NBC News
Cheap, fake doses of Botox administered by people untrained in facial injections, in places where no doctor is available, have become a dangerous combination that has landed more than a dozen women in the hospital.
In at least one case, a woman’s condition was so serious that she had to be put on a ventilator to help her breathe.
Seventeen women in nine states have experienced symptoms ranging from blurred vision to trouble swallowing and breathing after receiving fake Botox injections. Thirteen were hospitalized and several needed treatment in an intensive care unit.
A report released Thursday by the Centers for Disease Control and Prevention (CDC) provided alarming details of patients in New York City and Tennessee. The women ranged in age from 26 to 55.
A “perfect storm”
About three days before the symptoms began, four women attended a gathering at a relative’s home in Tennessee to receive Botox injections in their faces. A subsequent investigation showed that the product injected was counterfeit and was administered by an unlicensed person.
“In some cases, providers were concerned about patients’ breathing to the point of admitting them to intensive care units so they could be observed more closely,” said Dr. Christine Thomas, medical director of the Tennessee Department of Health and lead author of the new report.
Thomas, who was a CDC epidemic intelligence officer at the time of the investigation, called the situation a “perfect storm.”
“We saw that injections were being carried out in homes by people who were not licensed and that there were counterfeit products,” Thomas said.
In one of the most disturbing examples of health complications from fake Botox, a 49-year-old woman in Colorado experienced blurred vision and her otherwise healthy body became unusually weak after receiving an injection of what she thought was Botox.
It was nine days before the woman was hospitalized with problems swallowing and breathing. Her condition became so severe that doctors They were forced to intubate her and connect her to an artificial respirator.
They had no idea what was wrong with her until a family member mentioned in passing that the woman had recently received Botox injections.
That revelation likely saved the woman’s life, said Grace Nelson, a disease intervention supervisor at the Denver Department of Public Health and Environment, who helped lead the investigation.
“The patient was in a decompensated state and in a poor condition for us to ask her questions,” Nelson said. The information from the family member was what led Nelson’s team to intervene and authorize the administration of botulinum antitoxin to prevent the venom from causing further damage.
The woman had to stay in the hospital for more than two weeks and required further rehabilitation, Nelson added.
Doctors qualified to administer Botox fear that more patients like the one in Colorado will be injured, especially since the spas unregulated doctors have gained popularity.
“I’m extremely concerned,” said Dr. Kate Dee, founder of Glow Medispa in Seattle. “More and more people are buying fake Botox online. There could be anything in that vial.”
Fake Botox is not a new phenomenon, said George Karavetsos, an attorney and former director of the Food and Drug Administration’s Office of Criminal Investigations.
“Counterfeit Botox has been in the US supply chain for at least 20 years“Karavetsos explained. “I have personally investigated and prosecuted cases of individuals who were importing counterfeit Botox or formulating their own version of counterfeit Botox here in the United States to sell on the domestic market, in spas doctors and other clinics.”
Efforts to address the influx of contaminated Botox, including catching people responsible for tainted products in other countries, have been largely unsuccessful, Karavetsos said.
“How do you stop it? You have to educate the consumer.”
What to know when looking for Botox
There are several ways to identify potentially risky situations.
Ask to inspect the vials. Thomas said his team found spelling errors on the counterfeit bottles. And according to the FDA, the outer packaging of the counterfeit Botox products:
- They show the active ingredient as “Botulinum toxin type A” instead of “OnabotulinumtoxinA”.
- It indicates a dose of 150 units, which is not a unit manufactured by AbbVie.
- It is printed in a language other than English.
It is important to only get Botox in a licensed medical setting and from a licensed provider.
“A cosmetic treatment license does not allow you to practice medicine“Dee noted. And if the Botox in question is administered in a salon, home or hotel room, that’s “a big red flag because those places typically don’t have a doctor nearby.”
Thomas recommended making sure vendors are properly licensed ahead of time.
The Tennessee Department of Health, for example, has a link to search for licensed facilities, including spas doctors, in that state.
Don’t be fooled by appearances, Karavetsos advised: “People come in and see a person in a white coat. They see what are pretending to be professionals administering Botox. They are unwitting victims.”
Beware of offers that are too good to be true. One of the women treated in Tennessee “reported paying less for her injections than we know botulinum toxin costs,” Thomas said.
Dee said the average price for Botox is about $15 per unit, so charging between $12 and $25 would be reasonable. That accounts for not only the vial itself, but also supplies like isopropyl alcohol, gauze, refrigeration and other overhead costs at medical facilities.
If someone charges much less ($6 to $9 per unit, for example), that’s a warning.
“Nobody can do that long term and stay in business.“Dee said. “These people are probably doing this illegally.”