The Early History of Botox

Botox is currently the most commonly performed cosmetic procedure in the United States with over 7 million people undergoing this non-invasive procedure in 2016 alone1. It's been almost 30 years since Botox has been used to treat wrinkles, and is now a household name.

Botox or botulinum toxin is considered a wonder drug of sorts by many patients and cosmetic dermatologists, but in its early days, both patients and medical professionals looked at Botox with skepticism. Botox, or botulinum toxin is the most powerful neurotoxin in the world2, and if you think about it, it is a rather unlikely substance for millions of people to pay good money to voluntarily inject themselves with. Today, we'll take a brief look at the early history of Botox.

As early as the 1820s, when germ theory still wasn't firmly established, a scientist studied a case of botulism that caused the death of several Germans who had eaten a bad sausage3. By 1900, several types of botulinum toxin were identified, and it was even considered for use in warfare during World War II. The first time Botox was studied for potential uses in medicine, rather than warfare was in the 60s and 70s, when they started testing processed forms of Botox on animals. During the 80s, Botox was used exclusively in the field of ophthalmology, not dermatology, to treat spasms of the eye. Botox's property to freeze the muscle movement; the deadly toxin causes paralysis, but used for treatment, this solution is diluted to obtain the desired effect without causing harm.

In 1987, a husband and wife team of Vancouver doctors, Dr. Alastair Carruthers and Dr. Jean Carruthers had come to Botox through serendipity. The original medical indication of Botox comes from the field of ophthalmology, to treat blepharospasm and Jean Carruthers, being a ophthalmologist, was practicing with Botox. The diluted botulinum solution paralyzes the movement of the muscles, controlling the spasms until the botulinum solution eventually wore off. The discovery came from Jean's patient being treated for eye problems, who complained that the forehead wasn't being injected. When asked why, the patient claimed that the Botox injections made her wrinkles go away, and that was the spark that started the discovery4. Yet, as with most discoveries, Botox didn't immediately take off into the giant that it now is. After the doctors initially tried it on their receptionist, and on themselves, there were still only a handful of patients, through word of mouth, that were willing to try it. Initially, it wasn't just the patients that were understandably skeptical; doctors were resistant, skeptical, or plain flabbergasted at the idea of injecting Botox into a wrinkle. The idea of injecting a toxin sounded too crazy, and for a cosmetic and medically unnecessary procedure no less. Initially, the growth was slow, as the Carruthers continued conducting clinical trials whenever they found patients were willing.

In 1990, there were 10 patients; the next year, there were 185. A glacial pace indeed. All in all, it took half a decade until Botox started to gain traction as it took many clinical trials, conferences, and most importantly, time for an initially very small group of treated patients to spread the good news through word of mouth. In 2002, the FDA approved Botox Cosmetic6 specific to treating frown lines between the brows. This was a departure from previous uses, where they were for other conditions, mostly with eye muscles, to be used in an off label fashion.

Initially, the idea of injecting yourself for cosmetic purposes was not well received in the public sphere. For many years Botox seemed all too vain, and more than anything foreign and dangerous - something reserved for weird and wealth Hollywood Stars. Due to its clear and obvious efficacy, however, attitudes were changing, and with more production volume, prices lowered to affordable levels. With more people using Botox, it became less stigmatized and weird over time. Today, Botox is a juggernaut that anyone knows, and a procedure that many men and women have routinely planned out, but it was not always the case.

Dr. Alastair and Jean Carruthers practice at their cosmetic dermatology clinic, Carruthers & Humphrey in Vancouver. Jean Carruthers and Alastair Carruthers are regular speakers at International level conferences, authors of hundreds of academic works on cosmetic dermatology.