Dangerous beauty: the spread of botulism cases after Botox injections

Botox injections have recently become extremely popular as a means of reducing wrinkles and crow’s feet (fine lines around the eyes), albeit temporarily. However, between May and June 2025, 10 cases of iatrogenic botulism caused by the improper use of botulinum toxin during cosmetic procedures were identified in the United States. In addition, this spring in Zaporizhia, there was also a case of a woman falling ill after receiving botulinum toxin injections. The patient received a special serum used to treat botulism and is now healthy.

Botulinum toxin, or Botox, is known for its ability to smooth out wrinkles. This exotoxin is produced by the bacterium Clostridium botulinum and can cause botulism. However, in the form used in medicine, botulinum toxin does not pose a risk. The compound was first used in medicine in the 1970s by American ophthalmologist Alan Scott to help patients with strabismus. The doctor noticed that injections around the eyes not only helped treat the underlying condition, but also reduced wrinkles. Given people’s desire to look younger, there was enormous interest in this discovery. However, the toxin was not approved for use in cosmetology by drug regulatory authorities until 2002 in the United States.

Iatrogenic botulism is a rare type of disease caused by accidental overdose or systemic exposure to botulinum toxin (usually type A), which is used for therapeutic or cosmetic purposes. The neuromuscular synapse is affected: the toxin blocks the release of acetylcholine, leading to descending muscle paresis, starting with the cranial nerves. Patients experience diplopia (double vision), ptosis, dysphagia (difficulty swallowing), weakness, and shortness of breath. The causes of this life-threatening condition are usually excessive or too frequent administration of Botox, as well as a violation of the administration procedure: if an injection into a vessel occurs, the toxin will enter the systemic bloodstream.

Symptoms, which may appear within a few hours or days, include facial weakness, drooping eyelids, blurred vision, difficulty swallowing, and breathing difficulties. Treatment includes the administration of botulinum antitoxin to neutralize the toxin, as well as supportive therapy, which in severe cases may even include artificial ventilation.

Despite all the modern advances in medicine, botulism remains fatal in 5-10% of cases, and recovery can take several months, with some patients experiencing long-term effects such as fatigue and difficulty breathing even after the disease has been cured.

According to statistics, there were 17 cases of botulism resulting from cosmetic procedures in the US in 2024. According to American doctors, patients fell ill after Botox injections from counterfeit or untested sources or because of specialists who did not comply with government requirements. The only way to completely prevent the possibility of side effects is to refuse to use botulinum toxin. Currently, the use of the drug is permitted for the treatment of various pathologies: strabismus, blepharospasm, migraine, neurogenic bladder, and even depression. The only thing people who want to get rid of wrinkles can do is check the license of the institution and the qualifications of the specialist who will perform the procedure. Since the intervention is invasive, it requires knowledge that only a specialist with a higher medical education possesses.