Short answer: botulinum toxin is derived from a substance known in nature as a powerful poison; that is true. However, a licensed product administered by a doctor after an examination and at an appropriate dose is not the same as poisoning. The real risk increases with products of unknown origin, incorrect doses and unauthorised treatments. As with any medicine, it has side effects, and these should be discussed with your doctor.
The part of the myth that is true
Botulinum toxin is a protein produced by a bacterium called Clostridium botulinum. The toxin this bacterium produces in spoiled canned food or food stored in unsuitable conditions can cause a serious illness called “botulism”. In botulism the muscles become progressively weaker; if the swallowing and breathing muscles are affected, it becomes life-threatening.
So saying that “botox originates from a toxin” is not wrong. Scientists also count this substance among the most potent biological toxins known. The myth becomes wrong at the point where, starting from this fact, it concludes that “every treatment is poisoning”.
Why does dose change everything?
There is an old and fundamental principle in medicine: what makes a substance a poison or a medicine is often the amount. Many medicines we use in daily life can cause serious harm if taken in high doses; at the correct dose they are therapeutic.
Botulinum toxin produced for medical use is a purified medicine, measured in standard units, that has gone through a licensing process. The doses used in aesthetic treatments are injected locally into specific small muscles and are far below the amounts thought to cause general poisoning. The aim is to temporarily relax only the targeted muscle, not the whole body.
This is why the same substance has been used in a controlled way for many years both in aesthetics and in some medical conditions (for example some muscle spasms, excessive sweating and some forms of chronic migraine).
Why is treatment by a doctor different?
It is not only the medicine itself that determines safety. Who carries out the treatment, with which product and how, is at least as important:
- Licensed product: a product with a traceable source, stored in the cold chain and correctly prepared is used.
- Correct dose and injection points: the doctor assesses facial anatomy and the muscles to plan the dose and injection points.
- Examination: conditions that may rule out treatment, such as pregnancy, certain neuromuscular diseases or medicines that may interact, are asked about in advance.
- Managing complications: if something unexpected happens, there is the knowledge and the means to recognise and manage it.
Safety is not determined by the medicine alone, but by who administers it, with which product and how. Do not hesitate to ask whether the product is licensed and where it was obtained.
Dr. Hamza GemiciMedical Director, DoktorClub · Aesthetic Medicine Physician
So what are the real risks?
Side effects can also occur with treatments using a licensed product and performed by a doctor. These are mostly mild and temporary: redness or bruising at the injection site, a mild headache, or a temporary drooping of the eyelid or eyebrow due to an effect on neighbouring muscles.
There is also a rarer but serious risk: the effect of the toxin spreading far from the treatment area. Medicine package leaflets carry this as a special warning. Symptoms such as difficulty swallowing and breathing, speech problems, double vision or widespread muscle weakness require urgent assessment.
The real danger: counterfeit and unlicensed products
A significant proportion of the serious cases reported in recent years are linked to counterfeit products or products of unknown origin bought online, and to treatments carried out outside healthcare facilities (such as homes and salons). For example, in the USA in 2024, drooping eyelids, difficulty swallowing, shortness of breath and widespread weakness were reported in many people treated by unauthorised persons or outside a healthcare facility; some were treated in hospital.
With such products the contents, amount and storage conditions are unknown. This is why a “cheap” or “easily accessible” treatment may actually be the riskiest option.
- Do not buy botulinum toxin online and inject it yourself.
- Stay away from treatments carried out in places that are not healthcare facilities.
- You can ask the doctor who will perform the treatment whether the product used is licensed and where it was obtained.
Call 112 (or your local emergency number) immediately if you notice these symptoms after treatment
- Difficulty swallowing
- Difficulty breathing
- Impaired speech or a change in your voice
- Double vision, blurred vision or marked drooping of the eyelid
- Weakness in the arms, legs or whole body
Conclusion
The statement that botulinum toxin is poison reflects a fact about the substance's origin; but it is incomplete as a description of its medical use. Using a licensed product after a doctor's assessment and at an appropriate dose is a controlled medicinal treatment. This does not mean the risk is zero: as with any medicine, there are side effects, and the decision should be made together with your doctor after an examination.
Frequently asked questions
Does botulinum toxin build up in the body?
The effect is local and temporary; muscle movement returns over time. The interval between repeat treatments and the total dose should be planned by your doctor.
Are aesthetic doses the same as doses in medical treatment?
No. In some medical treatments, for example treating large muscle groups, higher doses than in aesthetic treatments may be used. The dose is always set by the doctor according to the indication and the person.
Is natural or “herbal botox” safer?
Expressions such as “herbal botox” do not describe a medicine; they are usually marketing language and do not have the same effect as botulinum toxin. A product being “natural” does not mean it is safe or effective; evidence for such claims is limited.
How can I tell if I have been poisoned after a treatment?
Difficulty swallowing or breathing, impaired speech, double vision or widespread muscle weakness are warning signs. If these symptoms occur, call 112 without delay and say that you have had a treatment. If there is a milder change that worries you, call the doctor who performed the treatment immediately.
Can I tell whether the product is counterfeit?
Most of the time it is not possible to tell from the outside. That is why the most important precaution is to have the treatment done by a doctor in a licensed healthcare facility, and to ask whether the product was obtained from a licensed, traceable source.
Sources
- Botulinum toxin as a biological weapon: medical and public health management (Arnon SS et al., JAMA 2001;285(8):1059–1070) — JAMA (American Medical Association), 2001
- Botulinum toxin type A prescribing information (US-approved label; boxed warning: distant spread of toxin effect) — U.S. Food and Drug Administration (Drugs@FDA), 2023
- Warning about counterfeit botulinum toxin products found in multiple states (FDA Drug Alert, April 2024) — U.S. Food and Drug Administration, 2024
- Notes from the Field: Illnesses After Administration of Presumed Counterfeit Botulinum Toxin in Nonmedical Settings — Tennessee and New York City, March 2024 (MMWR 73(27)) — U.S. Centers for Disease Control and Prevention, 2024
- Botulinum toxin therapy: FAQs — American Academy of Dermatology
Medical Aesthetics Expert Board
This article has been reviewed by the DoktorClub Medical Aesthetics Expert Board.
