Botox complications are rare. But what happens when an injection goes awry?
We’re living in an era of “tweakments,” where minimally invasive cosmetic procedures like Botox and filler have been reduced to nothing more than an ordinary step in one’s skincare regimen. But what happens when a routine injection of Botox goes awry?
In January 2025, a New York-based aesthetician was arrested after being accused of administering counterfeit Botox injections to clients. A number of clients who received injections at the clinic in question, JGL Aesthetics, claimed to experience several adverse side effects, with at least one confirmed case of botulism, USA TODAY reported.
If you get Botox from a licensed healthcare provider, the likelihood of experiencing any kind of complication is incredibly low. But how do you know if your injector is reputable? Here’s what experts need you to know.
What exactly is Botox? What is in Botox?
Botox is a neuromodulator injection that's known for its ability to improve the appearance of fine lines and wrinkles when injected into the facial muscles, says Dr. Nayoung Lee, an assistant professor of dermatology with NYU Langone. Botox also has other FDA-approved uses: It can help treat migraines, muscular dystonias, a neurogenic bladder and a few other medical conditions, she says.
Botox is derived from botulinum toxin type A, a toxin that’s produced from the bacterium Clostridium botulinum. It just so happens to be the same bacterium that causes botulism, a rare condition that attacks the body’s nervous system, according to the U.S. Centers for Disease Control and Prevention.
What is botulism?
Botulism is often caused by ingesting foods contaminated with botulinum toxin (or in the case of infants, by ingesting foods contaminated with Clostridium botulinum spores), per the CDC.
Iatrogenic botulism is a more uncommon form of botulism. It’s a possible complication of Botox that could happen if botulinum toxin spreads beyond the area that it was injected into, according to Cleveland Clinic. This type of situation is very rare, and “likely happens due to improper doses being injected or injection directly into a vessel,” says Lee.
Botulism can cause double or blurred vision, slurred speech, drooping eyelids and difficulty swallowing or breathing. As symptoms progress, the muscles become progressively weakened. In severe cases, the respiratory muscles can become paralyzed, creating a life-threatening situation, per the CDC.
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Can you recover from botulism?
You can definitely make a full recovery from botulism if it’s caught early enough. If you’re experiencing any symptoms consistent with the illness, you’ll need to receive immediate medical attention, says Dr. Raman Madan, the director of cosmetic dermatology at Northwell Health. Botulism antitoxin can neutralize botulinum toxin that’s reached your bloodstream, helping to prevent any further nerve damage to your body. Unfortunately, the antitoxin can’t correct existing nerve damage, and long-term effects could persist for months, Madan tells USA TODAY.
Luckily, when Botox is injected by a licensed medical provider using authentic materials, the risk of experiencing botulism “is almost next to nothing,” Madan says. The real concern is when someone’s been injected with fake Botox, or if they’ve received injections from an individual who is unlicensed to do so.
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How to find a reputable Botox injector
When it comes to finding a reputable Botox injector, always take the time to thoroughly research the providers in your area. You should only ever receive Botox from a trained healthcare provider that has the appropriate credentials, Lee and Madan agree.
When it comes to who’s actually licensed to inject Botox, different states have different laws. Typically, licensed medical providers are the only individuals who can give Botox injections. This includes physicians (such as dermatologists, plastic surgeons and sometimes dentists), physician assistants, nurse practitioners and registered nurses. Depending on the state, when nonphysicians administer Botox, they may require supervision from another licensed medical professional. In most states, including New York, it is illegal for aestheticians to inject Botox.
Say you’ve found a licensed provider with glowing reviews, and that provider happens to operate out of a med spa. There are plenty of reputable med spas where licensed medical providers are taking all the necessary precautions to ensure you’re safely being injected with FDA-approved neuromodulators like Botox. At the same time, there are also med spas that don’t uphold the same sterility standards you might see in a doctor’s office. The point is: If you’re going to opt for getting Botox at a med spa, make sure you’ve done extensive research on the clinic. If you’re on the fence, Raman says your safest bet is to get Botox from a licensed provider at a physician’s office.
These days, Botox and other neuromodulators have become incredibly normalized, but that doesn't mean these kinds of cosmetics procedures should be taken lightly. Botox, after all, is still a potent toxin. Ultimately, finding a safe, reputable injector will help you attain the most desirable results and lower your risk of experiencing adverse complications.
This article originally appeared on USA TODAY: What is botulism? Plus tips on finding a safe Botox injector
