Does Freezing Botox Change It?

I have been told that a local doctor only injects Botox in his patients on the day he gets it in....other offices have it all the time...because they freeze it. Does freezing the product in the doctor's office change it or make it less effective?

Doctor Answers 16

Botox storage

Botox comes as a powder and is shipped on dry ice so it is frozen. It's not as if a physician gets it fresh and then can freeze it. Once the physician needs the Botox powder is mixed with a sterile liquid to make a solution. That solution is then kept refrigerated until the next dose is needed and in busy practices this might be less than one day. An expiration date or the date mixed is written on the bottle. Using fresh mixed or refrigerated Botox has not made any clinical difference when the stored time is less than two weeks.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews


Thank you for your question.

No, Botox does not need to be used the same day that it is shipped to the doctor. Please make sure that you are having a certified doctor perform the injections.  There are dentists, nurses, aestheticians, etc. who do Botox injections... be careful!

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Storage of Botox

Whether Botox is stored in a fridge or freezer, it works consistently well, even if stored for many weeks. It certainly does not need to be injected the same day it is received, though the sooner it is injected after it is reconstituted with saline, the better.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon
4.8 out of 5 stars 50 reviews

Botox is Freeze Dried Not Frozen

Hi Tilly's Mom.  Botox is freeze dried when it is received and not frozen.  Like any other pharmaceutical product, Botox has a useful shelf life and this shelf life changes once saline solution is added (reconstitution).  

As long as the Botox has not expired (which it rarely will at any office that uses it regularly), using it on the same day is no different than using it days or weeks later, especially if it has not been reconstituted.

It sounds like the MD that is purporting to use it on the same day is trying to use this as a marketing tactic to scare consumers into thinking this is the only way it will be useful.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Does Freezing Botox Change It?

I have used Botox for over 20 years and it comes from the company as a freeze dried powder that needs to be turned into a solution prior to injection.  Once reconstituted, it's recommened that the solution be refrigerated but not frozen.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Freezing Botox

It sounds like you may have some confusing information.  Botox is shipped from the manufacturer on dry ice.  It is then kept in the refrigerator at the recommended temperature until it is reconstituted and used.  Reconstituting it, means that you are mixing the dry powder in the vial with saline so that it can be injected with a syringe.  In general, the Botox should then be used within four hours, but some studies have shown that it last much longer.  In our office, we open a new vial for each patient and reconstitute it right infront of them and then inject it.  That way, the patient knows that they are getting the freshest Botox available and also that they are getting the whole vial.  It would be  inpracticel and unnecessary to use the Botox the day it arrives from the manufacturer. 


Good Luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Freezing Botox and its Effectiveness

Botox Cosmetic  comes as a sterile, vacuum-dried powder in a vial. It is delivered from Allergan, its maufacturer, on dry ice. It can be stored in a refrigerator or freezer until use, when it is reconstituted with preservative-free or  bacteriostatic saline. 

Storing Botox as a vacuum-dried powder, does not reduce its efficacy once it is reconstituted. Once reconstituted, refrigerated Botox can be used within a 2 weeks period without losing efficacy. Reconstituted Botox should not be frozen.


Anifat Balogun, MD
Seattle Otolaryngologist

Why we used to have "Botox Days"

When Botox first came out, we used to have Botox Days--we thought that it had to be mixed fresh and used that day or it would lose its potency. (As you have read, it comes to us as a freeze-dried product that is kept frozen until it is reconstituted with saline.) What studies have shown is that its potency will remain the same for two weeks or more. So, most of us keep it refrigerated (not frozen!) after reconstitution and use it for the next two weeks.

I suspect if a doctor is still doing Botox Days, they either have a very small volume of Botox patients, or they are uninformed.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 39 reviews

You don't have your facts right.

BOTOX comes as a dry powder in a tiny sealed vial.  It is shipped frozen but it can also simply be kept cold.  Once reconstitute, Allergan, the manufacture has told the FDA that the product should be used within 4 hours or discarded.  However, they have also told doctors that the product is good for many weeks if kept in a refrigerator once reconstituted with saline for injection.  Practically most offices rapidly use up their reconstituted BOTOX so it is virtually never stored once reconstituted.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Does freezing Botox decrease its effectiveness?

Botox comes in 50 or 100 unit vials that contain vacuum-dried botulinum toxin A complex.  There are expiration dates on the package.  We keep the un-reconstituted vials in their packaging in the freezer.  Botox has been shown to be fully effective up to six weeks after reconstitution with bacteriostatic saline. Once reconstituted, the unused Botox is kept in the refrigerator.  So it does not need to be used the day it is received.

Emily Altman, MD
Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.