‘Possibly Counterfeit’ Botox Has Been Linked to Hospitalizations and Illness in 2 States
Cost doesn’t always reflect quality in the skin care world (just ask this dermatologist), but there are certain times when paying a high price for beauty is, without a shadow of a doubt, worth it. And getting Botox is one of those times: Two women in the same rural Illinois county and four women in Tennessee were recently treated for botulism-like symptoms tied to possibly fake botulinum toxin (the scientific name for Botox), according to releases issued by each state’s public health department in the last week.
Per the CDC, botulism is a rare but serious illness caused by a bacteria-borne toxin that attacks your nerves, and the signs include blurred or double vision, drooping eyelids, muscle weakness, and difficulty breathing. The women in Illinois were hospitalized for similar symptoms after they got injections of “either Botox or a possibly counterfeit version of the product” from a nurse who wasn’t trained to perform them. (The Tennessee release doesn’t specify who gave the injections, but it does mention “concerns about products with unclear origin administered in non-medical settings such as homes or cosmetic spas.”)
If that sounds scary, it is—so much so that both the Illinois Department of Public Health and the Tennessee Department of Health urged health care providers to be on the lookout for related cases, and a CDC spokesperson told The Hill that it’s conducting a multistate investigation into the sketchy shots. “I tell my patients [to see doctors for Botox] because we are qualified not only to give the injections, but to prevent, predict, and treat complications, should they arise,” Shasa Hu, MD, board-certified dermatologist and director of cosmetic division at the University of Miami, tells SELF.
Unfortunately, reports of questionable injectors and products are all too common in Dr. Hu’s practice. “We have a lot of home shops here in Miami–people just go to someone’s house to have a ‘Botox party’ or ‘filler party,’ and they don’t even know what they’re getting injected into their face a lot of times,” she says.
And while it makes sense that major metropolitan areas like Miami, New York, and Los Angeles provide plenty of shady opportunities to get cosmetic “tweakments,” big cities also offer access to a lot of superior (albeit pricier) options, with more than enough dermatologists and plastic surgeons to go around. The rural Illinois county where the two women got their ill-fated injections, on the other hand, is a “dermatology desert”—an area with few dermatologists and, likely, long drives and long waits to see the ones who are there. A quick search on the American Academy of Dermatology (AAD) Find a Derm tool turns up just two doctors in the entire county, which isn’t surprising considering that a 2018 Yale University study found that less than 10% of dermatologists in the US practice in rural areas.
So what are you supposed to do if you want to get Botox and derms are not a dime a dozen where you live? Dr. Hu recommends looking for qualified doctors via the AAD tool as well as a similar one on the American Society for Dermatologic Surgery (ASDS) website. (Not all members of the ASDS belong to AAD, so you may find different providers on each site.) If you can’t find anyone, Dr. Hu recommends calling the nearest dermatologist or plastic surgeon who does show up and ask if they can refer you to someone closer to you who’s well-trained in giving Botox. “I get referrals from physicians who are in more rural areas and vice versa; I can make a referral for patients who live there,” Dr. Hu says.
And regardless of where you live, there are a handful of smart ways to ensure you’re getting the real deal from a legit injector—and that you don’t live with regret.
Know that credentials come first.
From a medical standpoint, you’ll be safest if your provider is board-certified by the American Board of Dermatology or American Board of Plastic Surgery, David Shafer, MD, FACS, a double board-certified plastic surgeon and founder of Shafer Clinic Fifth Avenue in New York City, tells SELF. (Again, they’ll be trained to deal with complications, should they come up). If you’re set on the non-doctor route, at least make sure your provider checks all the boxes in this guide to finding a qualified Botox injector. And you should also confirm that they’re purchasing authentic botulinum toxin by running a quick background check on the manufacturer’s website. Allergan (the maker of Botox), Galderma (which manufactures Dysport), and Merz (the brand behind Xeomin) all offer directories of official providers.
Also important to note: Just because someone is a dermatologist or plastic surgeon, that doesn’t necessarily mean they’re well-trained in cosmetic injections, so the qualification checklist above applies to doctors too.
Ask to see the box.
Having your provider open the box in front of you is one of the surest ways to ensure you know what’s going in your body, Dr. Hu says. For Botox, specifically, you can also look for the hologram seal that’s on all legit boxes and vials, Dr. Shafer adds. If you’re getting Dysport, look for the full product name on the front and sides of the box, the Galderma logo in the top left corner, and a barcode on the bottom. Regardless of the brand, the product (if it’s legit) will also have an expiration date, which you can ask to see (don’t be shy; a good injector should appreciate your diligence). “If someone walks into the room with a prefilled syringe, I would be suspicious,” Dr. Shafer says.
Be wary of a bargain.
In this economy? Unfortunately, yep. When it comes to neuromodulators like Botox and Dysport, if a price is too good to be true, it probably is, Dr. Shafer says. A good rule of thumb: “Anything less than $10 per unit is very suspicious,” according to Dr. Hu. “Either they’re diluting the Botox, and it won’t last as long, or they’re not giving you actual US FDA-approved Botox.”
Keep in mind that you’re likely to see per-unit prices much higher than that—around $30 per unit, at practices in major metropolitan areas with experienced, credentialed, and in-demand doctors. At Shafer Clinic, for example, the price per unit is $29, which amounts to an estimated $1,000 to $2,000 per session. You may also see Botox priced per area, which Dr. Hu says is popular in Miami—$400 for the glabella (between the brows) or the outer corners of the eyes is common. To see if the price per unit checks out, just ask the practice how many units they typically use for the area you’re getting treated, and divide the total cost by that number. It should still come out to more than $10 per unit, or there’s likely something amiss.
We know, it’s easy to say, and less fun to do—getting injections from a doctor can be budget-bustingly pricey. I, for one, have walked out of an appointment at a Beverly Hills plastic surgeon’s office with a $1,300 bill for a Botox “brow lift” and a squirt or two in my masseter muscles to soften my jaw’s square look. I’ll admit—I looked good a week later, but I wanted to throw up on the spot. In retrospect: Better the severest case of sticker shock than symptoms serious enough to warrant a hospital trip.
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Originally Appeared on SELF
