Fake Botox: how to tell if your Botox is real

Botox is the brand name for onabotulinumtoxinA, a prescription medicine, and AmSpa's position is that injecting it is the practice of medicine precisely because a prescription drug is being used on living tissue.

A counterfeit version is a fake product made to pass as that drug: FDA warned in 2024 that unsafe counterfeit Botox had been found in multiple states and administered to consumers for cosmetic purposes.

FDA said the incidents occurred when the product was injected by licensed and unlicensed individuals and/or in non-medical or unlicensed settings, and that the products appear to have been purchased from unlicensed sources.

So the authenticity question starts with the supply chain, not the brand name on the menu: federal law requires providers to buy prescription drugs only from authorized sources.

On April 16, 2024, FDA warned that unsafe counterfeit versions of Botox had been found in multiple states and administered to consumers for cosmetic purposes, causing adverse events including hospitalizations.

FDA's symptom list at the time included blurred or double vision, difficulty swallowing, dry mouth, shortness of breath, weakness and difficulty lifting the head.

The CDC's investigation, closed with a final update on June 24, 2024, counted 17 people in 9 states with harmful reactions between November 4, 2023 and April 11, 2024, after injections with counterfeit products, products from unverified sources, or from individuals who were not following state or local requirements.

Thirteen of the 17 (76%) were hospitalized and 6 (35%) received botulism antitoxin; all were female, aged 25 to 67, with a median age of 43.

FDA said there was no indication the events were linked to genuine AbbVie Botox.

FDA's 2024 advisory described specific markings on the counterfeit product it found:

• Lot number C3709C3 on both the outer carton and the vial.
• The active ingredient shown as "Botulinum Toxin Type A" instead of onabotulinumtoxinA.
• A 150-unit vial — a size AbbVie and Allergan do not make.
• Text in a language other than English on the carton.

Genuine Botox Cosmetic comes in 50-unit and 100-unit vials; therapeutic Botox comes in 100-unit and 200-unit vials.

Those signs describe the specific counterfeit lot FDA identified in 2024, so packaging that looks clean is not proof of a genuine product.

Dilution is a labeled step, not a hack: the Botox Cosmetic label calls for reconstitution with preservative-free saline.

The labeled concentration is 4 units per 0.1 mL, the label says to refrigerate the mixed product and use it within 24 hours, and any remainder is discarded.

The number of units in a vial is set by the manufacturer — Botox Cosmetic comes in single-dose 50-unit and 100-unit vials — and reconstitution changes the concentration, not that count.

Units are also product-specific: the label states that Botox Cosmetic's units cannot be compared to or converted into units of any other botulinum toxin product.

What about the story that a clinic stretches a vial with extra saline?

We could not confirm any FDA or CDC finding of that: the 2024 investigations described counterfeit products, products from unverified sources, or providers not following state or local requirements.

If you want to know what you received, ask your provider how many units were injected and where the product was purchased — the same confirm-it-with-your-provider check FDA recommends on sourcing.

FDA advises consumers to confirm with their provider that the product comes from an authorized source and to ask whether the provider is licensed and trained to give the injection.

For fillers, FDA's consumer guidance says the same in product terms: choose a licensed provider experienced in dermatology or plastic surgery and trained to inject, who uses properly labeled, sealed vials or pre-filled syringes of FDA-approved filler.

If you use Allergan's Allē program, you can also check the Allē provider directory.

Allergan says the directory lists providers that buy Allergan Aesthetics products from authorized, legitimate sources; all other directory information, including credentials, is entered by the provider and is not verified by Allergan.

CDC's symptom list from the 2023–2024 counterfeit botulinum toxin cases: blurry and double vision, drooping eyelids, difficulty swallowing, dry mouth, slurred speech, difficulty breathing, fatigue and generalized weakness.

FDA's advice: anyone who has these symptoms after a botulinum toxin injection should contact a health care professional or go to the emergency room.

FDA asks consumers to report suspected counterfeit products to the agency at 800-551-3989; adverse events can be reported through FDA's MedWatch program.

For what to do after any treatment goes wrong — what to document, who to contact and when — see what to do if something goes wrong.

Who may inject botulinum toxin varies by state: AmSpa says injecting it is the practice of medicine, so it must be done by a physician, an independent-practice nurse practitioner, or another licensed professional acting within their scope, under rules that vary by state.

License lookups, the carton-and-vial check and the Allē directory signal are all things you can do before you book, not after.

CDC's bottom line for consumers: only get botulinum toxin injections if the product comes from an authorized supplier and the provider is licensed and trained to give the injection.

In CDC's words, "If in doubt, don't get the injection."