A handful of years ago New Hampshire was hit with severe snow and ice storms, resulting in widespread power outages across the state. As a result, there was no refrigeration for 5 to 7 days and we had several vials of Botox on hand. Worried about the effect of lack of refrigeration, I called Allergan. Their answer- go ahead and use it it's fine and does NOT need to be thrown out or replaced. In their EXACT words, "We learned something during Hurricane Katrina." That natural disaster of course left many many locations without power for extended periods of time. Botox vials which were affected were subsequently evaluated and used and there were no issues. I then asked, 'Well if that's the case why do you still ship it on dry ice?" They said well we have always done it that way so we're not going to change. We still recommend refrigeration (because that's what we have been saying previously) but we expect no problems in terms of the potency of your vials since they were not exposed to "extreme heat". I tested a vial out on myself, it worked as expected and the use of the other vials was also uneventful. We still refrigerate all of our toxins because, well, it's keeping it at a consistent temperature I guess!Best,Lisa Vuich, MD