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Dangerous 'Botox Dupes' Reportedly Linked To Botulism Cases. Here's What To Look Out For.

A sign for Botox, fillers and facial treatments in Lafayette, Calif. (Smith Collection/Getty Images) (Smith Collection/Gado via Getty Images)

Health officials are reminding the public about the dangerous side effects of counterfeit cosmetic injections after nearly 20 cases of the muscle-weakening disease known as botulism were reported in Massachusetts and Oregon in June.

Botulism is a medical condition that makes it difficult for people to move, see clearly or breathe. Its causes, in addition to certain contaminated foods, traumatic injuries and intestinal issues, can be traced to botulinum toxin type A, a chemical used in cosmetic neuromodulator injections such as Botox, Dysport and Daxxi, which blocks muscle movements to reduce wrinkles or alter facial appearances when administered properly.

These minimally invasive injectables are among the most popular beauty treatments in the United States, according to the American Society of Plastic Surgeons (ASPS), which describes Botox as a "go-to treatment patients can't do without." (The Botox brand is not the only injection that uses botulinum toxin type A, but it's arguably the best-known.) In 2024, over 9.8 million Americans got neuromodulator injections, the ASPS reported.

The growing popularity of such treatments has also seen the rise of non-FDA-approved injections, or "dupes," which can be purchased online. But these knockoffs can be dangerous.

According to the Centers for Disease Control and Prevention (CDC), mishandled or counterfeit neuromodulator injections can cause botulism in patients, which can require hospitalization.

The Massachusetts Department of Public Health (MDPH) is currently investigating 18 cases of botulism that were traced back to injections administered at a spa in Milton, Mass., a spokesperson for the organization told Yahoo. On the other side of the country, public health authorities in Multnomah County, Ore, issued a warning on June 18 after a resident was hospitalized with botulism symptoms on June 6 "following injections of possibly counterfeit or improperly handled botulinum toxin" from "a person found to be unlicensed to administer the injections."

The recent cases of botulism in Massachusetts and Oregon are not the first to be linked to counterfeit or poorly administered botulinum toxin injections this year. Around the same time last month, 28 cases were reported in northwest England, which have been associated with several unconnected practitioners in Durham County, a U.K. Health Security Agency spokesperson told Yahoo.

In April 2024, the CDC launched an investigation into 17 cases of botulism reported in nine U.S. States between Nov. 4, 2023, and April 11, 2024. Those cases resulted in 13 hospitalizations and no fatalities. The CDC's investigation, which was closed in December 2024, found that some patients "received injections with counterfeit products or products with unverified sources," while others "received injections from individuals who did not follow jurisdictional (state or local) requirements."

While the CDC's investigation focused on the 17 cases reported between Nov. 4, 2023, and April 11, 2024, the agency noted that it had also received "reports of similar cases, including at least four harmful reactions in August and September linked to counterfeit botulinum toxin products. Some products were self-injected."

"If in doubt, don't get the injection," the CDC warned in the findings of its 2024 investigation.

How much of a risk is botulism when getting injections like Botox?

The likelihood of getting botulism from neuromodulator injections is very low, the World Health Organization reported in 2023, especially if it's administered in a medical setting.

"If the botulinum toxin is manufactured properly and comes from a good brand, the strength is such that even if it spreads a little bit, it doesn't cause a huge amount of side effects," Ash Mosahebi, professor of plastic surgery at University College London, told the BBC in May 2024. "However, the problem we've had is that there are dodgy counterfeit versions in circulation. They are poorly made and manufactured, and not well controlled."

A spokesperson for AbbVie, the company that owns Allergan Aesthetics, which manufactures Botox, told Yahoo that it has a security program for its supply chain to make sure all products are safe and sold through authorized distributors.

"We have no reason to believe that our product, Botox, is involved in the recent botulism incidents in the U.K., Massachusetts or other U.S. States," the AbbVie spokesperson said in an emailed statement to Yahoo in. "We also have no evidence to suggest that the clinics and practitioners identified by authorities are customers of Allergan or AbbVie."

"We cannot stress enough the importance of receiving botulinum toxin injections only from licensed and trained medical professionals using FDA-approved products obtained from authorized suppliers," Multnomah County Health Officer Dr. Richard Bruno said in the press release issued on June 18. Echoing the CDC's earlier warning, Bruno added: "If in doubt, don't get the injection."

What are the signs of botulism?

Since the botulinum toxin targets muscles, common symptoms of botulism, according to the CDC, include:

Difficulty with vision — whether that's from drooping eyelids, double vision or complications moving the eyes

Slurred speech

Difficulty breathing

Muscle weakness throughout the body

The CDC recommends that anyone experiencing these symptoms within days of getting an injection should see a doctor or visit an emergency room immediately.

'I Was Poisoned By Fake Botox'

Philippa Goymer

BBC North East Investigations

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Nicola Fairley was given anti-wrinkle injections containing fake Botox and ended up in hospital with botulism

In recent weeks, 28 people in the north-east of England have been left with potentially fatal botulism after having anti-wrinkle injections believed to have been fake. Such reactions are usually so rare hospitals stock very little anti-toxin and they were in danger of running out.

