By Dr Stephanie Lam, Plastic Surgeon, Hong Kong

The recent six cases of suspected iatrogenic botulism in Hong Kong has raised the awareness of dangers of injectable products amongst the general population once again. The majority of these patients received their injections in China, by doctors or non-doctors. One patient brought a vial of toxin back from China, injected herself and her friend, and both subsequently developed symptoms of botulism with weakness, slurred speech and shortness of breath. The current trend of injecting bigger muscle groups over the arms or the lower limbs, which require a bigger dose of toxins, certainly is quite worrisome as well.

There is not a big market for counterfeit products in Hong Kong. However, since the sales of hyaluronic acid, which is considered a medical device here, is not regulated, we do have a big problem with parallel imports. Parallel imports, for those who are not familiar with the term, refers to genuine goods imported by companies other than the sole distributor or manufacturer, from countries that may be selling the product at a lower price or cheaper due to the exchange rate. These goods, although they are genuine, could be transported in sub-optimal conditions resulting in possible alterations of the product itself.

Manufacturers or sole distributors try to fight this by issuing “genuine goods” certificates to doctors who buy from them. But there is nothing stopping the high volume users from buying a small number of products from the legitimate source, just to get the certificate, and the rest from parallel good sellers.

Many Hong Kong patients travel to China to have injectable treatments because it is often cheaper there. In China, the problem of counterfeit products is much bigger because of the restrictions the government has placed on imported goods. At the time of writing this article, only Restylane without lidocaine and Juvederm Ultra without lidocaine are approved imported injectables available in China. However, it is quite common to be able to see clinics or hospitals offering a full range of products from various manufacturers. Now whether these are parallel imports or fake products, only they will know. I have certainly seen patients who were told that they were being injected with hyaluronic acid that does not resolve at all even after 2-3 years and this material also does not seem to be affected by repeated high doses of hyaluronidase.

Of course injectables are not the only category of products susceptible to be faked. In particular, the consumables used in various energy-based skin tightening devices can also be faked. Normally, these consumables, typically treatment heads, will have a limited number of shots or lines after which it is no longer usable. But now and again, I would receive e-mails touting rechargeable or even limitless treatment heads at a discounted price compared to the originals.