Fake Botox Is Making People Sick. Here’s What to Look Out For

Health authorities are urging the public to only receive botulinum toxin (Botox) injections from trained and licensed professionals and to ensure that only FDA-approved products are used.

The Centers for Disease Control and Prevention (CDC) issued a health alert after 22 people reported adverse effects after receiving counterfeit Botox injections or injections from someone who wasn’t licensed or trained. The symptoms included shortness of breath, slurred speech, and generalized weakness. Eleven people were hospitalized, and none died.

Experts say the alert serves as a reminder that Botox injections can be dangerous if they aren’t given in proper healthcare settings.

“Many people consider cost when considering Botox treatment, as treatment is needed every three to four months to maintain its effects,” Michele Green, MD, a board-certified cosmetic dermatologist based in New York, told Verywell. “While medical spas may be more cost-effective in the long run, it is safer to have your Botox treatment performed by a board-certified healthcare professional.”

It’s worth verifying that a provider is licensed and only uses FDA-approved products, said Joshua Zeichner, MD, a dermatologist at the Mount Sinai Hospital.

“When it comes to getting cosmetic procedures done, you need to be very careful who you see and what products are used,” Zeichner said. “Your outcome depends on what is injected and how it is injected.”

How to Ensure You’re Seeing a Certified Injector

It’s crucial to ensure that the person administering your Botox injections is properly trained and licensed.

“Only licensed [healthcare] professionals are allowed to administer Botox, [and] your injector should also have years of experience and be performing procedures in a sterile medical environment to avoid cross-contamination and infection,” Green said.

Healthcare providers who can provide Botox injections after specialized training include the following:

• Physicians (MD, DO)
• Registered nurses (RN)
• Nurse practitioners (NP)
• Physician assistants (PA)
• Dentists (DDS, DMD)

Fake or mishandled Botox products can lead to botulism, a potentially fatal illness causing symptoms such as blurred vision, eyelid drooping, and slurred speech.

There are multiple ways to confirm a provider's qualifications. “If you are going to a medical office, you can contact the state’s medical, nursing, or physician assistant board to ensure that your injector has an active medical license,” Green said. “If you are receiving Botox from a medical spa, you can confirm that the owner of the medical spa is a licensed medical professional.”

If you don’t yet have an injector, you may want to use a credentialing website to find a qualified injector. “Some sites, such as the American Academy of Facial Esthetics [AAFE], have an online professional locator where you can look for medical professionals with an AAFE certification in Botox injections,” Green said.

“In terms of licensure, you can search for a board-certified dermatologist or plastic surgeon using online tools created by the American Academy of Dermatology [AAD] or the American Society of Plastic Surgeons [ASPS],” she added.

If you’re already established with a provider, don't hesitate to ask them about their training and certification, especially given the recent news about botched injections.

How to Ensure Your Injector Uses an FDA-Approved Product

Before getting injected, ask your provider which formula they use. “While Botox is a brand name, it is also used interchangeably to refer to other injectable neurotoxins, such as Xeomin and Dysport,” Green said. These work similarly to Botox injections, but it’s still a good idea to clarify what type of product your provider uses, especially if you’re only interested in Botox injections, she added.

Botox injections in the United States should only come from one source. “One way to tell if a Botox product is FDA-approved is to look at the packaging, as AbbVie and Allergan Aesthetics are the only approved suppliers of Botox,” Green explained. The company offers an online registry that allows you to find providers in your area who use their product.

Additionally, English is the only language used on FDA-approved Botox packaging; the FDA has warned that if other languages are found on the packaging, they may be counterfeit. You should also pay attention to the words on the box: “FDA-approved Botox will have the active ingredient displayed as ‘OnabotulinumtoxinA’ on the packaging instead of ‘Botulinum Toxin Type A,’” Green said.

Botox Safety Checklist

Finding a legitimate injector can be difficult, but the following checklist can help you make sure your bases are covered. This checklist is specifically for people looking for Botox injectors, but many of the questions can be applied to injectors of other neurotoxins, like Dysport or Xeomin, as well.

• Is the injector a qualified healthcare provider?
• Did they receive their training at an accredited institution?
• Are they offering injections in a clean setting?
• Do they use Botox?
• Do AbbVie and Allergan Aesthetics supply their product?
• Is English the only language used on the packaging?
• Is the packaging stored in a cool place?
• Has your injector given you instructions for follow-up care?
• Have they given you a way to reach them after your procedure?

Red Flags to Look For When Getting Botox Injections

Your injector’s place of work should resemble a doctor’s office. “You always want to make sure you are in an environment where there is good lighting, proper seating, access to sterilized tools, and refrigeration because the toxin is usually stored at a cool temperature," Zeichner said.

Significantly discounted shots are likewise risky, according to Green. “A treatment price that is far below the average costs in your area may be a sign that they are not properly qualified or are using knockoff or counterfeit products," she said.

Your injector should give you a way to reach them after the procedure. “You want to make sure you always have a point of contact in case there are any questions or concerns,” Zeichner added.

Though “Botox parties”—or gatherings at which many people get injections at once—are now popular, it’s in your best interest to avoid getting injected at one.

“These parties generally receive a discount or group rate for treatment,” Green said, adding that many states have banned them. “Botox parties can be unsafe as these parties are not in a clean medical office, increasing the risk of infection at the injection site, [and] home settings are also not equipped with any medical equipment in the event of an adverse reaction.”