Consumer advocacy group Public Citizen recently made a formal request to the U.S. Food and Drug Administration (FDA) regarding Botox and similar injections. They asked for clearer warnings on these products because of the risk of a severe muscle-paralyzing sickness that could be dangerous.

Although these injections are used to remove wrinkles by targeting specific muscles with botulinum toxins, they already have a warning about the intended effect spreading to other areas. Public Citizen wants more explicit warnings that these bad effects could happen even when the injections are given at recommended doses. The group focused their request on six specific injections, including popular ones like Botox, Daxxify, Jeuveau, Myobloc, Dysport, and Xeomin. Additionally, Public Citizen asked the FDA to remove statements saying there are no serious side effects associated with the spread of the toxin from these treatments. They based their request on analyzing over 5,400 reports of deaths, life-threatening events, and other severe side effects related to these treatments. They studied the FDA’s adverse events database to find unusual side effects that might need more investigation or warnings on the products. The group’s main concern was to warn people clearly about a dangerous condition called systemic iatrogenic botulism, which causes muscle paralysis if the toxin spreads beyond where it should.