing it for earning extra money {being honest} I would like to know If its allowed or not.
What would be the answer if the need is for medicational use.

Answer :

In the Name of Allah, the Most Gracious, the Most Merciful.
As-salāmu ‘alaykum wa-rahmatullāhi wa-barakātuh.
Botox (Botulinum Toxin Type A) is by nature a poisonous toxin. It has been approved by FDA in US for specific medicinal use, however it has gained more popularity in the cosmetic surgeries. [1]
Botox serum uses enzymes from pig’s milk in its initial stage which is later on purified through industrial process. [2] Although the serum may be clinically categorized void of these enzymes in its final product form, it will still be considered an impure substance according to Shariah.
Moreover, Botox has been clinically classified as a lethal toxin which if consumed in larger quantities can have devastating effects. Even in the lower medicinal usage, it is not free from some side effects. In some cases it may lead to problems in swallowing, speaking, or breathing, all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice (dysphonia), trouble saying words clearly (dysarthria), loss of bladder control, trouble breathing.[3] While these may be isolated conditions, they are sufficient enough for the FDA (Food and Drug Administration) to issue caution against Botox usage.[4]
It was perhaps this vital information which pushed many Ulama, locally in South Africa, as well as internationally (Malaysia) to rule against Botox. [5]
While many people have used Botox for beauty treatments it has been equally popular in the medical field. Since Botox is essentially a toxin with the ability to weaken or dampen the response in muscles, it has been targeted by many doctors as a temporary relief medication for illnesses due to spasmodic muscles. Some of the practical medical uses for Botox in practice are treatment for inflammation in specific areas, controlling bleeding after intramuscular injection, excessive weakness or wasting in the muscle, swallowing difficulties (dysphagia) or liquid accidentally going into the lungs (aspiration), chronic breathing problems, Diseases or conditions affecting the nervous system, seizures like epilepsy, closed angle glaucoma(eye disease) etc.[6]
The medicinal usage is still not void of the potential harmful side effects that could emerge from using this serum, hence, Shariah affords a balanced approach towards its usage. The rules of Shariah are more relaxed in the case of medical need and necessity. However such relaxation is also governed closely by rules. In principle:
Necessity renders the restrictions permissible[7]
And
Necessity warrants (permissibility of the restricted) to the extent of (one’s) necessity.[8]
Hence, the use of an impure Botox serum will become permissible for medicinal use only if,
i.  The experts of the field opine the need for such a medicine[9]
ii. There is no halal alternative available
As a doctor one will be responsible in providing a permissible or impermissible service to the consumer. If there is a suitable alternative for skin care treatments then that avenue should be adopted.
It is not permissible to use an impure substance to beautify one self. Since Botox is impure because of the use enzymes from pig’s milk it will be impermissible to use it for purely beatification purposes.
Facial Peels and dermabrasions or other cosmetic procedures.
Facial peels and dermabrasions are skincare procedures which use various techniques like exfoliation of upper layers of skin to rejuvenate a healthier and smoother skin. These procedures are permissible provided that,
        i.  The creams or lotions used do not contain impure or impermissible substance;
      ii.  The procedure does not aim at changing the physical features.[10]
    iii.  The procedure is not harmful to one’s health.
At the same time, we also caution that venturing into the skincare procedures should not compromise the general Shar῾ī work ethos (i.e. unnecessary gender interaction etc).
And Allah Ta’āla Knows Best
Mawlana Faisal bin Abdul Hameed
Student, Darul Iftaa
Canada
Checked and Approved by,
Mufti Ebrahim Desai.
www.daruliftaa.net