The American Society of Aesthetic Plastic Surgery reports that due to Botox's rapid, remarkable effects and minimal disruption to daily life, its use is growing at a 30% annual rate. Currently, the domestic market is flooded with Botox products from various countries. Even at unlicensed beauty salons, consumers are often encouraged to try these "imported drugs."However, since 2008, Chinese regulations have stipulated that only licensed hospitals at Level II or above are authorized to use, manage, and store this drug. Beauty salons are prohibited from administering it. Furthermore, even within licensed hospitals, not all doctors possess the qualifications to administer botulinum toxin. Only plastic surgeons and neurologists holding a bachelor's degree or higher and having undergone formal training in this field are permitted to use these medications.
Highly Toxic Protein Freely Traded
Recently, Ms. Li discovered on Taobao that live botulinum toxin cell solutions were selling like hotcakes. She even saw comments like: "Bought botulinum toxin on Taobao, used myself as a guinea pig, injected it myself."
"I'd only heard of Botox injections at hospitals and beauty salons—can you really try it at home?" Ms. Li wondered.
"The Botox frequently mentioned in media is actually called Botulinum Toxin Type A. It's a biological toxin produced during the reproduction of Clostridium botulinum bacteria and ranks among the most toxic proteins."Dr. Song Chunqiong from the Laser Plastic Surgery Center at Beijing Zhongguancun Hospital clarified the distinction between botulinum toxin and Clostridium botulinum. "Clostridium botulinum is widely distributed in nature, but Type A botulinum toxin is extensively used in cosmetic procedures."
The mechanism of botulinum toxin is straightforward. "It temporarily blocks nerve impulses to muscles. Without perceiving neural excitation, muscles cannot contract and gradually thin. This resembles muscle atrophy after hemiplegia in stroke patients, though the difference lies in causation: stroke involves damage to the brain's functional centers, while botulinum toxin induces temporary paralysis."Muscle thickness can reduce by about 1 centimeter, becoming as thin as several sheets of paper. The effect is very noticeable, producing cosmetic results like wrinkle reduction, facial slimming, and body contouring," said Song Chunqiong.
Chaotic Management of Botulinum Toxin Use
"Although modern medicine has a thorough understanding of botulinum toxin's pharmacology, properties, and metabolic mechanisms, and its side effects and duration of action are well-documented, the low barrier to entry in the cosmetic surgery industry means virtually anyone can open a beauty clinic. This allows the unregulated use of botulinum toxin, a controlled substance, leading to endless problems and incidents.""Wang Zhijun, Vice President of the Chinese Medical Doctor Association's Aesthetic and Plastic Surgery Branch, Deputy Director of the Chinese Medical Association's Medical Aesthetics and Cosmetology Branch, and President of Xinhua Hospital affiliated with Dalian University, candidly stated that the current medical aesthetics market is rife with counterfeit products and fraudulent practices. "This isn't a problem with botulinum toxin itself, but rather one of management."
Abroad, the miraculous effects of injectable cosmetics have led many to self-administer treatments. The American Society of Plastic Surgeons has noted that in recent years, numerous individuals have injected unapproved substances like silicone and baby oil at home.In Illinois, a woman named Halter died from a bacterial infection after self-injecting beef fat into her face to reduce wrinkles.
"This is a matter of life and death. Within a medical setting, botulinum toxin can only be purchased with a prescription from a qualified medical professional (plastic surgeon, dermatologist, neurologist) and must be administered by a licensed specialist with appropriate credentials.So-called botulinum toxin obtained through unofficial channels is often privately repackaged, lacking guaranteed precise dosing and frequently contaminated with impurities. Sterility cannot be assured, which explains why reports of respiratory or swallowing difficulties requiring emergency treatment, or even anaphylactic shock leading to death, are common after botulinum toxin injections." Song Chunqiong noted that the market is now flooded with counterfeit botulinum toxin products from various countries, making it difficult for consumers to distinguish genuine from fake.
