Botox: Shaken, not stirred

Purpose: To determine whether the effect of botulinum toxin type A is maintained and has the same duration when it is reconstituted vigorously. Methods: A prospective, double-blinded, randomized study was performed on 7 consecutive patients who underwent botulinum toxin type A injections to the forehead by one oculoplastic surgeon. Half of each patient's forehead was injected with botulinum toxin type A that had been gently reconstituted according to the package insert and the other half of the forehead was injected with botulinum toxin type A that had been reconstituted vigorously. Eyebrow excursion was measured in millimeters before injection, 1 week after injection, and every month after injection up to a total of 6 months. Results: Seven consecutive patients with an average age of 39.9 +/- 2.8 years were evaluated. There was no statistically significant difference in eyebrow excursion between the side of the forehead that had been injected with gently reconstituted botulinum toxin type A and the side that had been injected with vigorously reconstituted botulinum toxin type A at every visit. Conclusion: The effect of botulinum toxin type A is maintained and has the same duration when it is reconstituted vigorously compared with when it is reconstituted gently.