FAKE VS. REAL BOTOX – ADVICE FOR CONSUMERS
According to the Centers for Disease Control and Prevention (CDC), counterfeit Botox has made its way into the United States. Fake Botox has recently caused botulism-type illnesses in patients. Symptoms included slurred speech, double vision, difficulty swallowing, and difficulty breathing that sometimes required hospitalization. Several patients across the United States have been treated for outright botulism for fear that the fake Botox had spread beyond the injection site. This required emergency treatment with botulism antitoxin that blocked the potent neurotoxin within the fake Botox.
Nearly two dozen females across the United States so far have been victims of fake Botox, nine of whom were hospitalized. All these injections were performed by either non-trained individuals or in a non-healthcare setting such as in health spas or in private homes.
Fake Botox is extremely dangerous because the manufacturer of the potent toxin and the standards applied in the laboratory manufacturing the biological product are unknown. For example, fake Botox may contain dangerously high doses of the toxin, unapproved doses of the toxin, unknown doses of the toxin, unpurified versions of the toxin, or perhaps none of the toxin at all. There are simply no checks and balances during the manufacturing process and no government-enforced standards to be upheld by the unscrupulous manufacturers creating knock-off Botox. U.S. Customs has intercepted shipments of counterfeit Botox and other cosmetic injectable agents from countries such as Bulgaria, China, Korea, and Spain.
Why is fake Botox even produced? The reason is simple. Counterfeit Botox is priced significantly lower than real, FDA-approved Botox. Real Botox is sold and produced by a company called Allergan Aesthetics (an AbbVie company). Real Botox is manufactured in Westport, Ireland using a secret process that Allergan passionately guards.
I’ve had an account with Allergan for decades. This is the company from which legitimate plastic surgeons and dermatologists purchase Botox directly. There are other FDA-approved manufacturers of authentic botulinum toxin products that are competitors of Allergan’s famous Botox product. These legitimate botulinum toxin products are sold under the names Xeomin, Dysport, Jeuveau and Daxxify.
Unfortunately, Allergan has progressively raised the price of its botulinum toxin product marketed under the famous brand name “Botox.” Allergan’s Botox has been around since about 1992, decades before legitimate competitors emerged. No other company can legally use the well-known brand name “Botox,” and Allergan has always owned the largest market share of the cosmetic botulinum toxin industry. Authentic Botox is indeed expensive, and Allergan chooses to constantly increase the price that plastic surgeons have to pay to acquire authentic Botox directly from Allergan.
Knowing this, counterfeit scammers approach businesses (such a spas and physicians’ offices) via email, U.S. mail, or fax offering them “Botox” (stamped with the legitimate company name Allergan) at ridiculously cheap prices. For example, the scammers may claim to be a “Canadian pharmacy” offering Botox for sale to the United States at dirt-cheap discounted prices. I’ve also heard of consumers (lay people) being able to purchase fake Botox directly online from counterfeit scammers, and then they inject the counterfeit product themselves at home.
This is similar to buying a fake Louis Vuitton handbag from the resale market. Fake Louis Vuitton handbags usually look like the real thing, including the official logo and brand name appearing on the handbag itself. Counterfeit Botox manufacturers generally do a good job of realistically reproducing the knock-off product packaging but not the actual toxin itself. The old adage, “if the price is too good to be true, buyer beware,” certainly applies here.
From a consumer standpoint, there are a few things you can do to decrease the chances of falling victim to being treated with fake Botox. First and foremost, avoid getting Botox injections in non-healthcare settings. Injections of any substance into the human body, including Botox, should never be performed in someone’s private home or in a health spa. These are simply not appropriate settings for injections of any substances or any cosmetic fillers into the human body.
Instead, I suggest finding a well-established, board certified plastic surgeon or board certified dermatologist and receiving your cosmetic injections in a medical office setting (always check your doctor’s credentials first at certificationmatters.org). The chance of a board certified plastic surgeon or board certified dermatologist taking the risk of secretly buying cheap fake Botox from a shady source is extremely small since they have a lot to lose by doing so – including their license to practice medicine.
