Botulism and Anti-Wrinkle Injections: What You Need to Know

Sep 7

4 min read

You may have recently seen reports about cases of botulism following cosmetic botulinum toxin treatments in the UK. Understandably, headlines like these can sound alarming, particularly if you regularly have anti-wrinkle treatments or are considering treatment for the first time.

At Reem Medical Aesthetics, patient safety is always our priority. We therefore wanted to explain what happened, what botulism actually is, and importantly, the steps we take to ensure your treatment is carried out as safely as possible.

What happened?

In 2025, the UK Health Security Agency (UKHSA) investigated an outbreak of iatrogenic botulism associated with cosmetic botulinum toxin injections.

Between 4 June and 6 August 2025, 41 clinically confirmed cases were reported across five regions of England. Of these, 32 people were admitted to hospital and eight required intensive care treatment.

This understandably generated considerable media attention.

However, there is an extremely important part of the story that patients should be aware of:

Investigations found that the majority of affected individuals had received products that were not licensed for use in the UK.

A detailed investigation into the North East England cluster also found a strong association between cases and an unlicensed botulinum toxin product. Laboratory testing of seized product found that it contained approximately 370 units per vial despite being labelled as containing 200 units.

The MHRA subsequently launched criminal investigations connected with the illegal supply of unlicensed botulinum toxin products.

Does this mean Botox and other botulinum toxin treatments are unsafe?

No medical or aesthetic treatment can be described as completely risk-free, and botulinum toxin is no exception.

Botulinum toxin medicines have been used extensively for both medical and aesthetic indications. Iatrogenic botulism is a recognised but rare complication, occurring when the effects of botulinum toxin spread beyond the intended treatment area.

In July 2026, the Medicines and Healthcare products Regulatory Agency (MHRA) strengthened the warnings supplied with botulinum toxin type A medicines to make this rare risk clearer to both healthcare professionals and patients.

The MHRA advises that risk may be increased by factors including:

counterfeit or unauthorised botulinum toxin products
high doses
treatment in unapproved sites or outside licensed indications
certain underlying medical conditions
inappropriate use of the medicine.

This is why who treats you, what product they use and how that medicine has been obtained are so important.

Why our patients should feel reassured

At Reem Medical Aesthetics, we take the prescribing, sourcing, storage and administration of prescription medicines extremely seriously.

Botulinum toxin is a prescription-only medicine in the UK. It should not simply be purchased online and injected without appropriate clinical oversight.

I am an Advanced Pharmacist Practitioner and Independent Prescriber, with extensive NHS and aesthetic medicine experience. Every treatment begins with appropriate clinical assessment, consideration of your medical history and suitability for treatment.

We use established botulinum toxin products that are authorised for use in the UK and obtained through legitimate UK pharmaceutical supply chains.

We do not purchase cheap, unlicensed or imported "Botox-like" alternatives simply because they cost less.

The UKHSA lists UK-authorised injectable botulinum toxin products used for aesthetic procedures as including Azzalure®, Alluzience®, Bocouture®, Botox®, Letybo®, Nuceiva® and Relfydess®.

Why licensed products matter

A medicine being authorised in the UK means there are regulatory safeguards around its quality, safety and manufacture.

When an unlicensed or counterfeit product enters the supply chain, those assurances may disappear.

As demonstrated by the investigation into the 2025 North East outbreak, a product may not necessarily contain what its packaging claims. In that investigation, seized product labelled as containing 200 units per vial was found to have a potency of approximately 370 units per vial.

This highlights why patients should not choose an injectable treatment based on price alone.

A very cheap anti-wrinkle treatment should prompt sensible questions:

Who is prescribing it?What product is being injected?

Is it authorised for use in the UK?

Where has it been purchased from?

Is the practitioner appropriately qualified and trained?

These questions matter.

What are the symptoms of botulism?

It is important to distinguish expected local effects of botulinum toxin treatment from symptoms suggesting systemic spread.

According to the MHRA, symptoms of iatrogenic botulism typically develop around 4–8 days following treatment, although they can occur up to four weeks afterwards.

Symptoms requiring urgent medical assessment can include:

difficulty swallowing
difficulty speaking or slurred speech
difficulty breathing or shortness of breath
significant generalised muscle weakness
severe drooping of the upper eyelids.

These are not normal post-treatment symptoms.

If you develop difficulty breathing, swallowing or speaking following botulinum toxin treatment, seek urgent medical attention and make healthcare professionals aware that you have recently received botulinum toxin.

Should I be worried about having my next treatment?

For patients receiving appropriately prescribed treatment using legitimate UK-authorised products from a suitably qualified healthcare professional, the recent cases should be viewed in context.

The 2025 outbreak did not demonstrate that routine botulinum toxin treatment had suddenly become unsafe. The investigation highlighted a very different and extremely important issue within the aesthetics industry: the danger posed by unlicensed, unauthorised or counterfeit products and inappropriate practice.

At the same time, responsible practitioners should never dismiss genuine risks. The MHRA's 2026 update reminds us that iatrogenic botulism remains a rare recognised adverse effect and reinforces the importance of appropriate prescribing, patient selection, dosing, product sourcing and aftercare.

Our commitment to you

At Reem Medical Aesthetics, safety is not simply something we discuss when there is a news story.

It influences how we practise every day.

From consultation and prescribing through to sourcing medicines, dosing, injection technique, documentation and aftercare, our approach is based around safe, responsible medical practice.

If you are ever concerned about a product being used during your appointment, please ask us. We are more than happy to show you the product, explain what it is and discuss why it has been selected for your treatment.

Ultimately, the recent cases reinforce a message we have always promoted:

Choose your practitioner carefully. Ask what is being injected into you. And never compromise medical safety for a cheaper treatment.

If you have an upcoming appointment with Reem Medical Aesthetics and have concerns following recent reports about botulism, please contact us. We are always happy to discuss your treatment and answer your questions before you proceed.

This article is intended for general patient information and does not replace individual medical advice. If you experience difficulty breathing, swallowing or speaking following botulinum toxin treatment, seek urgent medical attention.