Counterfeit Products and Unlicensed Treatments: Risks, Warning Signs and What to Do

What do we mean by an “unlicensed” treatment?

In this article, by an “unlicensed” or “backstreet” treatment we mean medical aesthetic procedures carried out in places that are not healthcare facilities, by people who are not physicians, or with products of unknown origin. Home visits, injections given at hairdressers or beauty salons, “group” sessions organised in hotel rooms and procedures done by people reached only through social media all fall into this category.

Although injections such as botulinum toxin and hyaluronic acid filler may look simple, they are medical procedures. They require knowledge of facial anatomy, choosing the right product and dose, sterile conditions and the ability to respond immediately to a possible complication.

Why is a counterfeit or unlicensed product dangerous?

A licensed product is one whose contents, purity and dose have been checked. With a counterfeit, smuggled or unlicensed product, however, you cannot know what is inside the box, how much active ingredient it contains or whether it is sterile.

• The dose is unknown: a counterfeit product containing botulinum toxin may contain a much higher amount than expected, and the effect may spread beyond the injection area.
• The contents are unknown: a product sold as a filler may contain substances that do not dissolve in the body or that can cause serious reactions.
• Sterility is unknown: a contaminated product or unsuitable conditions can lead to infection.
• If a problem occurs, treatment may be delayed because no one knows what was injected.

Problems reported around the world

These risks are not just theoretical. In 2024, health authorities in the USA issued a warning that counterfeit botulinum toxin products were circulating in several states. According to these warnings, after injections given mostly in non-healthcare settings such as homes and by unauthorised people, some people developed botulism-like symptoms such as drooping eyelids, double or blurred vision, dry mouth, difficulty swallowing, shortness of breath and muscle weakness. Some of these people were treated in hospital, and some in intensive care.

Similar case series linked to injections given outside healthcare facilities have been reported from other countries as well. What they have in common is that the product's origin was unknown, the treatment was given outside a healthcare facility and the practitioner was not a physician.

Licensed products are generally considered safe when given by a physician at appropriate doses. The problem stems less from the active ingredient itself than from the product's origin, the dose and the conditions of the treatment.

Warning signs: when should you stop?

If even one of the following signs is present, it is advisable to stop and reconsider before having the procedure:

• The price is far below the general market level; there are offers that rush you, such as “today only” or “last two places”.
• The treatment will take place somewhere that is not a healthcare facility, such as a home, hairdresser, beauty salon or hotel room, or you are told someone “will come to your home”.
• It is not clear whether the practitioner is a physician; only phrases such as “certified”, “trained practitioner” or “expert” are used.
• You are not shown the product's box, the product arrives already drawn into a syringe, or you are not told which product it is.
• The box or label is entirely in a foreign language with no information in your language; the packaging has spelling mistakes or looks unusual.
• No examination is done, you are not asked about your medical history and no consent form is given.
• The product is sold to you online or on social media “to apply yourself”.
• It is unclear whom to contact, and how, if a problem occurs.

What you can ask before the procedure

A trustworthy physician will answer these questions readily and will not mind you asking. For a detailed list on choosing a physician and clinic, you can also see our article Safety Checklist for Choosing a Clinic and Physician for Medical Aesthetics.

• Who will perform the procedure? Is it a physician, and trained in which field?
• In which healthcare facility will the treatment take place?
• What is the active ingredient of the product to be used? Can I see its box and label?
• Is the product licensed, and was it obtained through authorised channels?
• If a complication occurs, can it be managed here?
• If there is a problem outside working hours, how can I reach you?

What should you do if you have had such a treatment?

If you have had a treatment in the past with a product of unknown origin or outside a healthcare facility and you have no complaints now, there is no need to panic. However, it is important to watch yourself over the following days and weeks and to see a physician without delay if any new symptom appears.

Serious side effects related to botulinum toxin usually appear within days of the treatment, but they can also start later. Infections or inflammatory reactions related to fillers, on the other hand, may appear weeks or even months later.

1. If your symptoms are urgent, call 112 or go to the nearest emergency department.
2. Tell the healthcare team which procedure you had, when and where, and what you were told.
3. If you have the product's box, label, a photo of it, or payment and messaging records, keep them and show them.
4. For symptoms that are not urgent but worry you, see a physician without delay.

Having had a treatment of unknown origin does not stop you from asking for help. The healthcare team asks questions not to judge you but to start the right treatment quickly. Explaining clearly what happened is important so that treatment is not delayed.

Final word

The most important safeguard in medical aesthetics is that the right person performs the treatment, in the right place, with a product of known origin. An offer that looks cheap or convenient can later turn into a much bigger health problem. When you are not sure, it is always your right to ask and, if necessary, to walk away.