A seemingly simple "wrinkle removal injection" actually allowed 42 year old Ms. Yang to spend a full 18 days in the ICU. Previously, she purchased botulinum toxin preparations online to lighten wrinkles around her eyes and received injections at a small clinic. Unexpectedly, just two days later, she experienced difficulty opening her eyes and blurred vision. Six days later, she was unable to eat independently and had to rely on nasogastric feeding to maintain nutrition. She was urgently referred to the Medical Aesthetics Department of the Second Hospital of Heilongjiang Province. When she was admitted, she had severe ptosis in both eyes and limited mouth opening. The next day, she fell into a moderate coma and respiratory failure. This is not an isolated case. From June 2024 to March 2026, Li Guoliang, member of the Youth Committee of the Medical Aesthetics and Beauty Credit Association of the Chinese Medical Association and director of the Medical Aesthetics Department of the Second Hospital of Heilongjiang Province, and his team have treated more than 330 hospitalized patients with botulinum toxin type A poisoning caused by cosmetic injections, including 4 critically ill patients who had to undergo tracheotomy. Among the poisoned individuals, 97% are women, and most of them receive injections in private clinics or studios. Botulinum toxin, regarded as a "medical beauty artifact," is essentially a highly toxic substance. Li Guoliang introduced that botulinum toxin is a biological toxin secreted by Clostridium botulinum, with a toxicity about 10 million times that of arsenic, and 50 nanograms can be fatal. Its principle of action is to temporarily relax the muscles by blocking the release of acetylcholine at the junction of nerves and muscles, thereby achieving wrinkle removal effect. The type A botulinum toxin currently used in the field of medical aesthetics is a strictly regulated prescription drug, and only qualified practicing physicians have the authority to prescribe medication. Li Guoliang analyzed that most operators in informal institutions lack the ability to control dosage, have insufficient understanding of facial anatomy, and do not have the ability to distinguish the authenticity of drugs. In clinical practice, 98% of poisoned individuals will experience cranial nerve dysfunction, 93% will present with downward paralysis, 85% will experience difficulty swallowing, 81% will experience ptosis, and 65% will experience shortness of breath. The symptoms start from the eyes, gradually develop into articulation disorders, limb weakness, and ultimately involve respiratory muscles, endangering life. ”Li Guoliang said. The premise of beauty is safety. Scientific injection of botulinum toxin requires guarding three lines of defense. The first line of defense is to choose a reputable medical institution. Botulinum toxin injection belongs to medical beauty projects and must be carried out in formal medical beauty institutions or hospitals that have obtained a "Medical Institution Practice License". Private studios and individual beauty salons lack sterile operating environments and professional emergency equipment, making it impossible to effectively treat emergencies. The second line of defense is to use legitimate drugs and scan the code for traceability. Legitimate botulinum toxin products all have national approval numbers and traceability codes. Applicants have the right to request doctors to present complete packaging and scan the code on site to verify authenticity before injection. Products with unknown sources, no packaging, and no traceable source code must not be used. The third line of defense is operated by qualified professional physicians. The operator must hold a physician qualification certificate, a practicing certificate, and possess medical beauty related qualifications for chief diagnosis. Medical beauty can become beautiful, but it must not come at the cost of safety. Only by guarding these three lines of defense can beauty and health go hand in hand. ”(New Society)