Law 491, IV drips and mycobacteria: the legacy of unregulated aesthetic medicine

Law 491 of 2025

On October 17, 2025 Panama enacted the law regulating filler and modeling substances. According to TVN and Telemetro, only "qualified physicians specialized in Dermatology or Plastic Surgery, accredited by the Technical Health Council" may apply them¹². Consent must include "possible complications, adverse effects and risks associated with the procedure"². Fines range from B/.10,000 to B/.50,000, with the maximum "for those who apply them without authorization from the Ministry of Health"¹. MINSA must issue an official list of permitted substances, updated every 90 days, and the State must care for victims, including "ASIA syndrome"¹.

The bill was partially vetoed by the Executive in December 2024. According to Panamá América, MINSA's view then was that "the only substances that should be used are those with sanitary registration"³.

Panamanian cases

In 2017 MINSA closed the Acqua Viva clinic after a patient died following a "rejuvenating vitamin treatment"; the judicial inspection found "expired medicines without sanitary registration", and the self-styled doctor advertised stem cells for Parkinson's, Alzheimer's and diabetes⁴. In 2018 surgeons warned that biopolymers might be offered in beauty clinics under other names; one surgeon called them "a time bomb"⁵.

The region: drips, clandestine clinics and aesthetic tirzepatide

• Sonora, Mexico (2026): 8 deaths after "vitamin drips" prepared individually. According to Publimetro, Cofepris's main preliminary hypothesis is that "the drips may have been contaminated with bacteria"; as of that report, the accused doctor was still a fugitive⁷⁸.
• Bogotá (2026): after a patient's death, authorities closed at least 11 clandestine clinics, with "operating rooms hidden in houses and residential apartments", and the city health department reported 282 complaints about these services between January 2025 and May 2026⁹.
• Colombia (2026): INVIMA flagged tirzepatide "advertised and sold in Colombia for aesthetic use" on Facebook, noting that "it is a medicine and not a product intended for aesthetic use"⁶.
• Colombia, Law 2316 of 2023: injecting non-permitted modeling substances is a crime; for a health professional, 96 to 180 months in prison¹⁰.

Mycobacteria: the infectious risk that keeps recurring

Nontuberculous mycobacterial infections after aesthetic injections appear again and again in Latin America:

• Caracas: 49 infections after mesotherapy, 81.6% confirmed as mycobacteria (M. abscessus, M. fortuitum), with treatment lasting 3 to 18 months; two products were contaminated¹².
• Barinas, Venezuela: at least 68 patients of the same practitioner and product; according to the authors, the largest mesotherapy-associated outbreak described at the time, likely due to a contaminated injectable product¹¹.
• Buenos Aires: 28 of 169 mesotherapy patients (17%) with lesions from an organism compatible with M. immunogenum; after the antiseptic solution in use was discarded, no further cases occurred¹³.
• Trujillo, Peru (2025): 7 women after various aesthetic procedures (DMAE, bicarbonate, PRP or hyaluronidase infiltrations, tensor threads and surgeries); the authors note few cases have been reported in Latin America, suggesting underdiagnosis¹⁴.
• Belo Horizonte (2024 outbreak, congress abstract published in 2026): 29 patients reported with rapidly growing mycobacterial infection after submental liposuction at a dental clinic; M. abscessus was isolated in all 13 analyzed¹⁵.

We found no published outbreak in Panama. In the regional reports, the source usually lies in the chain: contaminated injectable products, antiseptics or biosafety failures^11121315.