Counterfeit Botox: Here’s What You Need to Know

A few months ago I read about Individuals becoming ill from counterfeit Botox in the New York Times. This came after several of my friends started asking me, So how has the fake Botox affected your business?”  

My initial reaction was “what?” and then “What fake Botox?”   

That response was partly due to the fact that I would never contemplate purchasing anything that wasn’t manufactured by a legitimate source and partly because I didn’t realize the extent of the problem. 

Those of you who know me, have heard me say “please don’t buy your skin care products or your supplements online… there are too many counterfeit products out there, don’t bargain with your skin/face or your health, bargain for your shoes!  I even caution buying anything online that isn’t tied to a legitimate professional and I have personally vetted the companies whose products I use and sell in my practice.  

Some of you ignore my warnings and continue to buy your supplements online, but the worst thing that can happen there is that you are buying crushed sand and who knows what dose (if any) of the nutrient that is labeled on the body, but counterfeit Botox? This is a serious medication that needs to be injected by a trained healthcare professional. 

Currently there are five FDA approved neuromodulators or neurotoxins (I just don’t like that term).  

1. Botox (Onabotulinumtoxin A)  It’s manufactured by Abbvie (formerly Allergan 

2. Dysport (Abobotulinumtoxin A) which is manufactured by Galderma.  

3. Xeomin ( Incobotulinintoxin A) which is manufactured by Merz 

4. Jeuveau (prabotulinumtoxinA-xvfs) which is manufactured by Evolus 

5. Daxxify (daxibotulinumtoxinA-lanm), which is manufactured by Revance.   

There are some slight differences between them, but each is safe and effective when used properly.  

I started injecting Botox in 2005, shortly after it was approved for cosmetic use in 2002. I introduced new products into the practice when they were FDA approved and only after I tested them out on a group of eager volunteers.  The various nurse injectors and nurse practitioners that I employed over the years were not allowed to inject these products until they went through a thorough training program followed by vendor supported training in my office (another provider offices), attended trade conferences and then only after I personally supervised a minimum number of procedures.  

Not every physician is this strict, but I am a stickler when it comes to patient safety, so much so that my nurses sometimes roll their eyes in their heads when I tell them that I actually have to report these statistics and policy and procedures to my malpractice insurer.  

So, all of you who come to us for treatment – rest assured, we do NOT purchase anything that doesn’t come directly from each of the manufacturers listed above.  None of you will be treated by anyone in my office who hasn’t had sufficient education and supervision. In fact, I could not have obtained malpractice insurance this year without clear documentation regarding all the manufacturers and pharmacies that I use, including the compounded products.  

That said, if you are passing this newsletter on to a friend this is what you need to know: 

• These treatments are expensive. They just are. If you are going to a legitimate, experienced provider expect to pay between $450 - $1500 for a single treatment. (depending on how many areas of the face are being treated. If the masseter muscles (chewing muscles), temples and other areas are being treated for headaches or to prevent your teeth from fracturing due to grinding, you may even pay more.) 

• Botox is a medical treatment, so it should be done in an environment that meets the cleanliness standards of a hospital operating room.   

• Botox is a medical treatment; it should never be performed while you are consuming alcohol or while the injector is consuming alcohol. 

• Check the credentials of the individuals that you are going to. There are “med spas” popping up on every corner and an injector setting up shop in “Salon Lofts”  and in hair salons and nail spas all over the country. As mentioned above, these locations may not be the safest places for medical treatments.  Just because they are wearing a white coat or scrubs, doesn’t mean that they are trained providers. 

• Check to see if the clinic is covered by malpractice insurance. Do you know how many spa’s aren’t?  

I’ve heard “it’s only Botox, you’ve gotten too expensive, so I found someone cheaper…” To which I used to  reply, “don’t bargain for your face or health, we can work with you to achieve your goals and your budget.” But now I will say “Have you SEEN the number of people who have ended up in emergency rooms all over the US because “it was just Botox”?  Trust me – we try to work with you to make these treatments fit your cash flow if not your budget.”  

So, when your friend tells you “I’ve got a great provider, and you can get full face Botox for $400 or less… run for the hills.