Is it okay to open up a vial of botox with a bottle opener to get the last drops out?

Thank you for your question in regards to Botox. This is a very common practice that is done by medical professionals who inject Botox. As long as it was performed in a sterile manor, I wouldn't have any concerns. To be sure, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

As long as it was done in sanitary and sterile conditions by a licensed and certified medical professional, then this is fine to do.

This is common practice. It is very challenging to get the last bit of botox out of the vial, most often people use bottle openers to get it open as long as done in "clean" conditions.  Best, Dr. Emer.