Massachusetts health officials are investigating four recent cases of suspected botulism connected to cosmetic injections of Botox.

The outbreak on the South Shore prompted the Department of Public Health to warn health care providers to be alert about symptoms . consistent with botulism occurring after botulinum toxin injections.

Botox is widely used for cosmetic purposes to reduce wrinkles and fine lines.

“While generally safe when administered by trained professionals, improper dosing, administration technique, or use of non-FDA-approved products may increase the risk of systemic botulism symptoms,” the DPH advisory said.

Botulism, though rare, can be fatal. It occurs when botulinum toxin enters the bloodstream and can produce effects far from the injection site, according to the

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