A recent case in the United States has reignited global concern over the potential dangers of aesthetic treatments gone wrong. In Georgia, a mother of three was left partially paralysed after routine botulinum toxin injections, developing a severe migraine within hours. By the next day, she was hospitalised, unable to speak or function, and doctors confirmed she had suffered small strokes.
While such extreme complications are rare, the incident underscores the importance of ensuring any injectable procedure is carried out by a qualified, experienced medical professional in a reputable clinic.
Dr JD Erasmus, MBChB (UFS) BSc (UP) – General Practitioner with a special interest in aesthetics and Head of Aesthetics at the Longevity Centre at RXME – stresses that fears of botulism from botulinum toxin injections are largely unfounded when treatments are performed correctly.
“People hear the word ‘toxin’ and understandably get nervous. But iatrogenic botulism after aesthetic treatments is extremely rare in medical clinics with qualified doctors who follow proper protocols and use trusted products from regulated manufacturers,”.
he says
One of the Safest Anti-Ageing Treatments
Botulinum toxin is one of the most extensively studied treatments in aesthetic medicine. In cosmetic applications, it relaxes targeted facial muscles, smooths lines and wrinkles, rejuvenates the skin, and can even help relieve tension headaches.
“In aesthetics, it’s used in very small, highly controlled doses. When done correctly, it stays where it’s injected, does its job, and is naturally broken down by the body over time. The horror stories you hear are almost always linked to unqualified practitioners, dangerously high doses, or fake and unregistered products – not the work of reputable South African doctors.”
Dr Erasmus explains
Globally, botulism of any form is extremely rare, occurring in less than one in 100,000 cases. According to Dr Erasmus, there have been no recorded cases linked to aesthetic treatments in South Africa to date.
The Risks of Cosmetic Tourism
Regulatory gaps overseas can heighten risks. In one extreme example in Turkey in 2022, 71 people developed iatrogenic botulism from botulinum toxin injections in just over a month – 66 traced back to a single clinic.
“That’s the danger of medical or cosmetic tourism to poorly regulated markets. You don’t always know what product is being used, who’s injecting it, or whether proper safety standards are in place. And you may have no follow-up support once you return home.”
says Dr Erasmus
South Africa’s Strong Safety Regulations
South Africa’s strict regulations help prevent the misuse seen elsewhere. Botulinum toxin injections are classified as Schedule 4 medicines, approved by the South African Health Products Regulatory Authority (SAHPRA) or the FDA in the USA.
Only doctors registered with the Health Professions Council of South Africa (HPCSA) can purchase and administer the treatment, and distributors require special SAHPRA permits. Reputable clinics store and prepare the product under tightly controlled conditions, keep detailed usage records, and discard any unused product safely after a set time.
What Patients Should Check
Dr Erasmus recommends patients:
- Confirm their practitioner is HPCSA-registered.
- Ask to see the unopened product box before mixing.
- Note the lot number for their records.
- Ensure a follow-up plan is in place.
Ethical clinics welcome these questions and see them as part of informed consent.
“Overseas headlines should remind people of the dangers of taking shortcuts, not fuel panic. Botulinum toxin has one of the best safety records in aesthetic medicine. In South Africa, choosing a qualified doctor and reputable clinic makes the risk of serious complications almost non-existent.”
Dr Erasmus concludes
