Stale Botox?

How Botox Is Mixed and Given

How Long Does Botox Last?

How Can You Ensure That You’re Getting Fresh Botox?

The Bottom Line-  Go To a Trustworthy Injector

Stale Botox?

You know that a tortilla chip is stale when it’s chewy.  Ugh.  And obviously your bagel is stale when you can pound a nail with it.  But did you know that your Botox can go stale too?

Unfortunately, it’s true.  The Botox injections that you’ve been receiving may not have been the freshest Botox possible.  Read on to learn why this is important and one of the secrets of the Plastic Surgery World.

How Botox Is Delivered, Mixed, and Given

As you know, Botox is an uber-popular procedure, and getting Botox injections will stave off the wrinkles in your face.   Muscles that can’t tense up, can’t create wrinkles and deep furrows.  You’ll still have facial expression, but your wrinkles look better – less deep, and some of them will fade and go away.

However, this whole magic show only happens when the goods are fresh.  There are several steps to ensure that your Botox is as fresh as possible.  Botox is shipped as a dry powder in an insulated container with dry ice, to preserve the temperature.  Once received, it needs to be kept frozen until it’s mixed with solution.

Once I pull the Botox out of the freezer, then I mix it sterile saline solution (salt water), and then inject it immediately.  The amount that is not used is kept in a refrigerator, and can be used within about 1 week with the SAME effectiveness.

If any of these steps aren’t followed, you could be getting “stale” Botox.  Of course, I avoid the following behind-the-scenes, mistakes:

–       the Botox dry powder is not kept chilled

–       the mixed Botox with saline solution is kept at room temperature too long after mixing, so it’s no longer as effective

–       the Botox in solution is kept in a refrigerator that’s not cold enough

–       the Botox is kept longer than a week or so, and is still injected

What Happens if You Get Injected with Stale Botox?

If you get injected with stale Botox, you won’t know by the initial results.  Stale Botox will still work to weaken your facial muscles, and your wrinkles will look better… just not as good as they could look.  You may have more muscle activity and deeper wrinkles than usual.

Another thing – your Botox will probably not last the usual 3-4 months, and may start to fade away more quickly, possibly in 1-2 months.

Get Botox made and shipped within the country

As a plastic surgeon in San Francisco, CA, I only order Botox made by Allergan in the USA, and shipped within the USA.  I am constantly receiving faxes and emails from Botox vendors in Canada, Mexico, and elsewhere to buy Botox at a lower cost.

Although Allergan does have subsidiaries throughout the world, and yes, the prices from a wholesale pharmacy may be cheaper than what I could get from Allergan in the USA, I stick to the local stuff.

If I ordered from abroad, how could I know if the Botox was really fresh?  What if it got held up in customs?  There would be no way to know if the Botox was counterfeit or shipped warm.  Well, that is, I wouldn’t know until I injected a patient with it – and I’m not going to take a risk with my patients, nor am I going to risk my reputation, by using potentially stale Botox.

I’m not slamming other countries or their pharmacies.   If you’re in Canada, why would your order Botox from the US?  Hey, even if you get authentic Botox from Allergan or a legitimate vendor, by the time it gets through Canadian customs, it may no longer be fresh or frozen.  I’m just illuminating a concern that customs and shipping companies may not be able to overnight deliver authentic Botox across international borders.

Two-day-old Botox, or (yikes) older Botox, will lose it’s potency, and simply not work as well or last as long as Botox that undergoes overnight, less than 24 hour cold delivery.

How Can You Ensure That You’re Getting Fresh Botox?

The bottom line: you have to go to an honest Botox injector.

In my office, we’re constantly getting fresh Botox.  (Just ask my office staff how often we’re getting dry ice insulated boxes, direct from Allergan, from the delivery guy!)

I’m injecting so much of the stuff, my Botox is less than 24 hours, and never a week old.  In fact, I rarely use Botox that’s even older than an hour or two, because I’m a busy injector.

Whenever I need to mix up Botox, I do it in front my of patients, and they get a little show on how I mix it, and they know that I’m giving the freshest Botox possible.  Several of my more knowledgeable patients have commented to me that they like watching me mix it-  because they know that they’re the freshest Botox possible.

A Word On “Botox Parties

Another secret subtlety; if you go to a “Botox Party” at someone’s house, you should be able to see that the Botox is frozen, that it’s mixed in front of you, and that in between patients, your Botox injector keeps the mixed liquid Botox cold.

Off-site parties may not have access to a great freezer, a cold refrigerator, or the most sterile and clean mixing environment.

I do offer Botox and dermal filler parties and events, but at my office-  and never at a nightclub.

How can you be sure that you’re NOT getting stale Botox?

Honestly, in this fast paced industry, anything can happen.  But I personally couldn’t live with myself if I provided stale or old Botox.   As a higher volume Botox practice, with frequent patients and injections, you can rest assured that in my office you’re getting Botox made in the USA, shipped directly from Allergan HQ, that is stored properly, mixed properly, and ethically given and injected in the proper amounts.

Now that you know the inside scoop on Botox, you can ask, in a respectful manner, these questions to your Botox injector.

Is the Botox made and shipped within the USA?  (or within your country?)

Has the Botox been stored properly?

Can you mix the Botox in front of me, or can you assure me that it’s less than a week old, or even a couple of minutes old?

Any great Botox injector will be happy to assure you that you’re not getting stale Botox.  Any hedging or unusual body language may (read: SHOULD) cause you to switch Botox injectors.

Any questions or comments, now that I’ve revealed one of plastic surgery’s dark secrets, that of stale Botox?  I’ve written a book, “Botox University”, where you can educate yourself on the matter.  Better yet, educate others too, by sharing this article, with the social media buttons below.

Finally, if you’d like a Botox injection of NON stale Botox, contact me at or 415 362 1846, and you’ll get the freshest stuff available.


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