What had I been injected with?
No matter how much I traveled, I couldn’t outrun time.
Silencing my morning alarm, I slumped from the bed of my Albanian apartment and began my day. But that day was different. Sometime between scrubbing sleep from my face and dermarolling a thin patch of hair, it dawned on me.
At the end of the year, I’d turn 40.
I remembered my parents turning 40. They had three kids, a house, and friends to chide them over their age. At 39, I had an Xbox and a three-legged dog.
Previously, a dermatologist back in Buenos Aires said I looked good for my age, though she might have also been trying to sell me a facial laser treatment. I didn’t feel old either. Sure, my neck occasionally tweaked out at the gym, and my back would pop if I sat on the toilet wrong, but that happened to everyone. Right?
Still, I knew if I found myself sitting alone when my 40th birthday hit in December, all sorts of depressive thoughts would creep in, and I wanted to prevent that. Maybe an “I’m still sexy at 40” photoshoot with pics nobody but me would ever see would help. Just a little something to feel better about myself.
It was May, so I had time. I could blast away pounds with the leg press and Jazzersize on my own, but I’d need help with the crow’s feet clawing out the sides of my eyes. My “I’m still sexy at 40” photos wouldn’t look great if my face resembled a weathered catcher’s mitt.
On my daily walks to the gym in Tirana, Albania, I’d pass a dozen or more cosmetic surgery offices. Signs advertising affordable medical care welcomed travelers landing at the airport. Phone numbers for people interested in perfect noses and improved hairlines were slapped on buses, while mailers for discount facelifts were frequently left outside my apartment door.
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I was no stranger to international medical care. I received regular health screenings and bloodwork in Argentina, and visited Mexico for dental care more than a few times. Outside of dated Good Housekeeping magazines in the lobby, the only differences between U.S. and Latin American healthcare providers were Spanish forms and thousands in savings.
After all, what better time to test a new medical service in a developing country than right before a wedding?
Before my move to Albania, I had no clue the nation wanted to position itself as a go-to medical tourism destination. But several months in, I couldn’t walk a city block without some kind of advertisement–almost always in English. Fortune Magazine did a write-up on Albania’s push to lure tourists to the country for cosmetic care, while Vox reported the country brought in roughly €250 million ($288 million) in 2023 alone (not an insignificant amount for a country whose GDP was $24B in 2023). With a trip to the States for a friend’s wedding a few weeks away, I decided to give Botox a try. After all, what better time to test a new medical service in a developing country than right before a wedding?
Sifting through Google for top-reviewed cosmetic clinics, I booked an appointment. The Botox injections would cost €250 ($288), regardless of how many units were used (just as long as I didn’t require more than the 125 units in a single vial).
At the facility, which would have looked right at home in Los Angeles or Miami, the staff cleaned my skin, lathered it with a numbing cream, then injected away, though I think they jumped the gun a little–the numbing didn’t actually kick in until I was back at the apartment.
Satisfied with the results and the trimming of my crow’s feet, I contacted the same service provider months later in October. That round of injections would last me through my 40th birthday and whatever “I’m still sexy” photoshoot I decided on.
The clinic responded that they were no longer offering Botox and instead pushed a variety of fillers. I declined.
Strange. What cosmetic offices didn’t offer the world’s most used cosmetic product? So I contacted a second office. A third. Fourth. Fifth. Nobody offered the injections any longer.
Something felt off.
It didn’t take long to uncover the problem. A year earlier, over 30 cosmetic offices in Tirana were busted for using either smuggled or counterfeit Botox. These weren’t shady, back-alley spots with tinted windows and flickering fluorescent lights overhead. These were Albania’s premier providers. As it turned out, Botox was an unregulated medical product, which meant there was no government oversight on its import. In short, the use of Botox in Albania was illegal.
It also meant that my facial injections months earlier were either smuggled, counterfeit (made in an unregulated lab), or real Botox cut with something else.
Whatever was used on me, I didn’t like it. I had visions of Walter White cooking up Botox in an RV somewhere, only for it to end up in the back room of my service provider. According to the FDA, possible side effects of counterfeit Botox include systemic botulism, a rare yet potentially life-threatening condition if not immediately treated.
Thankfully, that didn’t happen. Those would not have been good 40th “I’m sexy” photos. Doubling back with the original service provider, they wouldn’t answer any specific questions, instead noting, “It is a service that here in Albania is not offered.” Another clinic said, “Due to legal reasons, we do not offer the service.”
Even the Google reviews for Botox services had vanished. I didn’t even know you could expunge those.
In 2022, the Forensic Science International Journal published a peer-reviewed paper about the dangers of fake medicine and substandard medical procedures. In low to middle-income countries, one in 10 procedures relied on counterfeit medication. The “Botox” injection I received fell into that category. Thankfully, I did not suffer any adverse side effects. All of the fillers the cosmetic offices recommended were on the up-and-up. There had been no police raids to nab lip or forehead fillers, and the government regulates those products. I found it strange that the Albanian government regulated fillers and not Botox, but then again, questioning how governments work is a fool’s errand at times.
Don’t leave any stones unturned, because if you have severe reactions to counterfeit drugs or products, you’ll be stuck with a massive medical bill back in the U.S. trying to fix the issue.
I did check with several Albanian expat Facebook communities, and surprisingly, nobody had any knowledge of the lack of government oversight on Botox. Many stated they received the injections in months past with no adverse effects. Nobody seemed to mind not knowing what was actually being used on them as long as it worked. I’m not sure what was more concerning: people not caring about what drugs were used on them (especially considering potential side effects), or medical providers not informing their patients that what they were doing was illegal.
This is not intended to frighten anyone from seeking medical attention in another country. Exceptional care can be found outside of the United States for a fraction of the price. In fact, the rest of my experiences were all exceptional. These international services allow you to correct cosmetic issues robbing you of your confidence, restore your hairline, waistline, or bustline, and even give you access to treatments not yet approved in the U.S. (former NBA superstar Kobe Bryant famously went to Germany for platelet-rich-plasma injection therapy as the FDA hadn’t yet approved the product). Just make sure to do your due diligence and investigate not only the service provider, but also the service within the country.
For this, a little research goes a long way. Beyond looking up potential service providers, search the medical treatment within the country and look for any news stories associated with the topic. Here you’ll see if there have been any product recalls, cosmetic office raids, and so on. While you’re at it, do a deep dive on not only the service provider you’re interested in, but also the doctors on staff. Find out where they received their medical degrees. This info should be readily available on the service provider’s website. If not, contact the provider (usually via WhatsApp) and ask. If they won’t tell you, it’s a major red flag, and move on to another option. Don’t leave any stones unturned, because if you have severe reactions to counterfeit drugs or products, you’ll be stuck with a massive medical bill back in the U.S. trying to fix the issue (which entirely defeats the purpose of going abroad for treatments in the first place).
In terms of determining the authenticity of a product–that’s going to be very difficult. You’ve done your research on the service and the country, so you know it’s legal and the clinic seems on the up and up. Really, the only other thing you can do is to see the product (i.e. filler or Botox) before it is used. Watch them break the seal on the vial and ask to see the expiration dates. At the very least, you will know the product is new and hasn’t expired.
With some extra research, you can go into an international medical service with peace of mind knowing you’ll receive excellent care. And if you ever have any doubts, walk away. It’s not worth a roll of the dice. After all, there are far worse things in life than looking like a weathered catcher’s mitt for your 40th birthday.
