"Botox is safe when used properly - but the checks exist for a reason," said Cheryl Barton, lead nurse at the Aesthetika clinic near Sheffield, who often gives expert evidence in malpractice cases.
"The truth is that shortcuts by registered and regulated medical professionals who should know better are an open secret in the industry. Prescribers are supposed to see patients face to face and issue a valid prescription - but too often they don't."
Without those safeguards, explained Barton, prescribers can miss vital conditions that make treatment unsafe, or channel counterfeit and unlicensed products on to the market. Misuse of botulinum toxin can cause serious harm - from headaches and blurred vision to, in rare cases, respiratory failure or even death.
Official figures back up her concerns. The UK medicines regulator recorded 52 suspected Botox-related complications in 2019, rising to 225 in 2024, with 141 already logged this year. Since 2015, 12 deaths have been recorded.
For patients such as Antonia Hannah, from Twickenham, west London, the impact can be devastating. She booked Botox as a birthday treat, but the qualified practitioner gave her no proper consultation, asked no questions about her medical history and failed to assess whether the treatment was suitable.
Within days her eyelid had drooped and swelled. "It was constant discomfort and pain, like glass in your eyes," she said. "I'd be out shopping with my daughter, glance in a mirror, and just burst into tears."