Will Botox Expire if Left Unchilled for 24 Hours?

We have used Botox onstage on my partner Drew Ordon's show, The Doctors.  We go through great pains to keep it cold but one time it was left out in our office overnight.  Unsure if it would work, we tried it out on our staff members.  It worked perfectly. We had very happy staff after that!

If your botox vials were not reconstituted there might be less of a concern to have been left in the cooler, but if it was diluted already and then left out, it could potentially increase the risk of bacterial growth.  If you are a licensed injector, then you should be able to contact Allergan and ask their scientific division your question. They may have privileged information that is not available on line.

Hello Western.  It's really impossible to say unless you knew how cool it was in the box.

The only way to really know the answer is to inject a patient and bring them back in a few days.  If they can't animate then it's still fine.

Thank you for your question Western cape. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.Botox comes in a powder in small vials on dry ice or a cold container. Upon receipt from the manufacturer the product is refrigerated or frozen until it is used. However, there have been reports that if the product is left at room temperature upon arrival for as long as 72 hours before refrigeration, there is no change in efficacy. Per the manufacturer’s guidelines, Botox is prepared by reconstituting the powder with preservative-free normal saline. I prepare the product using preserved saline which allows for greater comfort during injection and for the product to last longer. The guidelines call for use of 2.5 mL of saline for 100 units on Botox or 1.25 mL of saline for 50 units of Botox, which yields 4 units per 0.1 mL. I use these volumes, but some doctors prefer to use more or less to make the product more dilute or more concentrated. When the product is more dilute, it is easier to use smaller doses which are generally required in the lower face. On the other hand, when the product is more concentrated, it is less likely to spread. Because of variability in preparation, the terms used for dosing are units, not volume. This is because the same number of units can be administered with different volumes of product depending on the preparation. Recommended dosing is given in units, which is a measurement of activity seen in laboratory testing.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

I agree with the other docs in regards to bacteriostasis. Trial and error will safely tell if it's effective, and keep note of those patients who get this Botox to offer them retreatment if less effective than usual, but I would have a much lower threshold for the time I'd be willing to use a reconstituted vial before tossing. And I agree about using bacteriostatic saline especially in this case.

This has happened to me with a power outage, and the neurotoxin still worked. If it does not, let the patients know that they may need further injection (comped of course)

It is best to keep Botox refrigerated, but leaving it out of the refrigerator, especially since it was cooled part of the time, for one day should not affect its potency.

My guess? Yes. It will still work. I would only use, however, if preserved saline was used. Bacteria could grow at warmer temperatures if non-preserved saline was used to reconstitute. If the Botox does not work, you can always reinject. Let us know!

If you are a physician, I would suggest contacting Allergan directly as they will be able to assist you. Best of luck!

As long as the Botox was not exposed to heat it should be fine. If you are not satisfied with results after using this Botox, do supplemental injections on those patients.