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A botulism outbreak in June 2025 linked to counterfeit Botox products in the North East has highlighted serious gaps in UK aesthetic regulation, with 28 patients requiring emergency treatment.
Iatrogenic botulism is a life-threatening condition caused by botulinum toxin entering the bloodstream, typically due to counterfeit or mishandled products, and presents with systemic symptoms like muscle paralysis, difficulty swallowing, and drooping eyelids.
The incident underscores the importance of proper aesthetic training, product authentication, and safe practice protocols, especially as untrained injectors and illegal products continue to endanger public health.
Smileworks Aesthetic Training HUB advocates for comprehensive, safety-led training for all aesthetic practitioners, offering CPD-accredited online and hands-on courses that go beyond injection technique to include complication management, anatomy, and patient safety.

In June 2025, health officials in the North East reported a shocking development: 28 people had developed botulism from botox after receiving what they believed were legitimate botulinum toxin injections. This outbreak was unprecedented and sent shockwaves through the facial aesthetics community here in the UK.

This incident is yet another example of the critical gaps in our country’s aesthetic medicine regulations. It serves as a stark reminder of the life-threatening risks associated with counterfeit products and inadequate training.

In this specific case from the North East, investigations revealed illegal Botox-type products and untrained practitioners. This only emphasises the importance of proper training, product authentication, and safety protocols in every aesthetic practice.

What is Botulism from Botox?

Iatrogenic botulism occurs when botulinum toxin enters the bloodstream and causes systemic effects, leading to descending paralysis. Unlike typical Botox side effects that remain localised to the injection site, botulism affects the entire nervous system. Botulism most commonly occurs when Botox is injected in too-high quantities or with counterfeit products.

When properly manufactured and administered, botulinum toxin works as it is intended, by temporarily blocking nerve signals in the targeted muscles. However, counterfeit products often contain impurities, incorrect concentrations, or bacterial contamination that allows the toxin to spread further than intended.

Normal side effects of Botox are localised to the injection site and include mild drooping, bruising, or swelling. None of these side effects are cause for concern, and they should resolve within a few days. Botulism, on the other hand, presents with more widespread, systemic symptoms.

How long does it take for botulism to appear?

It can take anywhere from a few days to four weeks after treatment for symptoms to appear. Most botulism cases manifest within the first few weeks. This delayed onset makes diagnosis challenging, as most patients may not initially connect their symptoms to their recent aesthetic treatment.

Botulism symptoms include:

Drooping eyelids
Double vision
Slurred speech
Difficulty swallowing

Muscle weakness and/or paralysis (usually in face/neck region, but could progress further down)
In severe cases, difficulty breathing

In the recent UK outbreak, patients reported severe drooping of upper eyelids, double vision, difficulty swallowing, slurred speech, and overwhelming lethargy. Without proper treatment, botulism can be fatal in 5-10% of cases. With prompt antitoxin treatment, most patients make full recoveries.

The Recent Botulism Outbreak in the North East

On a single night, five patients visited one A&E in Durham with serious adverse effects after recieving Botox treatment. The BBC interviewed one patient who was under the impression she received legitimate Botox.

In the days after treatment, her throat began to close up, one eye swelled shut, and one side of her face started drooping. She couldn’t smile, struggled to eat and swallow, and felt overwhelmingly exhausted. These are all classic symptoms of botulism.

The outbreak was so severe that hospitals, which typically stock minimal amounts of antitoxin, were in danger of running out. Emergency supplies had to be sourced from hospitals all over the UK.

To put this into perspective, this region typically sees zero cases of botulism that require treatment. In 2023-2024, only six cases were reported across the whole of England. This outbreak is extraordinary in its scope and severity. The concentration of cases in a single region over a short timeframe points to a systematic problem rather than a few coincidental incidents.

But What Was The Cause?

As for what caused it, investigations are still underway. However, the Medicines and Healthcare products Regulatory Agency (MHRA) has already found evidence of illegal Botox-type products being sold in the region. These products likely contained substandard formulations that made them significantly more dangerous than legitimate products from reputable pharmaceutical companies.

When an injector doesn’t have proper training or a medical background, they’re more likely to cut corners when buying injectable products to save a few pounds. One of the best ways to spot if an injector is using counterfeit Botox products is if they’re selling 3 areas of Botox for £150 or less. For example, our Liverpool-based clinic Smileworks has a starting price for 3 areas of Botox set at £299, which is in line with the industry standard.

What This Means for Qualified Injectors

This botulism outbreak has only intensified the scrutiny that has already been placed on the aesthetic industry. Incidents like this give the whole industry a bad rap, even the injectors that are properly qualified and trained.

