Health officials in New York are warning the public against Botox injections from non-medical providers, after three people suffered from botulism, a disease caused by toxins that induce muscle paralysis, difficulty breathing and even death.

The Botox industry is infamously under-regulated. A UK survey found that more than two-thirds of cosmetic practitioners who administer injections are not qualified medical doctors, but the truth is that just about anyone can inject filler: there are currently no national minimum standards for practitioner training or regulated qualifications. We do not know exactly how many people have Botox or fillers each year, nor do we have any age-specific data to reveal the magnitude of the trend amongst young people. In America it is estimated that the use of Botox among those aged 19-34 rose by 87% between 2013-2018.

Greater legislation and regulation in the injectables industry is undoubtedly needed, as well as more awareness of the potentially dangerous side-effects: pain, headaches, swelling, bruising, infection, face paralysis, permanent disfigurement. We can crack down on dodgy backstreet practitioners, but the truth is that if demand is there, then supply will follow. Therefore we need to ask ourselves what is driving women (and it is predominantly women) to seek out black-market Botox in the first place, in spite of the horror stories of drooping eyelids and half-frozen faces.

Botox is an expensive habit: the cost usually varies from around £100 to £350 per treatment, depending on the clinic and the area being treated. It’s also an addictive habit: Botox is cleared from the body in about three to six months, and so customers have to keep coming back to maintain their smoothed-over skin and flawless features.

Much is made of how Botox is a gateway drug, leading to more invasive, permanent, complicated procedures, but it’s virtually impossible to do in moderation. Once you start to tamper and tweak, it’s difficult to stop: if one part of your face is eerily smooth, this will draw attention to other bits which aren’t, and once muscles start to atrophy then other muscles work harder, causing more lines. So you have more and more, and soon you have an entirely new, entirely waxy face: not so much an act of defiance against ageing as an act of defeat.

In their pursuit of the beauty and glamour and the value that supposedly comes with youth, women either spend thousands on the real deal, sometimes even falling into debt to achieve a real-life filtered face, or they turn to cheaper, unregulated alternatives, sometimes even buying fake facial fillers online. The fact that women are willing to risk being potentially scarred for life to chase a beauty standard is not a public health crisis, but rather a mental health crisis. Social media may tell young girls that this is an act of self-love or self-care, but it’s an act of self-sabotage.

It might go against the “love yourself” mantra which Gen Z and millennials love to espouse, but we desperately need online counter-narratives to the “Botox isn’t that bad” brigade. For too many, the journey through “follow, filter, filler” is irresistible, and our obsession with appearance — magnified by constantly seeing ourselves and others via screen — means we have ended up in a situation where paralysing your facial muscles is no longer seen as drastic but desirable.

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