It would also be wise for consumers to know what to look for to identify counterfeit Botox. Of course, the counterfeit producers are quite intelligent and will eventually revise the appearance of their fake product to look even more believable in the future. Currently (2024), however, here are a few things to look for to help you spot outer-carton packaging of fake Botox and fake Botox vials. Fake Botox may contain one or more of the following characteristics (but not necessarily all of them):
- Fake Botox may display the words “Botulinum Toxin Type A” on the outer carton instead of the correct word, “OnabotulinumtoxinA,” which is displayed on real Botox outer cartons.
- Fake Botox may display “150 UNITS” on the outer carton and vial itself, which isn’t a unit produced by the legitimate manufacturer, Allergan Aesthetics.
- Fake Botox packaging or vials may contain some words in a language other than English. Real Botox has all of the wording (everywhere) in English.
- Fake Botox outer cartons and vials may contain the lot number C3709C3.
- Fake Botox also lacks the subtle, multicolored hologram of the word “ALLERGAN” on the vial itself. This is difficult to see. It’s not simply printed with black ink on the vial. If you hold a real Botox vial at a certain angle, you’ll see the faint, multicolored hologram displaying the word “ALLERGAN.”
Again, counterfeit Botox may not contain all the above characteristics, but currently (2024), it’s likely that fake Botox will contain at least one of the above characteristics. This will hold true until the counterfeit manufacturers decide to revise the fake outer cartons and fake vials to make them even more believable. My guess is that they’ll do so very soon.
If the individual performing your Botox injection walks into the room with Botox already drawn up inside a syringe, then obviously you won’t have the opportunity to see the Botox vial or outer carton. You’re then essentially at the mercy of the person performing the injection. Hypothetically, it would also be quite easy for them to simply transfer the fake product into a real Botox vial or into a real Botox outer carton to help convince you that the Botox they’re using is indeed real. Seeing a real Botox outer carton or real Botox vial may not be enough to 100% guarantee that you’re getting the authentic, FDA-approved product.
In summary, I strongly recommend going to a well-established, board certified plastic surgeon or board certified dermatologist in a medical office setting to receive your Botox injections. The chance of receiving fake Botox in such an environment is extremely small (but still not zero). I believe the consumer should always ask themselves if the Botox price is “too good to be true” and if the person giving the injection has anything to lose by injecting fake Botox. In my practice, I inject Botox into patients myself. I don’t delegate the task of Botox injection to a nurse or physician assistant, as if I regard it as some trivial nuisance to actually perform the injection. Many of my Botox patients come to me solely for that reason. I have been personally performing Botox and cosmetic facial filler injections for my patients for several decades (since 2002). My accrued experience with cosmetic injectable agents is another reason patients choose me for their Botox and cosmetic facial filler injections, even though less expensive options exist.
Keep in mind that board certified plastic surgeons and board certified dermatologists have a lot to lose if they use fake Botox, including their medical license. Take three minutes out of your day and check your doctor’s credentials online at certificationmatters.org. All you have to do is visit certificationmatters.org, input your doctor’s last name, and then press the “find my doctor” tab. The only required field to fill in on certificationmatters.org is your doctor’s last name. You’ll be surprised at how many physicians have no board certification whatsoever despite official-sounding credentials that they proudly post on their websites, ads, and social media accounts.
If you do your research, you’ll likely find that many individuals who advertise aggressively that they do Botox injections and facial fillers hold no board certification whatsoever – or hold board certification in totally unrelated specialties. Another possibility is that the physician holds board certification by an unrecognized board that doesn’t meet the requirements to become an approved member board of the American Board of Medical Specialties (ABMS). Many unapproved boards that don’t meet the standards of ABMS approval exist, and they all sound very official to the lay consumer. My advice is to check certificationmatters.org and see if your doctor is truly a member of an ABMS-approved board in the specialty of plastic surgery or dermatology.
Following my advice won’t 100% guarantee that you’ll receive authentic (Allergan) Botox from the person doing the injection. I feel, however, that your chances of receiving authentic Botox will be greatly improved if you, as a consumer, know what to look for to spot a fake product and follow the recommendations outlined in my post. I also urge consumers to visit the website fda.gov and read the FDA’s latest posts regarding counterfeit Botox. Fda.gov posts photographs of current fake Botox packaging and will likely post updated photographs of the latest counterfeit Botox packaging in the future. As long as the high demand for cosmetic Botox injections continues, I feel that counterfeit Botox is, unfortunately, here to stay in the United States.
Please also watch Dr. Hayduke’s Instagram video on fake botox.