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Contact the Allergan company to find out. They have a most wonderfully supportive and academic science department. How many hours is satisfactory to be left at room temperature before dilution and storage, or restorage after delivery. The Botox is shipped on dry ice to protect it during transportation. It normally is unpacked and placed in a freezer before mixing with sterlie saline.
It is against Allergan's recommendations to use Botox that has not been stored at the appropriate temperature. You run the risk of delivering a treatment that may not be effective. While it is likely that it would be fine, if a patient that is paying for their product, you want to insure that it is efficacious.
Almost every office follows Allergan storage recommendations. The product is so expensive, there is no reason to leave this to change. However, it is clear that this product is actually much tougher that initially described by Allergan. It is likely that product left out on the counter will be just find, even for multiple days. Again, no office would be deviating from Allergan recommendations so the incentive to actually put this to the test does not exist. It is worth noting that Xeomin a competing botulinum toxin product requires no refrigeration.
Depending on how long the vial was left out, it is likely that the product is still acceptable to use but it could reduce the efficacy of the treatment you are offering to paying clients. Much like expiry date on a product, it is still good, but the active ingredients may become left effective.
It is possible that the unmixed Botox left out of refrigerator will lose it's effectiveness. If it was out for more than one hour, we will not use it. For best and most accurate answer to you question, call the manufacturer Allergan