Warnings about bogus Botox injections given by people who are not trained to give the shots are on the rise. On Friday, the New York Department of Health said three people had to go to emergency rooms after botulism injections in their face, neck, upper back or armpits.
Within days or weeks of receiving the shots, the three developed a range of symptoms, from double vision and drooping eyelids to difficulty swallowing, breathing and raising their arms.
Two were hospitalized and one had to be admitted to the intensive care unit.
The new information comes as both the Centers for Disease Control and Prevention and the Food and Drug Administration are investigating other cases of people hospitalized with potentially serious side effects after fake Botox shots from unlicensed providers.
On Friday, the CDC reported that at least 22 people in 11 states had bad reactions, including slurred speech, difficulty breathing and blurred vision, after taking fake versions of the wrinkle-smoothing treatment.
Eleven of those patients were hospitalized, the CDC said, and six were hospitalized
No deaths have been reported.
Of 20 subjects with available information, 11 (55%) subjects were hospitalized and 6 (27%) were treated with botulism antitoxin due to concerns that botulism toxin could have spread beyond the injection site. Of seven people tested for botulism, six people had negative results. Pending results for one person.
All reports came from people who identified as female, aged 25 to 59 years, with a median age of 41 years. Twenty (91%) subjects reported receiving botulinum toxin injections for cosmetic purposes. All people reported receiving these injections from unlicensed or untrained people or in non-health care settings, including homes and spas.
All are women between the ages of 25 and 59, most in their 40s. The women had received the shots in “non-healthcare settings,” such as homes and spas, the CDC said. Reports of symptoms possibly related to fake Botox were first reported in early November 2023.
“People shouldn’t be injecting themselves from friends or at parties,” said New York City Health Commissioner Dr. Ashwin Vasan. Press release Friday. “A price that is too good to be true, or if a service provider does not explain the risks and side effects of the procedure, are clear warning signs that the products or services may not be legitimate and may put your health at risk. “
The FDA said there is no evidence that the original Botox, from drugmaker AbbVie, is linked to any of the diseases.
The drug uses a pure form of a neurotoxin called botulinum toxin that causes muscle paralysis. By injecting precise amounts into specific areas of the face, it can relax the muscles that cause wrinkles.
In an email to NBC News, the FDA said it is “actively working” with state and federal health authorities to investigate the source of the counterfeit Botox.
“The question is, is this ‘faux-tox’ one and the same?” asked Dr. Adam Friedman, a dermatologist and chair of dermatology at George Washington University. “Or are many people creating different versions of it? We don’t know the answer to that.”
Dr. Kate Dee, a physician and founder of Glow Medispa in Seattle, blamed the recent illnesses on unregulated medical spas, which have grown in recent years and become 15 billion dollars wellness industry.
“The problem is not that there is fake Botox around and doctors can accidentally use it. That’s not what’s happening. Doctors get real botox and we pay a lot of money to do things legally and legally,” he said. “It’s these people who are busy trying to make money out of the medical spa industry, the beauty industry, who get it because it’s so much cheaper.”
Cases linked to counterfeit Botox have so far been identified in California, Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee, Texas and Washington. At least 11 patients have been hospitalized, according to the CDC.
Some symptoms, such as blurred vision and drooping eyelids, occurred close to the injection site, while others were more widespread, including fatigue and generalized weakness.
Other potentially worrisome symptoms could include constipation, incontinence, dry mouth and difficulty lifting the head, the FDA said.
The difference in side effects from fake botox
Usually, the side effects associated with actual Botox injections are the result of “poor technique,” such as injecting the toxin into the wrong muscle or in the wrong place, Friedman said.
“But if these patients may be experiencing respiratory distress or failure due to systemic poisoning,” he said, “that’s different than what doctors typically see.”
The FDA said there are several ways to spot fake Botox products:
- The outer carton and vial contain lot number C3709C3.
- The outer carton lists the active ingredient as “Botulinum Toxin Type A” instead of “OnabotulinumtoxinA”.
- The outer carton and vial indicate doses of 150 units, which are not AbbVie units.
- The outer box has a language other than English.
Dee recommends that patients ask to see the toxin vial before getting the shots. “At least look at the vial because if it’s in any language other than English, it’s not real botox.”
