Group Aesthetic Treatments at Home and in Hotels: Why Are 'Botox Parties' Risky, and What Should You Ask?

What is a group treatment day or 'botox party'?

In this article, by 'group treatment day' we mean gatherings in which several people come together in a place that is not a healthcare facility and have injections one after another from the same practitioner. The home gatherings popularly called 'botox parties' are the most familiar example. Treatment days organised in a hotel room, practitioners who come to a hairdresser's or beauty salon on certain days, and treatment corners set up at celebrations and events fall within the same scope.

What these gatherings have in common is that a medical procedure turns into a social event. There is usually a host, concessions are promised as the number of participants rises, and food and drink are on hand. We have dealt with counterfeit products and unauthorised practitioners in our article “Counterfeit Products and Unlicensed Treatments”, and with treatments people carry out on themselves in our article “Needle-Free Filler Pens and At-Home Treatments”. Here we focus only on the particular risks of group and mobile treatments.

This article is not aimed at any particular institution, professional group or country. The aim is to explain the risks that arise from the setting and the arrangement themselves. For the general principles on who can carry out treatments and where, see our article “Who Can Perform Medical Aesthetic Treatments?”.

Why is an injection at home, in a hotel room or at a hairdresser's risky?

What makes an injection safe is not only the hand holding the needle; the assessment beforehand, the conditions of the setting and the follow-up afterwards are also part of the procedure. In group treatments several of these links are missing at once.

Among the things to avoid when choosing a practitioner for an aesthetic procedure, the United Kingdom's National Health Service (NHS) lists group treatments and events where alcohol is present, mobile services where procedures are carried out in homes or hotels, and practitioners who advertise only on social media. The same source recommends having a consultation with the person who will carry out the procedure before paying, and being given time to decide after the consultation.

How do alcohol and the group atmosphere affect your decision?

The little-discussed risk of group treatments is not medical but psychological. It becomes harder to say 'no' while your friends are having it done one after another. You may decide on the spot on a procedure you did not have in mind, or on more areas than you had planned. Offers such as 'today only' or 'if there are five of you' shorten the time for reflection.

• Alcohol affects judgement. Someone who has been drinking cannot be expected to give consent after weighing the risks and options; a patient information article by an aesthetic surgery society also draws attention to this point.
• Alcohol can also increase the tendency to bruise. For the general principles of preparing for a procedure, see our article “Preparing for a Medical Aesthetic Procedure”.
• In a crowded setting the practitioner is in a hurry too; the time allowed per person is shorter, and the face at rest and in motion may not be adequately assessed.
• The host being someone you know gives a feeling of trust; however, the host usually cannot know the source of the product or the competence of the practitioner.
• Images shared on social media can raise expectations. We have explained how to look at these images in our article “Reading Before-and-After Photos”.

An aesthetic procedure is a decision that can be postponed. Waiting a day, a week or a month costs you nothing as far as your health is concerned; a decision made in haste, on the other hand, may not be reversible.

What has been reported about counterfeit or smuggled botulinum toxin?

These concerns are not hypothetical. In April 2024 the US Food and Drug Administration (FDA) announced that counterfeit botulinum toxin products had been found in several states. According to the warning, these products appeared to have been obtained from unauthorised sources, and some had been administered in non-medical or unlicensed settings by licensed and unlicensed individuals. The FDA stated that medicines obtained from unauthorised sources may be counterfeit, contaminated, stored or transported in unsuitable conditions, ineffective or unsafe. The same warning also said there was no indication that the reported events were linked to the genuine licensed product.

In the same period the US Centers for Disease Control and Prevention (CDC) published a case series in which seven women became ill. Six of the injections had been given at home and one in a beauty salon; those who administered them were confirmed or suspected to be unlicensed. All seven had a drooping eyelid, dry mouth, difficulty swallowing, shortness of breath and weakness. Four were admitted to hospital and two were monitored in intensive care; none was placed on a ventilator. The symptoms had begun a median of three days after the injection.

According to the latest update on the CDC's investigation page (December 2024), the event involved 17 people in nine states; 13 were admitted to hospital and no deaths were reported. The CDC stated that some of the injections had been given by people who did not comply with local rules, while some people had injected themselves with counterfeit or unverified product.

