ProductsTwo recent Manhattan cases involving counterfeit or illegally sourced Botox sent patients to the hospital. One happened in Hell's Kitchen. The other happened on the Upper East Side, just blocks from my dermatology practice.
Botox has become so popular that many people no longer think of it as a medical procedure. That is a mistake.
Two cases, one warning
In 2025, a Hell's Kitchen aesthetician was arrested after federal authorities alleged that counterfeit Botox had been imported from China and other Asian countries and injected into clients. One patient developed symptoms of botulism and needed treatment at three hospitals.
In 2026, an aesthetician at a spa on East 78th Street pleaded guilty in federal court. Prosecutors said she obtained a botulinum toxin product from Korea and injected it into clients as Botox without medical authorization. One client was hospitalized with botulism.
Botox is not a facial
A facial is very different from injecting a prescription medication into someone's face. The person injecting you needs to understand facial anatomy, dosing, dilution and technique. They also need to recognize a serious reaction and know how to treat it.
Someone can know a lot about skincare and still lack the medical training to safely inject a neurotoxin. That is why I personally perform every Botox treatment in my office.
The product matters
Botulinum toxin is extremely potent. It must be properly made, stored, diluted and injected. With counterfeit or illegally imported products, no one can be sure what is actually in the bottle. A familiar-looking label does not mean the product is real.
There are several legitimate botulinum toxin products approved in the U.S. The key is that yours is authentic and comes from a legitimate medical supplier. For more on the warning signs, see my blog post Fake Botox and Illegal Fillers.
New York is taking action, but the problem continues
New York State has begun cracking down on medical spas. In January 2026, the Department of State announced it had inspected 223 med spas statewide and cited 87 for possible violations, including the unlawful practice of medicine.
The state has also warned consumers about unlicensed injectors and counterfeit or improperly sourced Botox. Its own guidance lists neurotoxins such as Botox, Dysport, Xeomin and Jeuveau as medical procedures.
The rules are clear. The real question is whether law enforcement and public awareness can keep up with the fast growing med spa industry.
Questions to ask before any injection
- Who is injecting me, and what is their medical license? Don't rely on titles like "injector" or "medical aesthetician." You can look up any New York license on the NYS Office of the Professions website.
- What exact product am I getting, and is it approved in the U.S.?
- Where did the product come from?
- Who is medically responsible if something goes wrong?
For more help, read my guide on how to choose a Botox injector.
Don't choose based on price
If the price of Botox seems too good to be true, it should be a red flag. Real medication, proper training, sterile supplies, insurance and follow-up care all cost money.
It’s not a bargain if you’re getting a fake product or being injected by someone who isn’t licensed to perform the procedure.
Before anyone injects your face, know who is treating you, know what is being injected, and make certain they are licensed and trained to do it.
