When a properly prepared and stored solution of botulinum toxin is injected locally, the risk of mortality is essentially zero. The morbidity associated with the procedure is less than three percent in skilled hands.

There have been at...

least four reported incidents of botulism that resulted from the use of a highly concentrated solution of botulinum toxin by an unlicensed physician. The toxin was prepared and shipped by a reputable manufacturer for research purposes. The illegal injections contained a concentration approximately 2,500 times the usual concentration of the toxin. All four people injected with the concentrated toxin experienced widespread paralysis and required treatment in an intensive care unit. This incident is considered isolated and highly unusual. With proper dilutions of the toxin prepared for cosmetic and medicinal use, this type of outcome is not possible. However, it does underscore the need to receive treatment from a qualified medical provider using toxin that is specifically licensed and approved for the purpose.