BACKGROUND Botulinum toxin A is considered to be an extremely fragile molecule, with recom-
mended usage of some reconstituted botulinum toxin A formulations within 4 hours of reconstitution.
Extreme caution is recommended to avoid agitation of the vial.
OBJECTIVE To determine whether the effect of reconstituted botulinum toxin A is maintained even
when it is agitated vigorously.
DESIGN Experimental, comparative, animal study.
PARTICIPANTS Sixty-four white Swiss Webster mice, aged 2 to 4 weeks, arranged in eight separate groups.
INTERVENTION Reconstituted onabotulinumtoxinA (2.5 U/0.1 mL) was placed securely in a battery-
operated mechanized apparatus. The apparatus with the vial was placed in the refrigerator, and the
apparatus continuously inverted and straightened the onabotulinumtoxinA vial 30 times a minute. Eight
mice were each injected intraperitoneally with 1 U of the agitated onabotulinumtoxinA on days 1, 3, 5, 7,
14, 21, 28, and 42, to evaluate the efficacy of the continuously agitated onabotulinumtoxinA.
MAIN OUTCOME MEASURE Death of the mice, demonstrating efficacy of the onabotulinumtoxinA
RESULTS Half of each group of mice (4/8 mice) died within 48 hours of the injection (range 16–48
CONCLUSION The effect of botulinum toxin type A is maintained even when it is agitated vigorously for
up to 6 weeks.
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Dr. Debraj Shome is Director and Co founder of The Esthetic Clinics. He has been rated amongst the top surgeons in India by multiple agencies. The Esthetic Clinics patients include many international and national celebrities who prefer to opt for facial cosmetic surgery and facial plastic surgery in Mumbai because The Esthetic Clinics has its headquarters there.