TikTok continues to demonstrate that it’s a tremendous source of poor health advice. The growing trend of DIY at‑home use of botulinum toxin has become a real public‑safety problem.

In late 2025 the U.S. Food and Drug Administration issued warning letters to 18 websites illegally selling unapproved versions of botulinum toxin (known by its brand name, Botox), noting “adverse events associated with unapproved and misbranded botulinum toxin products, including botulism symptoms.” These products, marketed online and often purchased via social media, bypass the controls that exist for licensed medical drugs – and have been linked to serious health harms. State health authorities like the California Department of Public Health are warning consumers that counterfeit and improperly administered products have caused hospitalizations and other serious reactions when used outside regulated healthcare settings. And it’s not just sketchy providers. People are injecting themselves, trained only by TikTok videos.

Botox is no ordinary cosmetic

David Weinberg covered the key points of botulinum toxin in his excellent post last year. It’s worth repeating: Botox is not a cosmetic in the ordinary sense. It is a prescription drug whose active ingredient is one of the most potent neurotoxins known. It works by blocking nerve signaling to muscle – which may be fine if you want to relax a frown line, but it’s bad when you paralyze an eyelid, your throat, or the muscles that are helping you breathe. The narrow margin between “useful” and “harmful” is what makes this drug so different from fillers and other skincare products that people may be used to experimenting with. When someone orders a vial online and injects it without training, sterile technique, or any reliable way to verify what is really in the syringe, they are taking tremendous risks with their health and gambling with a powerful neurotoxin.

Risks of DIY self‑injection

The risks of DIY botulinum are significant, and fall into three broad categories.

1. Product quality – Much of what is sold online as “Botox” or “botulinum toxin” appears to be unapproved, counterfeit, or manufactured without the quality controls that apply to legitimate, regulated prescription drugs. There is no assurance that a product purchased this way will be sterile or free of contaminants. Even if the vial contains real botulinum toxin, its strength may not match what the label claims.

2. Dosing – Botulinum toxin injection is measured in biological units. Small differences in concentration translate into large differences in effect. Experienced injectors rely on standardized products and precise dilutions. None of that is assured with internet‑purchased products.

3. Placement – Facial anatomy is not intuitive. Injecting a few millimeters too deep or too close to the wrong muscle can lead to eyelid droop, facial asymmetry, trouble speaking, or difficulty swallowing. And these are the milder outcomes. If enough toxin diffuses beyond the target area, it can cause the same generalized weakness and paralysis that make botulism poisoning a medical emergency.

Botox has moved beyond sketchy spas and into true DIY territory. The FDA warning letters were not aimed at fly‑by‑night estheticians, but at online vendors openly shipping injectable products claiming to be botulinum toxin directly to consumers. These sites market themselves as affordable, convenient alternatives to clinic‑based care, often with slick packaging and dosing charts meant to look medical and legitimate. Social media then completes the pipeline, with TikTok and Instagram referral links and videos showing viewers how to mix, draw up, and inject these drugs at home.

Why the appeal?

So why are people willing to take these risks? Social media plays a big role, but cost does too. In‑office Botox is expensive, has to be repeated every few months, and involves consultations and appointments. Online sellers promise to simplify all that. For a fraction of the cost of a clinic visit, you’re offered what looks like the same drug, shipped directly to your door. Influencers give you the confidence that self‑injecting a neurotoxin looks safe and normal. When your feed fills with Botox posts, it looks like an easy way to save money while reducing the signs of aging. Everyone else seems to be doing it!

What gets lost in that logic is how lopsided the trade‑off actually is. When Botox is used in legitimate medical and cosmetic settings, it comes from regulated manufacturers and is administered by people trained in anatomy and dosing. This makes a potentially dangerous drug relatively safe for use, even for cosmetic purposes. Strip it away to the internet and DIY and you’re multiplying your risk to an unknown degree. You’re taking an unknown substance of unknown strength and injecting it into tissue that is millimeters away from the nerves and muscles that let you see, speak, swallow, and breathe. No amount of online confidence or anecdotal success stories changes these facts or reduces the risk.

The uncomfortable truth is that DIY Botox only looks like a clever hack if you ignore what Botox actually is. This is not skincare or self‑care. It is the self‑administration of a prescription neurotoxin, obtained from an unregulated supply chain and injected without the training or safeguards that make its use tolerable in medical settings. That some people have apparent success with it does not make it safe. It just means the odds happened to be in their favor. For everyone else, the consequences can range from disfiguring to life‑threatening. No discount internet‑sourced mystery vial is worth that gamble.

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Scott Gavura, BScPhm, MBA, RPh

Committed to improving the way medications are used and examining the profession of pharmacy through the lens of science‑based medicine. He has a professional interest in improving the cost‑effective use of drugs at the population level. Scott holds a Bachelor of Science in Pharmacy degree and an MBA from the University of Toronto, and has completed an Accredited Canadian Hospital Pharmacy Residency Program. His background includes pharmacy work in both community and hospital settings. He is a registered pharmacist in Ontario, Canada.

Scott has no conflicts of interest to disclose.

Disclaimer: All views expressed by Scott are his personal views alone, and do not represent the opinions of any current or former employers, or any organizations that he may be affiliated with. All information is provided for discussion purposes only, and should not be used as a replacement for consultation with a licensed and accredited health professional.