The Centers for Disease Control and Prevention issued a health advisory this week warning people about counterfeit Botox, which has sickened 22 people in 11 states between November 2023 and March 2024.

According to the CDC, “all symptomatic people were females aged 25 to 59 years. All reported receiving botulinum toxin [also known as Botox] injections by unlicensed or untrained individuals or in non-healthcare settings, including homes or spas.”

The Botox that’s making people sick is counterfeit and was purchased from unlicensed sources, according to the Food and Drug Administration. People reported reactions such as vision problems, constipation, shortness of breath, dry mouth, trouble lifting their head and more. Some folks have even required hospitalization.

“People basically exhibit symptoms of actually too much botox — botulism,” Dr. Jimmy C. Sung, a board-certified plastic and reconstructive surgeon and founder of Tribeca Aesthetic in New York, told HuffPost. He added that the quality control checks that real Botox goes through is not happening for this counterfeit product.

Experts stress that receiving Botox is a medical procedure and should be treated as such. The product is FDA-approved for the treatment of wrinkles, migraines, excessive sweating and more, Dr. Deeptej Singh, a board-certified dermatologist and founder of Sandia Dermatology in New Mexico, told HuffPost. It’s best known for the treatment of forehead wrinkles, crow’s feet and frown lines, which it relieves temporarily.

“Readers should not be concerned about genuine Botox, because genuine Botox ... goes through several stages of quality assurance, and genuine Botox gives consistent, reliable, safe results,” Singh said.

According to the American Society of Plastic Surgeons, injections like Botox are the most popular minimally invasive treatment in the country. “Because it is so popular and so many people want it, there is this market for getting a ‘deal’ that turns out to not be a deal,” Singh explained.

The illness that’s happening across the U.S. is due to this issue. Some providers may be enticed by cheaper products, which could end up being counterfeit ― and that can spark a host of health problems.

“All drugs are relatively safe when it’s used appropriately,” Sung said. “That’s why not only the person should be licensed, they should be properly trained, because at the end of the day, this is a poison, it’s a toxin.”

To be safe, get your Botox from a licensed medical professional at a doctor’s office. “People want Botox because it works, but people also need to understand that it is a medical procedure,” Singh said.

You probably wouldn’t get any other medical procedure at home, right? If you want to protect yourself from counterfeit products, “the best thing to do is to go to a doctor’s office ... people who specialize in this, meaning the core providers, such as board-certified plastic surgeons, board-certified dermatologists,” Sung said.

It’s one thing to buy a fake designer bag, said Sung, “but this is a drug, and is it really worth it? I think the marketplace has created a situation where there’s actually room for counterfeits.”

Overall, you are more than likely safe from any bad reactions if you’re getting standard, real Botox. But if you notice symptoms like difficulty breathing, vision changes, drooping eyelids, fatigue or muscle weakness following your Botox injection, you should contact your doctor as soon as possible. These side effects can occur hours to weeks after injection, according to Medical News Today.

“I can’t give you a 100% bulletproof formula on how to make sure that your Botox is real because you could go to even a licensed person who has purchased unlicensed product,” Singh said. “The best advice is to go to a reputable source, treat it like a medical procedure and avoid anyone who is coming to your home or doing it in a spa.”