Three male doctors (three split)

@zcosmetichealth/Tiktok @andrewcohenmd/Tiktok @drcheraghlou/Tiktok

‘Don’t risk your face or your health’: Doctors on TikTok are warning about fake botox—here’s how to spot it

There’s a big wrinkle in the aesthetics industry right now: fake Botox.


Ryan Schocket

Pop Culture

In early April, the Center for Disease Control and Prevention issued a press release regarding counterfeit Botox after four patients were hospitalized for botulism-like symptoms in Tennessee. 

Botulism, in layman’s terms, is essentially when a toxin attacks a person’s nerves. It’s not something to take lightly.

According to the Tennessee Health Department, “All persons reported receiving botulinum toxin injections for cosmetic purposes. All four patients were seen by a healthcare provider and two were hospitalized. Similar botulism-like illnesses have been reported by multiple states. Ongoing investigation suggests that the product administered was counterfeit.”

A few weeks later, the CDC would issue an additional press release stating that 22 people in 11 states had experienced negative reactions after receiving counterfeit Botox. There was one disturbing commonality between them: They had all received Botox in a non-healthcare setting. 

Think spa, friend’s house, or Botox party.

The patients started to feel adverse symptoms three days after their treatment. Some had blurred vision and drooping eyelids. Others had dry mouth, fatigue, and other symptoms in line with botulism poisoning. More than half of these patients were hospitalized.

@drcheraghlou The CDC is investigating an outbreak of a botulism-like illness that is hospitalizing people and being linked to counterfeit Botox products. This is why dermatologists are so concerned about unregulated aesthetic procedures! #botox #botoxcheck #cosmeticprocedures #dermatologist ♬ original sound – Dr. Shayan | Dermatologist

US Customs, the CDC, and state health departments have been fighting the importation of fake or unapproved products for the past few years. But this latest string of headline-grabbing hospitalizations could be what truly makes people think twice about going to any run-of-the-mill place to get treated. 

Daily Dot spoke to doctors who administer real Botox in sterile medical settings. Double-board-ceritified plastic surgeon Dr. David Shafer of Shafer Clinic in NYC said, “Patients often don’t know what is being injected into them. So, they don’t know if they were injected with fake botox.”

He went on to explain how patients could experience adverse or innocuous symptoms, saying, “Worrisome symptoms would be trouble breathing, weakness, vomiting, fatigue, change in vision, difficulty swallowing, and pain in areas such as the abdomen. These could be signs of Botulism poisoning, which could occur if fake Botox was administered in exponentially wrong doses. Other signs would be no effect, as the fake Botox may not even contain Botulinum toxin, which is the active ingredient of Botox.”

@zcosmetichealth Beware of Fake Botox! ⚠️ There's been a rise in people getting sick from counterfeit Botox injections. These injections, often done by unlicensed providers, can lead to serious health problems, including hospitalization. Stay safe! Get Botox from a licensed healthcare professional and be wary of deals that seem too good to be true. Your health is not worth the risk #botox #fakebotox #doyourresearch @Dr. Zadeh | Cosmetic Doctor #greenscreen ♬ original sound – Dr. Zadeh | Cosmetic Doctor

The price of Botox can range from $10-$50 a unit or $300-$1000 each time a patient is seen. The product is essentially the gold standard for zapping wrinkles and fine lines. But because of price, patients are often lured in by promotions.

“If the price is too good to be true, then it’s not genuine Botox Cosmetic,” Dr. Shafer said.  “When I see advertisements for ‘Botox’ at other offices with prices that are below the actual cost of Botox Cosmetic, I know that something is fishy. If the injector doesn’t mix the Botox in front of you, then you should be suspicious. If the injector uses the word Botox generally and not specifically Botox Cosmetic then you should ask to see the box. The box and vial have special holograms on them so you can be assured it is the real thing.”

This has become a gray area of aesthetics. Because Botox is the go-to injectable for treating signs of aging, the word “Botox” itself is used almost interchangeably with other neurotoxins—like people using “ChapStick” or “Kleenex” to refer to lip balms or tissues, respectively.

In reality, that “Botox” you’re getting at a nail salon could be an off-brand product mixed with lidocaine or something you’re unaware of.

“Diluting is common, especially in non-medical practices, to gain more profit per treatment,” Dr. Shafer said. “This comes at the very real negative effect in the results—the correct number of units are not being injected, so it’s less strong.”

In essence, a patient isn’t gonna see long-lasting results, and they’re putting themselves at risk.

Dr. Blair Murphy-Rose, a board-certified cosmetic, medical, and surgical dermatologist at the Laser & Skin Surgery Center of New York, regularly treats patients with Botox. She said it can be difficult for some patients to identify real vs. fake products.

“Truthfully, it can be difficult for patients or consumers to identify,” she tells the Daily Dot. “You may ask your provider to show you the box and jot down the lot number and expiration dates, though if you are not very familiar with the packaging of Botox it would be hard to spot a fake. Botox in the US comes in 50mL, 100mL, and 200mL vials. If you notice a vial with a different quantity, you may have an increased suspicion about it.”

The topic of fake Botox has gone viral on social media. In an Instagram Reel with 400,000 views, one doctor said, “This is why you get your shoes on sale and not your face,” sparking many comments from viewers sharing their experiences. 

“We had a local spa recently get raided by the FBI for this very reason! The owner was shipping in counterfeit Botox and using it on her patients,” one person wrote. “She was trying to cut corners to save her bottom dollar.”

“My so-called licensed dermatologist was caught and reported with his fake Botox, and nothing happened to him. Just a slap on the wrist,” another person commented.

@andrewcohenmd #stitch with @TODAY Show Counterfeit botox has been found in several US states 💉 Here’s how to make sure it doesn’t happen to you! #todayshow #botox #botoxcheck #botoxnatural #dysport #warning ♬ original sound – Dr. Andrew Cohen

In a separate TikTok, one person wrote, “Where in Texas can we report this to? I was a victim of this, not knowing she wasn’t licensed.”

On a TikTok explaining the CDC investigation, one person shared, “I believe I was part of this in Texas. How do I report this! Just now finding out about this 3 months later, several hospitalizations, immunotherapy, and long-term care.”

The topic has even become a meme of sorts. One person said, “Y’all veneer techs next btw.”

Fake Botox and the consequences are no laughing matter, though. If you think this has happened to you, “You can contact the FDA MedWatch program to report your suspicion or call the FDA at 800-551-3989. Begin to document everything so that you have possible clues at home,” Dr. Blair said. 

Despite these recent events, it’s important to note that getting Botox is generally considered safe. But you should always see a trained, licensed injector in a sterile medical setting and always ask your injector to verify the Botox Allergan hologram on the box.

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