<i>Notes From the Field</i> : Severe Illnesses After Self-Injection of Botulinum Toxin Purchased Online — New York, Texas, and Wisconsin, 2025

Cosmetic botulinum neurotoxin (BoNT) can be used to temporarily diminish facial wrinkles (1); however, injection for this purpose occasionally results in localized paralytic effects, even when BoNT that is approved by the Food and Drug Administration (FDA) and purchased from authorized sources is administered by licensed and trained medical professionals. Rarely, improperly procured or administered BoNT can lead to severe illness. During May-June 2025, hospital clinicians and health departments in New York, Texas, and Wisconsin each alerted CDC about a person in their jurisdiction who experienced severe illness after self-injecting cosmetic BoNT that was purchased online.* None of the three patients met their state's requirements for purchasing or administering BoNT; no link was reported among the patients. This report describes the patients' characteristics, treatment, and outcomes. This activity was reviewed by CDC, deemed not research, and conducted consistent with applicable federal law and CDC policy.^†.