These days you can get Botox anywhere: The spa, the salon or even the dentist.
Reports of unsanitary storage conditions and hairdressers and beauticians being able to inject patients with the paralyzing substance after less than half a day's training have resulted in not-so-pretty results for Brits hoping for a more youthful appearance.
In the U.S., all that's needed to inject Botox is a weekend's training. Sometimes, even less.
"Unless you know the person’s reputation, their skill level, and how many patients they treat a week, you have to be careful," said board-certified NYC plastic surgeon Dr. Steven Pearlman.
The injectable can be injected by a medical doctor or dentist, or by a physician’s assistant or registered nurse, so long as they’re under a doctor’s supervision. But doctors, PAs and nurses need only to take a weekend course in order to start administering Botox.
Dr. Joseph Niamtu, a board-certified oral maxillofacial surgeon and spokesperson for the American Academy of Cosmetic Surgery, calls the rules on who can inject Botox "lax."
Plastic surgeon can do botox training for a registered nurse or physician’s assistant how to inject Dysport, which is similar to Botox, in just a day. "You see people opening up spas and injecting Dysport and Botox and facial fillers," Fiorillo says.
"I’m starting to see a lot of dentists giving Botox, too."
Fiorillo says consumers need to pick someone who could handle any complications from the muscle paralyzing poison.
While many complications are temporary, they can be disfiguring -- sometimes permanently.
In 2008, 'Dancing with the Stars' viewers were horrified by actress Pricilla Presley's puffy face, which she admitted had been altered with injectables.
"Watching the show, you can see that a whole group of things has gone wrong," former president of the American Society for Dermatologic Surgery Dr. Rhoda Narins says "There is no movement at all in her face, no expression. No expert in Botox would leave you like that.