The overall use of botulinum toxin type A in cosmetic procedures continues to rise, and the incidental exposures of pregnant women to the drug can occur. The author describes 2 patients who received botulinum toxin type A injections during pregnancy. The first patient was a 34-year-old woman who received 54 units of botulinum toxin type A to treat periorbital lines (crow's feet) unaware that she was 6 weeks pregnant. She had a healthy term baby delivered by cesarean section; Apgar scores were 9/10. The second patient was a 37-year-old woman who received 65 units of botulinum toxin type A to treat facial dynamic lines (forehead, glabelar, and periorbital), unaware that she was 5 weeks pregnant. She had a healthy term baby delivered by cesarean section; Apgar scores were 9/10. The 2 patients were injected only once in the first trimester. Both cases did not have any complications or detectable adverse effects on the fetuses.