The China Association of Plastics and Aesthetics has revealed that it believes 70 percent of the country’s Botox and hyaluronic acid, a type of dermal filler, to be either counterfeit or smuggled into China illegally, Sixth Tone’s sister publication The Paper reported Friday.

The association’s vice president, Cao Dequan, estimated that injection-based cosmetic treatments carried out according to industry standards were worth between 4 and 5 million yuan ($600,000 to $740,000) in 2016, though he added that the unofficial market was probably two or three times that size.

The National Health and Family Planning Commission’s section chief of the China Food and Drug Administration, Xing Luwei, told a reporter at The Paper that the current intractable state of the cosmetic medicine industry is largely a result of beauty salons carrying out procedures illegally. According to Xing, many consumers are unaware that beauty salons and medical cosmetic surgery organizations are not the same, and he went on to warn that even very simple injection treatments should be undertaken at a proper medical organization.

Until recently, because beauty salons are not registered as medical institutions, any malpractice could only be reported to the local industry and commerce department, which does not have the specialist knowledge to deal with such cases. However, consumers can now report beauty salons offering Botox injections to the local health and family planning commission.

Chen Guangyu, director of the plastic surgery hospital at the Chinese Academy of Medical Sciences, said at a conference dedicated to standardizing the cosmetic medicine industry that he stresses three points to his patients: choosing a proper medical institution, verifying that the doctor is properly qualified, and ensuring that the proper products are used. Chen added that he used to emphasize selecting a recognized medical institution as the foremost priority on this list, though he now believes that nonstandard products present the greatest risk to patients.

Several cases of Hong Kong residents getting sick after botched Botox treatments they received on the Chinese mainland made the news in 2016. The bacterial toxin botulin, which is used to produce Botox, is highly toxic, and only very small amounts are used to produce the medical product. Overdoses can lead to serious complications associated with botulism, such as difficulty breathing, paralysis, and — in a small number of cases — even death.

Xing told The Paper that the China Food and Drug Administration has a launched a new initiative in major Chinese cities requiring beauty salons to display signs warning customers that they cannot administer subcutaneous treatments — those that break the skin — at this kind of establishment.

The average age of those opting to undergo cosmetic medical procedures in China is 35, in contrast to the U.S., where over 70 percent are 45 or older. According to Zhao Ping, China chairman of the Irish pharmaceutical firm Allergan, this means Chinese consumers are not as mature as some of their Western counterparts, and that medical institutions, businesses, and the government therefore need to do more to educate them.

The Paper reported Sunday that a 27-year-old woman had been taken to the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine after a surgery designed to fill in her temples with fat taken from her leg went wrong. During the procedure, which involves high-pressure injections of fat into skin near the eyes, one of the injections hit an artery in the woman’s head, causing a blockage that cut off the supply of blood to her brain. She is now paralyzed on the left side of her body.

The production of Botox is tightly regulated in China, where only two firms — Allergan and the Lanzhou Institute of Biological Products — are allowed to produce and distribute the drug. An employee at Allergan told The Paper that to ensure the stability of the drug, all of the materials are sourced in the U.S. and sent to Ireland for processing.

Botox cannot be kept at room temperature for more than nine consecutive hours, and if the right kind of climate-controlled transportation is not used, it can be very difficult to ensure the quality of the drug. According to the Allergan employee, China will introduce a QR code system for verifying the origin of Botox products beginning in the third quarter of this year.

Editor: David Paulk.

(Header image: A plastic surgeon administers an injection during a cosmetic procedure at a hospital in Guangzhou, Guangdong province, Apr. 15, 2012. IC)