Blindness, paralysis and necrosis: What to know before you get Botox and filler
The government is calling for tighter regulations of the cosmetic surgery industry, in a bid to crackdown on "cowboy" practises.
Brazilian butt lift (BBL) surgery has the highest death rate of all cosmetic procedures, with the injected fat in some instances causing pulmonary embolisms – as was the case in January last year, when 26-year-old mum-of-three Demi Agoglia died after undergoing the treatment in Turkey.
But other popular treatments, such as Botox and dermal fillers, still carry risk. Just last week, the UK Health Security Agency (UKHSA) issued an update on the rise in botulism cases, a rare but life-threatening condition caused when toxins attack the nervous system.
Between 4 June and 6 August 2025, there were 41 reported cases of botulism involving botulinum toxin in the UK, per the agency, with side-effects of slurred speech and respiratory issues being reported in the North East, East Midlands, East of England, North West and Yorkshire and Humber.
Discussing the worrying rise in botulism, Dr Gauri Godbole, consultant medical microbiologist at UKHSA, said: "We are working closely with our partners to reduce the public health risk and would advise people to make sure they take precautions when seeking aesthetic procedures."
On the use of unlicensed and counterfeit products, Dr Alison Cave, the chief safety officer at the Medicines Healthcare Products Regulatory Agency (MHRA), meanwhile, stated: "Our Criminal Enforcement Unit works hard to identify those involved in the illegal trade in medicines and takes robust enforcement action where necessary. This can include criminal prosecution."
If you're considering cosmetic injections, then, here's what you need to be aware of.
9 things to know before getting Botox and filler
1. Botox is a brand – and a prescription drug
Botox is a brand name that has become synonymous with anti-ageing treatments.
But while Botox is the leading producer of botulinum toxin A, a prescription-only drug, other companies also supply the substance, and more still purport to be offering this anti-wrinkle solution, when in fact they're offering counterfeits.
Due to the rise in botulism cases of late, the UKHSA has launched an investigation into fake products and products that have not been licensed and cleared for use in the UK. They are also seeking to curb self-administration, as this, too, has risen in recent years.
2. ...but right now, anyone can administer it in the UK
As well as what is being injected, one of the main causes of concern is who is administering the treatment. While the drug itself requires a prescription, under current UK law, anyone can administer it.
You've no doubt heard of so-called "Botox parties", popularised in the early 2000s. Equally, some clinics may have untrained staff performing such treatments.
As part of its new crackdown, the government is looking at stricter criteria for those who inject and a local authority licensing system.
One of the obstacles in getting tighter restrictions in place to date has been the perception around such procedures. Despite it being a lucrative and highly popular industry, these procedures are largely seen as non-essential and, therefore, have not been readily available on the NHS or governed in the same way.
They are generally subject to VAT as well, meaning that while botched procedures have reportedly cost the NHS an estimated £1.7m in a year to fix, the government also receives revenue on these treatments.
3. Ask how many times your practitioner has performed these procedures
Even if the person treating you is a doctor, nurse, dentist or surgeon, it doesn't mean they are necessarily trained in this area.
Before you take the plunge and have treatment, be sure to ask the practitioner how many years they have been performing Botox and dermal filler treatments for cosmetic purposes, and how many patients they have worked on. Also ask to see examples of their results.
4. Botulinum toxin can cause blindness
While rarely reported, botulinum toxin A can cause vision impairment and loss if administered incorrectly.
5. It can also cause necrosis
Again, although rarely reported, botulinum toxin A can cause myofascial necrosis, or the death of muscle tissue in the face. When necrosis occurs, it cannot be reversed.
6. And patients can go into anaphylactic shock
Generally speaking, if administered properly and safely by trained and experienced practitioners, anti-wrinkle injections are perfectly fine.
However, in some instances, botulinum toxin A can cause anaphylaxis – even if a person has not reacted to the substance in the past.
7. Muscle atrophy is another potential side-effect
One of the known potential side effects of Botox is muscle atrophy, which is the wasting or thinning of muscle mass. It can also lead to numbness, muscle weakness and a tingling sensation.
This is largely down to how Botox works: by blocking the message from the muscle's nerve to the brain to temporarily paralyse it and prevent it from contracting and, therefore, deepening wrinkles.
8. Some fillers aren't safe
Generally speaking, dermal fillers have become far more sophisticated in recent years and technologies have thankfully moved on from the days of silicone and paraffin.
Nowadays, most dermal fillers are made from hyaluronic acid (HA), a naturally-occurring substance found within the body that attracts and retains water, in turn creating volume, structure and plumper, hydrated skin.
That's not to say there aren't risks associated with them, though. Beyond the usual side-effects of swelling, bruising, redness and itchiness in the treated area, there is some evidence that suggests that HA-based fillers can block lymphatic channels, which help the body drain fluid and fight off diseases.
Researchers in the US have also found fillers to be linked to cysts, lumps, swelling and facial pain. They are also planning research to see whether the treatment affects the risk of diseases, including cancer.