This incident has accelerated calls for stricter industry regulation. Health Minster Wes Streeting has faced growing pressure to implement the licensing scheme proposed in 2023, and patient safety groups are pushing for ‘Alice’s Law’ following the death of Alice Webb from a liquid BBL procedure.

After all the media attention our industry has received in the last couple of years, it’s no surprise that patients are becoming increasingly concerned with their safety. The bottom line is the UK needs tighter regulations on aesthetic treatments. It will help patients distinguish qualified professionals from the beauty salon injectors who are just looking to make a quick buck.

At the time of writing this in July 2025, no progress has been made towards implementing any aesthetic regulations.

How to Spot Real vs Fake Botulinum Toxin

Only seven botulinum toxin brands are currently licensed in the UK, with ‘Botox’ being the most recognised. Legitimate products must be prescription-only medicines, available only under the supervision of qualified healthcare professionals. While who can inject Botox is currently not regulated, the UK does regulate who can prescribe it.

Every authentic product will have:

Clear batch numbers and expiration dates
Official packaging with security features
Proper storage requirement documentation
Licensed distributor certification

Warning signs an injector is using counterfeit products usually include:

Low prices
Suppliers without a license
Missing documentation
Products offered outside of proper medical settings

As an aesthetic practitioner, you should always source products through authorised distributors with proper documentation. Be sure to maintain detailed records of batch numbers, supplier information, and storage conditions. Any reputable supplier will be transparent about their licensing and happy to provide verification of product authenticity.

If you’re a patient, never be afraid to ask your injector any questions, including about what products they use. They should be happy to answer any questions you have. If they are evasive or refuse to give you answers, this is a big red flag, and you should look elsewhere for treatment.

What to Do if Botulism from Botox Happens

Recognising botulism early can be the difference between life and death. As we’ve already covered, the condition presents with specific patterns that differentiate it from normal Botox side effects. Symptoms can be slow to present and may be subtle initially.

If you suspect botulism, treat it as a medical emergency. Time is critical, and early intervention significantly improves outcomes. Advise your patient to go to A&E immediately. Antitoxin treatment should not be delayed.

Once you’ve directed your patient to go to A&E, you should then make sure you’ve kept a record of all treatment details, product information, and the timeline of treatment. Set aside any remaining product and identify any other patients who received the same product. You’ll need this for any investigations conducted by your local health authority and insurance purposes.

The Importance of Proper Training

The truth is evident: patients get hurt when untrained individuals perform aesthetic procedures. Aesthetic training isn’t just about teaching prospective injectors proper technique. It’s about understanding product safety, how to recognise complications, and responding appropriately to emergencies.

Injectors must know the full scope of their responsibilities and the potential consequences of neglecting these responsibilities.

Every aesthetic course should cover the following areas:

Product Knowledge: Understanding the differences between licensed and unlicensed products, proper storage handling, and authentication techniques.
Anatomy & Technique: Detailed understanding of facial anatomy, proper injection techniques, and dosage calculations.
Complication Management: Recognition of normal vs. abnormal reactions, emergency response protocols, and when to seek immediate medical help.
Patient Assessment: Proper patient selection, contraindication identification, and risk factor evaluation.

Professional Standards: Understanding legal requirements, professional responsibilities, and ethical obligations.

At the Smileworks Aesthetic Training HUB, we’ve always emphasised that patient safety is paramount. Our CPD-accredited courses don’t just teach injection techniques. They build the foundations for a successful career in aesthetic medicine. When you choose the HUB, you don’t just learn how to inject. You learn how to practise safely and responsibly.

Superb Aesthetic Training in the UK

The recent botulism outbreak only reinforces our belief that proper training is not optional; it’s essential. As the industry faces increased scrutiny, practitioners with comprehensive training will be best positioned to provide safe, effective treatments while maintaining patient trust and professional credibility.

It’s time we introduce some of the HUB’s incredible online and hands-on course offerings.

If you’re just starting out in aesthetics, our Foundation Botox & Lip Filler course will give you the best foundations in aesthetic injecting. All of our courses start online, so you can jump into the course material right away!

It doesn’t stop there. If you already have some injecting experience, look no further than our Foundation Facial Ultrasound Course and our Advanced Facial Ultrasound Course, two must-haves for all aesthetic practitioners. Ultrasound is the single most important tool for ensuring safe and effective treatments every time.

For those looking for more in-depth training, we recommend booking a one-to-one mentoring session with Dr MJ. These sessions are 100% customisable, and you’ll receive personalised instruction based on your skill level and goals.

Join us at the HUB today. Let’s shape the future of aesthetic medicine together and ensure safe, effective, and transformative results for every patient.

Want to try out our courses before committing? Take advantage of our free trial for a taste of what learning at the HUB is like.

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