On one night in June, five people were in an accident and emergency department (A&E) in Durham suffering from serious adverse effects of anti-wrinkle injections - Nicola Fairley was one of them.

Within days of having what she was told was a Botox jab, but which turned out to be an illegal copy, her throat began closing up, an eye swelled shut and one side of her face started to droop. She could not smile, struggled to eat and swallow, felt exhausted and was desperate to sleep.

The 37-year-old mother of four from Bishop Auckland in County Durham told staff she had been given injections and was unwell.

"They got the doctor to see me within five minutes and started some tests there and then," Mrs Fairley recalls.

Of the 28 people, mostly in the Durham and Darlington areas, who have found themselves in a similar position, four others ended up in the same hospital on the same night as Mrs Fairley.

In an average year, the University Hospital of North Durham usually sees no cases at all of botulism that require treatment. Only six were recorded in the whole of England in 2023-24.

Since being approached by the BBC the Medicines and Healthcare products Regulatory Agency (MHRA) has set up an investigation.

Nicola Fairley suffered swelling and a closed eye after being injected with fake Botox

Botulinum toxin is widely used to reduce facial wrinkles and treat muscle conditions. While cosmetic practitioners do not need to be licensed, the drug does. Only seven brands are licensed in the UK, with Botox the most well known.

When used correctly the amounts are small and side effects are rare. But unregulated toxin, or larger quantities, can attack the nerves and cause botulism, a potentially life-threatening condition that causes paralysis.

Mrs Fairley had anti-wrinkle injections before, paying £100 for three areas, but then won a round of treatment from the same provider in a competition. She was told it was a stronger type of the toxin and again had three areas injected.

She says she had no idea this treatment was illegal.

Within two hours her forehead was "frozen", although genuine cosmetic injections should take several days to start working with the full effect visible after two weeks.

Of those in A&E at the same time, some had used the same practitioner as Mrs Fairley. They were all diagnosed with botulism and one doctor told the group they had never seen that many people with the condition at the same time.

It is so rare, hospitals do not typically keep large quantities of the anti-toxin - made from horse blood - that is used to stop the toxin spreading further.

Nicola Fairley could have to wait months before the effects of the toxin wear off

North Durham was already trying to source anti-toxin drugs from other hospitals as there had been a spate of cases in the days before Mrs Fairley and the others arrived in A&E.

In an internal communication seen by the BBC, a hospital leader said: "We've just about exhausted all stock of the antitoxin from local holders (Newcastle, Carlisle and Leeds) and have 10 more coming from London."

They were "bracing" themselves for more patients.

The MHRA told the BBC it was investigating allegations surrounding the illegal sale and supply of fake "Botox-type" products in the North East.

Chief safety officer Dr Alison Cave said the body's criminal enforcement unit "works hard to identify those involved in the illegal trade in medicines".

Buying anti-wrinkle injections and other medicines from illegal suppliers significantly increased the risk of getting a product which is either "falsified or not authorised" for use in the UK, she said.

Dr Steven Land said he had been warning of a botulism outbreak for years

An aesthetic doctor based in Newcastle, Steven Land, believes anti-wrinkle injections in three areas for less than £150 is very cheap and this could suggest the supplier was using an illegal toxin.

Dr Land, who has also worked in A&E, said he was contacted weekly by "fake pharmacies" offering to sell him the toxins for such small amounts he "knows they're illegal".

Genuine injections were "very safe if done properly" but called for the industry to be regulated, he said. As things stand it is not regulated at all, with anyone able to provide cosmetic injections.

"Your provider should be able to show you the product they are using and be happy to answer any of your questions - and have the answers," he said.

Dr Land said he had been fearing a botulism outbreak for years, noticing more and more businesses in the region offering injections that were suspiciously cheap.

An investigation into the cause of the recent cases of botulism is being led by the UK Health Security Agency with partners including Durham County Council's public health team.

Director of public health Amanda Healy said they were urging anyone with symptoms to seek treatment.

An incident management team had been set up to deal with the issue and they were working out if the cause of these incidents of botulism was the "type of toxin used or the way it was used", she said.

Durham County Council's director of public health Amanda Healy is part of an investigation team looking at what is happening

Mrs Fairley says the business owner who gave her the injections has apologised.

"I know she hasn't done this on purpose," Mrs Fairley says. "I just don't know where people get it from - it's scary.

"There needs to be more rules and stricter guidelines on who can do it - not just anybody who can go and do a course and just do it.

"There's that many people who do it - it's part of your beauty regime like getting your nails done or your hair."

What happened, and the continuing side effects, has put Mrs Fairley off having cosmetic injections again. She urges anyone considering it to ask questions about the product and make sure it has been properly prescribed.

The Department of Health and Social Care (DHSC) said people's lives were being put at risk by "inadequately trained operators in the cosmetic sector" and said this was why the government was looking into new regulations.

"We urge anyone considering cosmetic procedures to consider the possible health impacts and find a reputable, insured and qualified practitioner," a spokesperson said.

What Is Botulism, What Are Symptoms? What To Know About Tuna Recall

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