According to the Centers for Disease Control (CDC), over 20 people have become sick after receiving counterfeit Botox injections.

In small doses, botulinum toxin — AKA Botox — prevents the injected muscle(s) from contracting, thus reducing the appearance of wrinkles and lines. Botox is also used to treat non-cosmetic health conditions, like excessive sweating, chronic migraines, and overactive bladder.

But as the saying goes, the dose makes the poison. At high doses, botulinum toxin can cause botulism, a potentially fatal illness. Typically, botulism is caused by food — usually improperly canned, preserved, or fermented goods — contaminated with the toxin.

In a cosmeceutical context, Botox can cause adverse effects when the toxin travels beyond the injection site — and in this case, when patients are injected with counterfeit Botox that hasn't been tested and may contain any number of unsafe ingredients.

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In a release posted on April 19, the CDC announced it is launching an investigation into "reports of harmful reactions" among 22 people who "received injections of counterfeit or mishandled botulinum toxin." The patients are located across 11 states: New York, California, Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee, Texas, and Washington.

The "harmful reactions" reported include blurred vision, drooping eyelids, and difficulty breathing. While these reactions are common symptoms of botulism, six of seven patients tested for the illness were negative (the remaining result is pending).

According to the FDA, there's another reason behind the outbreak of adverse reactions: "These incidents have occurred when counterfeit Botox is injected by licensed and unlicensed individuals and/or in non-medical or unlicensed settings."

In other words: If you're going to get injected, choose your provider carefully.

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"Botox injections should only be performed in a medical office by a board-certified dermatologist, or other appropriately trained clinician under the supervision of one," Seemal Desai, the president of the American Academy of Dermatology, told NPR.

Cosmetic treatments like Botox may be as normalized as ever (particularly among young people), but that doesn't negate their risks. If you're considering going under the needle, head to the FDA's website for information on how to spot fake Botox, as well as things to consider when choosing your provider.

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