"Non-standard use of botulinum toxin injections has caused numerous problems. Whether it's the source of the drug, the purity of the agent, the dosage, or the injection site, even slight deviations can lead to serious safety issues. Facial paralysis is the mildest consequence," said Yan Shixiang, Vice Chairman of the Expert Committee of the China National Federation of Industry and Commerce Cosmetics Chamber of Commerce and Professor at Beijing Technology and Business University. Consumers must exercise extreme caution.
Effectiveness
Not Effective for Every Wrinkle
As we age, crow's feet, forehead lines, and nasolabial folds gradually appear and deepen.Many beauty clinics and online retailers claim Botox can "magically erase every wrinkle in two weeks," tempting many consumers. However, experts note that wrinkle type and severity affect treatment outcomes, and Botox is not universally effective.
Fan Xin, Director of the Cosmetic Surgery Center at Beijing Military Region General Hospital, explains that wrinkles are medically classified into six grades. Grade 5 and above are considered severe wrinkles, while grades 2 and below are mild. Grades 3 and 4 are moderate wrinkles. Treatment methods must be selected based on the specific severity of the wrinkles.
"In youth, factors like dry skin and seasonal changes can lead to insufficient skin hydration, causing fine, short wrinkles around the eyes and mouth. These wrinkles are reversible—reducing their appearance can be achieved through moisturizing cosmetics and ensuring adequate sleep," said Su Mingshan, Director of the Laser Plastic Surgery Center at Beijing Zhongguancun Hospital and a member of the Chinese Medical Association's Dermatology Branch. Only irreversible wrinkles require medical aesthetic interventions.
"Generally, Botox is most effective at reducing dynamic wrinkles—those that appear when you make facial expressions," said Song Chunqiong. If wrinkles are very pronounced and visible even when the face is relaxed, Botox injections may not yield optimal results. Therefore, while Botox has a broad range of users, its wrinkle-reducing effects are generally more pronounced in middle-aged and young adults than in older individuals.
Similar to its varying wrinkle-reducing effects, botulinum toxin's other cosmetic function—facial slimming—also yields different results for different individuals. Dr. Song Chunqiong explained that while botulinum toxin can transform a thick masseter muscle into a "V-shaped face," its effects are less pronounced for individuals with a square jawline due to bone structure or those with thicker subcutaneous fat in the face."Botox provides a relative slimming effect. Fundamental changes to facial structure require jawline and zygomatic arch surgery—commonly known as bone contouring or reduction," Dr. Song clarified.
Experts emphasize that injectable cosmetic procedures are highly specialized and should only be performed by qualified specialists.
Side Effects
Long-term repeated injections may cause respiratory paralysis
After Botox injection, muscles may lose their ability to contract or become droopy. While eliminating forehead wrinkles, it may also temporarily paralyze the frontalis muscle responsible for raising the eyebrows, causing a temporary loss of this function.
Additionally, nerve impulse recovery takes approximately 3-4 months, while the cosmetic effect lasts about 6 months. To maintain results, repeated injections are necessary. However, long-term, repeated injections carry risks. "Botox injections can cause mild reactions like generalized weakness, drooping eyelids, double vision, swallowing and speech difficulties, or respiratory paralysis. In severe cases, they can be life-threatening,"Song Chunqiong stated. Therefore, injections should only be administered after a specialist physician confirms suitability to avoid unnecessary complications.
Dr. Quan Yuzhu from Beijing Plastic Surgery Hospital noted that while injectable aesthetics may seem straightforward, it demands rigorous understanding of facial muscle anatomy and strict control over product quality—it cannot be mastered through mere injection training. Even specialists must continually refine their techniques through practice.Injecting Botox too shallowly or too deeply may fail to achieve the desired effect and could lead to mask-like facial expressions, facial deformities, facial paralysis, or cause irritation, redness, swelling, and bacterial infections.
Tracing the Origins
From Treating Muscle Spasms to Wrinkle Reduction and Facial Slimming