9. You can end up looking puffy and overfilled
Although "pillow face" and "duck lips" aren't necessarily a health risk, they aren't exactly pleasant side-effects. They occur when too much product has been applied, or when the product hasn't been spread in the treated area effectively with the cannula.
Due to the influence of reality TV and social media, these treatments are on the rise, and patients are getting younger and younger. Many young people who have undergone these procedures, however, are now seeking to reverse them – including Love Island star Molly-Mae Hague, who revealed to fans that she was having her lip filler dissolved in 2020.
Read more about cosmetic surgery:
Unlicensed Botox-like injections spark outbreak of disease many doctors have never treated (Sky News)
The hidden health risks of lip fillers (The Conversation, 4-min read)
Botox alternatives: Do they work? Derms weigh in on the best ways to fight wrinkles (Yahoo Shopping)
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If you're considering cosmetic injections, then, here's what you need to be aware of. 9 things to know before getting Botox and filler 1. Botox is a brand – and a prescription drug Botox is a brand name that has become synonymous with anti-ageing treatments. But while Botox is the leading producer of botulinum toxin A, a prescription-only drug, other companies also supply the substance, and more still purport to be offering this anti-wrinkle solution, when in fact they're offering counterfeits. Due to the rise in botulism cases of late, the UKHSA has launched an investigation into fake products and products that have not been licensed and cleared for use in the UK. They are also seeking to curb self-administration, as this, too, has risen in recent years. 2. ...but right now, anyone can administer it in the UK As well as what is being injected, one of the main causes of concern is who is administering the treatment. While the drug itself requires a prescription, under current UK law, anyone can administer it. You've no doubt heard of so-called "Botox parties", popularised in the early 2000s. Equally, some clinics may have untrained staff performing such treatments. As part of its new crackdown, the government is looking at stricter criteria for those who inject and a local authority licensing system. One of the obstacles in getting tighter restrictions in place to date has been the perception around such procedures. Despite it being a lucrative and highly popular industry, these procedures are largely seen as non-essential and, therefore, have not been readily available on the NHS or governed in the same way. They are generally subject to VAT as well, meaning that while botched procedures have reportedly cost the NHS an estimated £1.7m in a year to fix, the government also receives revenue on these treatments. 3. Ask how many times your practitioner has performed these procedures Even if the person treating you is a doctor, nurse, dentist or surgeon, it doesn't mean they are necessarily trained in this area. Before you take the plunge and have treatment, be sure to ask the practitioner how many years they have been performing Botox and dermal filler treatments for cosmetic purposes, and how many patients they have worked on. Also ask to see examples of their results. 4. Botulinum toxin can cause blindness While rarely reported, botulinum toxin A can cause vision impairment and loss if administered incorrectly. 5. It can also cause necrosis Again, although rarely reported, botulinum toxin A can cause myofascial necrosis, or the death of muscle tissue in the face. When necrosis occurs, it cannot be reversed. 6. And patients can go into anaphylactic shock Generally speaking, if administered properly and safely by trained and experienced practitioners, anti-wrinkle injections are perfectly fine. However, in some instances, botulinum toxin A can cause anaphylaxis – even if a person has not reacted to the substance in the past. 7. Muscle atrophy is another potential side-effect One of the known potential side effects of Botox is muscle atrophy, which is the wasting or thinning of muscle mass. It can also lead to numbness, muscle weakness and a tingling sensation. This is largely down to how Botox works: by blocking the message from the muscle's nerve to the brain to temporarily paralyse it and prevent it from contracting and, therefore, deepening wrinkles. 8. Some fillers aren't safe Generally speaking, dermal fillers have become far more sophisticated in recent years and technologies have thankfully moved on from the days of silicone and paraffin. Nowadays, most dermal fillers are made from hyaluronic acid (HA), a naturally-occurring substance found within the body that attracts and retains water, in turn creating volume, structure and plumper, hydrated skin. That's not to say there aren't risks associated with them, though. Beyond the usual side-effects of swelling, bruising, redness and itchiness in the treated area, there is some evidence that suggests that HA-based fillers can block lymphatic channels, which help the body drain fluid and fight off diseases. Researchers in the US have also found fillers to be linked to cysts, lumps, swelling and facial pain. They are also planning research to see whether the treatment affects the risk of diseases, including cancer. 9. You can end up looking puffy and overfilled Although "pillow face" and "duck lips" aren't necessarily a health risk, they aren't exactly pleasant side-effects. They occur when too much product has been applied, or when the product hasn't been spread in the treated area effectively with the cannula. Due to the influence of reality TV and social media, these treatments are on the rise, and patients are getting younger and younger. Many young people who have undergone these procedures, however, are now seeking to reverse them – including Love Island star Molly-Mae Hague, who revealed to fans that she was having her lip filler dissolved in 2020. Read more about cosmetic surgery: Unlicensed Botox-like injections spark outbreak of disease many doctors have never treated (Sky News) The hidden health risks of lip fillers (The Conversation, 4-min read) Botox alternatives: Do they work? Derms weigh in on the best ways to fight wrinkles (Yahoo Shopping)
