Bulgarian Botox injuries increase, authorities start investigations

The Bulgarian public prosecutor and the executive authority for the medical supervisory authority initiated an investigation after 27 women had suffered injuries from illegal botox injections in early 2025.

The investigation has again shown that control over the Bulgarian cosmetics industry must be strengthened.

The procedure with the botulinum toxin was carried out without medical supervision. The botulinum toxin that caused the injuries was imported from Turkey in Bulgaria in January, according to the first results of the investigation.

The medical lawyers Vili Kostadinova and Maria Sharkova announced Euractive that the cases of women who were violated by botulinum toxin injections show the need for an educational campaign in society.

Five cases in January

The first case was registered in Sofia at the end of January after doctors from the largest emergency hospital “Pirogov” saved a 30-year-old woman who was injected in a cosmetic studio Botox on January 8.

The young woman suffered from a severe form of iatrogenic botulism, which had symptoms such as striking eyelids, difficulties in swallowing and muscle weakness in the entire body.

Just three days later, four other women who had received Botox injections in the same cosmetic studio were recorded for emergency treatment in Pirogov.

The women had previously paid € 125 for the Botox injections. The subsequent investigation showed that the woman who managed the botox had no medical training.

“The woman who carried out these procedures a new photo.

The police announced that Russian citizen Arina Osipova had carried out the illegal procedures. As a dermatologist Dr. Goodz before, although she had no medical education.

Sick hospitals

According to the association's association, aesthetic medicine is expected to grow the scandal when more injured women turn to the police and the public prosecutor.

Bulgarian hospitals also proved to be insufficient to react.

Pirogov did not have an anti-botulinum serum and had to contact the Military Medical Academy, the country's largest military hospital, for the necessary care.

Iatrogenic botulism is a rare, but possibly life-threatening state that results from the use of botulinum neurotoxin. The progress of paretic changes can also lead to the participation of the respiratory muscles and even breathing failure, which requires the need for lung ventilation.

Need for regulation

Sharkova found that in 2023 several cases of iatrogenic botulism were associated with procedures carried out in Turkish hospitals that attract patients by offering lower prices as Bulgarian.

In April 2023, the European Center for Prevention and Control of Diseases warned of an outbreak of botulism cases in the EU due to the treatment of patients in hospitals in Izmir and Istanbul, Türkiye.

The cases were registered in Germany (30), Austria (1), France (1), Switzerland (2) and Turkey (53). At that time, the agency warned the EU citizen to avoid botulinum toxin treatment in Turkey.

“In my practice, I consulted specialists in the field of skin diseases that offer aesthetic services, and with them we have repeatedly proposed changes in the regulation, including the introduction of a new medical standard for skin diseases that would be clear and introduced and introduced and should be set up and introduce a new medical standard and clear and accurate rules and would distinguish medical aesthetic services from cosmetic services, “said Sharkova.

Not ready to examine

She added that they often reported the illegal provision of medical services from beauticians outside of hospitals to the Bulgarian health authorities, but the state has not shown any willingness to investigate.

“The use of botulinum toxin is a medical activity and [should] Are not listed by beauticians, hairdressers and manicurks with all respect for their profession. Botulinum toxin is a medical product and is used in addition to aesthetic procedures for a number of diseases, “commented Vili Kostadinova.

Sharkova added that there was weak control over the use of botulinum toxin by different people, especially those without medical training. She explained that botulinum toxin is a healing product prescribed by a doctor and should be registered in the country.

Unfortunately, it is imported via unknown channels in many places from countries outside the EU, and the origin of the product is not understandable. It is even possible that what is described on the label, such as the amount and concentration of the product, does not correspond to the actual product, said Sharkova Euractiv.

In recent years, Bulgaria has become an increasingly popular goal for health tourism. During the period of Christmas and New Year, many foreigners from European countries visit Bulgarian cosmetic studios that are attracted to the lower prices.

[Edited by Vasiliki Angouridi, Brian Maguire]