What You Need to Know About Fake Botox Causing Botulism in the U.S.
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Nearly 20 people across nine states have had bad reactions to fake Botox.
The CDC and FDA are investigating the cases.
Doctors stress the importance of getting injections from a reputable source.
The Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) are investigating reports of people who got injections of mishandled or counterfeit Botox (botulinum toxin). Nearly 20 people across the country have reported harmful reactions after receiving the cosmetic treatment from people who are unlicensed or in non-medical settings like homes and spas, the CDC says.
Reports of adverse reactions have come from nine states: Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee, and Washington.
Health officials found that some people received injections with counterfeit Botox or botulinum toxin from unverified sources. Symptoms included blurry vision and double vision, drooping eyelids, difficulty swallowing, dry mouth, slurred speech, and difficulty breathing. Some also reported having fatigue or generalized feelings of weakness after the injections.
Nine people were hospitalized after having injections and four were treated with botulism antitoxin because of concerns that the botulinum toxin could have spread beyond the injection site.
The news has raised a lot of questions about fake Botox and how to get injections safely. Here’s what dermatologists and public health officials want you to know.
What is counterfeit or fake Botox?
It’s not entirely clear what’s in these fake Botox containers. However, the FDA has detailed information online about what the counterfeit packages look like, including serial numbers.
AbbVie, which makes Botox brand botulinum toxin, makes its products in 50-, 100- and 200-unit dose forms, the FDA says—and that is considered safe to use. The counterfeit product has an outer carton and vial that contains the lot number C3709C3 and lists the active ingredient as “Botulinum Toxin Type A” instead of “OnabotulinumtoxinA.”
The outer carton and vial also says that it has 150-unit doses, which is not a unit that’s made by AbbVie. It contains language that is not English, too, the FDA says. The FDA has photos of the fake Botox products online, in case you want to see them.
Signs of botulism
If the Botox is counterfeit or injected incorrectly, it could lead to botulism, which the CDC says may cause the following symptoms:
Double or blurred vision
Drooping eyelids
Slurred speech
Difficulty swallowing
Dry mouth
Difficulty breathing
Those symptoms, which can show up within a few hours, are usually followed by muscle weakness that progresses over hours to days. (If you have these symptoms after Botox injections, the CDC recommends going to the ER right away.) If it’s not treated, botulism can lead to paralysis, respiratory failure, or death, the CDC says. Botulism can be addressed with the use of an antitoxin, according to the CDC, which stops the toxin from doing further harm. However, the antitoxin does not treat damage already done by the toxin. The Cleveland Clinic says that you can be left with long-term symptoms, including lingering weakness, shortness of breath, and nervous system issues, although mild nerve damage can heal.
Is Botox safe?
Dermatologists stress that real Botox is a safe product when it’s used appropriately. “Botox is the safest, most widely performed, and highest satisfaction cosmetic procedure performed in the world,” says Gary Goldenberg, M.D., a board-certified dermatologist practicing in New York City. “In the right hands, it is extremely safe and effective to improve one’s appearance,” he adds.
But Botox needs to come from a reputable source and be given by someone who knows what they’re doing, says Ife J. Rodney, M.D., founding director of Eternal Dermatology + Aesthetics. “Botox parties in random hotels are not a good idea,” she says. “This is a medical procedure and should be performed in a controlled environment.
Joshua Zeichner, M.D., director of Cosmetic & Clinical Research in Dermatology at Mount Sinai Hospital, agrees. “When it comes to getting cosmetic procedures done, you need to be very careful who you see and what products are used,” he says. “Your outcome depends on what is injected and how it is injected.”
If you’re considering getting Botox, the CDC recommends asking your provider if they’re licensed and trained to give an injection. (Some states have a license look-up tool, where you can check.) You should also ask if the botulinum toxin is approved by the FDA and obtained from a reliable source.
Just know this: Dr. Rodney says that it would be “very uncommon” to have your injector show you the box that the Botox came in before injecting you. “I don’t even keep the box after I reconstitute the vial of Botox,” she says. “Plus, anyone using the counterfeit Botox would likely show you the ‘real box’ if asked.” Ultimately, if you’re unsure about safety, she says don’t get the injection.
How long does Botox last?
It depends. The effects of Botox typically last three to four months, according to the American Society of Plastic Surgeons (ASPS), although they may last up to six months in some people and as little as two months in others. The ASPS also notes that the effects of Botox may not last as long after an initial injection as they do after the second treatment.
The effect of the drug will usually take effect in three to five days, but the full results may not be seen for up to 10 days, per the ASPS.
Botox alternatives
Botox is a brand name, but it’s often used interchangeably to describe other types of botulinum toxin. “Botox is just one brand of botulinum toxin,” Dr. Rodney says.
Other options include Xeomin, Dysport, Jeuveau, and Daxxify. “I like Xeomin a lot,” Dr. Rodney says. “I see it as the cleanest one.”
If you want to get Botox or a similar botulinum toxin, Dr. Rodney recommends doing your research and choosing a reputable provider. “You don’t to get a quick discount with these procedures. You want to go with someone who knows what they’re doing,” she says.
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