Can "Fake" Botox Be Safe?

A patient who was the recipient of fake botox (botulinum toxin type A product from Arizona-based Toxin Research International) told her local newspaper “I don’t think any harm’s done [from the TRI product] from a medical standpoint.” Is this the case, that fake Botox can be perfectly safe?

Doctor Answers 14

You should only use FDA approved Botox

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Is this a serious question?  You should only use FDA approved Botox - no ifs, ands, or buts.  If someone is part of a clinical trial for a new version of Botox that is one thing, but if you are using black market Botox or Botox off the internet, then you are not using good judgement. 

Fake Botox Safety

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There is a huge difference between "no harm done" and "totally safe". Certainly, I would not use non-FDA approved botulinum Toxin A for cosmetic treatments of my patients and I am sure, most (all?) physicians would agree with this conservative approach to care.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Fake Botox is not safe

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There are currently three botulinum products that are FDA-cleared in the U.S., Allergan's Botox (also BotoxCosmetic), Medicis Dysport., and one called Myobloc which is not used for cosmetic applications. These products have a long and extensive safety history. Keep in mind that these are toxins however so using anything else from any other source is playing with fire. You might get lucky but it just doesn't make sense.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews


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Non-FDA approved substances are not proven to be safe, nor effective. All the horror stories you have heard about (remember the chiropracter in Florida who put himself and 2 others in the hospital?) were all from illegal toxins, not Botox.

Take as much time making medical decisions as you make picking a digital camera or a car: get a safe and reliable procuct (BOTOX) injected by an expeirenced medical doctor, preferably one board certified in Dermatology, Opthalmology, or Plastic Surgery.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Maybe Not In That Batch

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If memory serves me right, that was the organization run by two so-called Naturapaths who distributed "fake" Botox to 200 unscrupulous physicians. One of these in South Florida sent himself and three patients to the ICU in respiratory failure.

This quote sounds like the gurglings of a pretty stupid woman. Her attitude should have been gosh I was pretty lucky. Not, well if it didn't harm me, I see no harm in it.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist

Safety of FAKE Botox

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You MUST be joking!

Would you take ANY fake Medicine?

Botox is a type of Botulinum Toxin A produced by Allergan. Other Boutlinum A toxins are produced by different companies and some illegal entities in North Korea and China- Some are ineffective. Others are much more potent than regular Botox and have resulted in Botulism (as in the Arizona produced toxin cases in Pal Beach Florida, which was actively marketed to us doctors as "NOT FOR HUMAN USE". I guess the company spent thousands of dollars faxing and sending those cards intending doctors to use their "Botox" on non-humans).

But the really scary aspect is that we simply do not know all the other contents and contaminants in these fake "Botox" medication which some of the unscrupulous amonbg us then inject in fellow human beings.


Peter A. Aldea, MD
Memphis Plastic Surgeon

Steer Clear of Botox Knock-Offs

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If you want to be safe about something you are putting into your body, use only FDA-approved Botox or Dysport.  Botox should have the Botox logo, an Allergan hologram and a serial # and exp date on the bottle.  Anything else is really, as you don't know what it is, the quality/purity, how safe it is. I would be highly skeptical of someone promoting such a product.

Steven Svehlak, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 31 reviews

Four people ended up on ventilators for months from "fake" BOTOX

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Dear RN2

Between 2002 and 2004, hundreds of persons were exposed to potentially fatal complications from the Arizona based company you are referring to. The owners of this company, Chad Livdahl, a microbiologist, and his girl friend Zarah Karim sold research grade botulinum toxin A to doctors as a "generic" alternative to legitimate FDA approved BOTOX. In total, it is estimated that approximately 219 doctors across the country purchase a total of 3,000 vials of this product. The material was never intended for human use and were not FDA approved, or tested for safety. The product was an animal research product that for profit, Livdahl unleashed onto the public in an attempt to make a fast buck. The 200 doctors who ordered and used the product also violated the public trust,the law, and many of them have lost their licenses or served jail time. Livdahl was sentenced in 2007 to 108 months of prison and fines totaling $1,228.000 for conspiracy to defraud the United States.

Reports indicate that Livdahl sourced his product from List Biological in California and repackaged the material in 500 unit vials that were sold on the internet and through seminars to physicians. Investigators found approximately 1000 people were injected with this product. The product was in no way "perfectly safe."

BOTOX is safe because it is a highly studied and controlled medication with each lot subject to FDA scrutiny and biological testing by Allergan. It was by luck alone that hundreds of people did not become sick and die because of the criminal behavior of Chad Livdahl and a group of greedy doctors who were ready to sacrifice the safety of the public for the sake of money.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Fake Botox

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Fake Botox could potentially cause real (serious) side effects.  It is simply not worth the risk.  At this time, your main options for injectable botulinum toxin for cosmetic indications are Botox (Allergan) and Dysport (Medicis). 

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

Can "Fake" Botox be Safe?

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Hi RN2 (are you Nurse Jackie?),

Ask the 4 people hospitalized for months in Florida after "fake" Botox. Ask the woman who died from respiratory arrest shortly after she received an "at home, discount" treatment. Ask the physicians who are serving sentences.

Do not be injected with anything but FDA approved Botox Cosmetic, or now Dysport in the United States. In other countries there are many other sanctioned products.

Stay away from the "fake" Botox from Arizona based TRI lab, your first hint should be the "Experimental Use Only, Not for Use in Humans" label.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.