Three women. One medical spa. One lot of a botulinum toxin product the FDA never approved. The CDC published the investigation on October 8, 2026. Dr. Frank Agullo on what it means, in his words.
What the CDC Found
| From the CDC report (MMWR, October 8, 2026) | |
|---|---|
| Where | A medical spa in Colorado, licensed provider |
| When | Injections December 2025 to January 2026 |
| Who | Three women, same lot of a non-FDA-approved product; upper brow, glabella or upper lip |
| Symptoms | Numbness and tingling, muscle weakness, voice changes, blurred vision, neck stiffness, within 24 hours |
| Outcome | All three recovered; one sought outpatient care |
| Did they know | None of the three knew the product was not FDA approved |
| Also found on site | Product bought from an online supplier, single-dose vials used for several patients, a preservative diluent, poor temperature monitoring, reconstituted vials used past their date |
The full report is on the CDC site.
What a Fake Looks Like From the Exam Room
Have you seen a patient harmed by a counterfeit or unapproved toxin, or by a bad injector?
Dr. Agullo: “The danger with counterfeit products is that we only find out because they go to the ED because of severe life threatening complications. Some counterfeit products result in no result at all because they do not contain the botulinum toxin. We see a good number of patients where the botulinum toxin is incorrectly applied resulting in eyelid droopiness, brow droopiness, and uneven smiles.”
No result, or the emergency room.
The Questions to Ask Anywhere
| Ask | A good answer |
|---|---|
| Where did this vial come from? | Direct from the manufacturer, not a discount pharmacy or an online supplier |
| Can I see the box? | Sealed, holographic seal, lot number on the box matching the vial |
| Where was it stored? | A monitored medical refrigerator |
| Who is injecting? | A registered aesthetic nurse or nurse practitioner supervised by a physician, or the physician |
| Is this vial mine? | One single-dose vial is not shared between patients |
Dr. Agullo, in the Daily Mail on cheap injectables: “That’s not a discount. That’s paying with risk instead of dollars.”
How Southwest Plastic Surgery Knows Its Vial Is Real
What does the practice do to make sure the toxin in the syringe is the real thing?
Dr. Agullo: “We buy directly from the manufacturers, Galderma, Allergan, and Evolus. The toxin is shipped to us directly from them in temperature controlled containers. The vials are stored in a medical temperature controlled refrigerator that is monitored 24 hours a day for temperature variations. Expiration dates are checked prior to administration and discarded if needed. We have so high volume of toxin patients that this rarely happens and the botulinum toxin is usually very far from the expiration date.”
And the paperwork?
Dr. Agullo: “We record the lot number and toxin information in every chart and encounter. Vials come sealed in a box with holograms. The lot number on the box matches the vial. All the toxins are reconstituted according to manufacturer FDA approved instruction. We do not use a middle man or discount pharmacy to order our toxins.”
Who injects?
Dr. Agullo: “Botulinum toxin are reconstituted and administered by registered aesthetic nurses, nurse practitioners supervised by Dr. Agullo. Dr. Agullo also administers the treatments. Patients can see the vial at any time.”
Ask to see the vial.
FAQ
Is the toxin at Southwest Plastic Surgery FDA approved?
“We buy directly from the manufacturers, Galderma, Allergan, and Evolus.”
Can I see the vial before my treatment?
“Patients can see the vial at any time.”
Who injects at the med spa?
By “registered aesthetic nurses, nurse practitioners supervised by Dr. Agullo. Dr. Agullo also administers the treatments.”
What happens if a fake toxin is injected?
“Some counterfeit products result in no result at all because they do not contain the botulinum toxin.” The other outcome is the emergency department.
Why Choose Dr. Agullo
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years, 2014 through 2026. The MedSpa at Southwest Plastic Surgery is physician-led and buys every toxin direct from the manufacturer.
Ready to Talk?
Botox, Dysport and Jeuveau at the Med Spa, from a sealed box, in a monitored refrigerator, injected by a nurse Dr. Agullo supervises or by Dr. Agullo.
Call (915) 590-7900, text 1-866-814-0038, or contact Southwest Plastic Surgery. #StayBeautiful
Find Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