There are similar reports from other countries too. A study reviewing ten years of records from a single centre described 161 people who presented with botulism after injections for aesthetic purposes, and reported that most of the patients had received product of unknown source outside a healthcare facility from unlicensed individuals.

These figures are events that were reported and investigated; they do not show the true frequency and cannot be directly generalised to other countries. The common thread is this: the source of the product is uncertain, and the treatment was carried out outside a healthcare facility. The side effects of treatments carried out with a licensed product, by a physician and in suitable conditions are a separate matter and are explained in our article “Side Effects after Botulinum Toxin”.

What to look for: warning signs

• The treatment will be carried out not in a healthcare facility but in a home, hotel room, salon or event space.
• The practitioner's name, profession and the healthcare facility where they work are not clearly stated; there is only a social media account or a telephone number.
• There is no one-to-one consultation with you; you are not asked about your medical history and medicines.
• The product box is not shown; the product arrives already drawn up in a syringe, or one vial is shared between several people.
• The product comes out of a bag; when asked how it was stored, no clear answer is given.
• There is no written information or consent form; no copy of the treatment record is given.
• There is alcohol on hand, or you are being hurried to decide.
• Incentives are offered, such as concessions depending on the number of people or a free treatment for the host.
• It is not clear where you should go if there is a problem, or how you can reach the practitioner.

The absence of these signs is not in itself an assurance; however, if even one is present, that is reason enough to stop and think again. All the points to look at when choosing a physician and facility are in our article “A 10-Point Safety Checklist for Choosing a Clinic and Physician for Medical Aesthetics”.

What can you ask when you are invited?

When a friend invites you to such a day, asking questions is not rude. If you cannot get clear answers to the questions below, not taking part is the safest option. The CDC's advice to the public is also brief: ask whether the practitioner is licensed and trained, and whether the product is approved and obtained from a reliable source; if in doubt, do not have the injection.

• Who will carry out the procedure? Is it a physician, and at which healthcare facility do they work?
• Why is this treatment being carried out here rather than in a healthcare facility?
• Will there be a one-to-one examination and consultation with me beforehand?
• Which product will be used? What is its active substance, and can I see the box and batch number?
• Where was the product obtained, how was it transported here and how was it stored?
• Will the product be opened for me, or shared with others?
• What can be done here in the event of an allergic reaction or another emergency?
• Will a record of the procedure be kept, and can I have a copy?
• Where will the follow-up examination take place, and how do I reach you if there is a problem?

If you find it hard to say 'no' to the invitation, postponing the decision works: saying 'I would like to be examined by a physician first' is a simple way to step back without offending anyone. Going to the gathering and not having a procedure is also an option.

What should you do if you have had a procedure in such a setting?

If you have no complaints there is no need to panic; most of the treatments carried out pass without problems. Even so, keep an eye on yourself over the following days and weeks. In the cases reported by the CDC, the symptoms had begun between two and twenty days after the injection. The signs of vascular occlusion after filler, by contrast, mostly appear in the first hours and days; the details are in our article “After Fillers: When Is It an Emergency?”.

1. For emergency symptoms call 112; do not drive yourself.
2. Tell the healthcare team clearly which procedure you had, when, where and from whom.
3. Keep and show every piece of information you have, such as the product box, a picture of the label, messages and payment records.
4. Let acquaintances who had a procedure the same day know; they may have symptoms too.
5. For a change that is not an emergency but worries you, be examined by a physician without delay.

Having had a procedure outside a healthcare facility is no bar to seeking help. The healthcare team asks questions not to judge you but to start the right treatment quickly. For what to do step by step, you can also see our article “What Should You Do If a Complication Occurs after an Aesthetic Treatment?”.

Conclusion

On group treatment days the risk arises not from a single point but from several shortcomings piling up: there is no examination, the setting is unsuitable, the source and storage of the product cannot be verified, what can be done in an emergency is limited, there are no records or follow-up, and the decision is usually made in haste. Injection treatments are not a social event but a medical procedure. Make your decision in a consultation setting, on your own and without hurrying; when you are not sure, not having it done is always your right.