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In the mid-1990s, a deadly neurotoxin known for causing botulism was making headlines for its unexpected potential: erasing wrinkles. Newspapers dubbed it “Pretty Poison.”
Botulinum toxin was far more toxic than cyanide and had been explored as a potential chemical weapon. However, in the decades following World War II, Dr. Alan Scott, an ophthalmologist, saw its promise in treating involuntary muscle spasms and crossed eyes. One surprising side effect – patients’ brows became smooth as a child’s.
While Dr. Scott is known as the “Father of Botox,” the true pioneers of cosmetic Botox were Dr. Alastair Carruthers, a Canadian dermatologist, and his wife, Dr. Jean Carruthers, an ophthalmologist. Together, they conducted hundreds of studies to investigate its cosmetic applications.
Dr. Carruthers passed away on August 19th, 2024, at his home in Vancouver, British Columbia. He was 79 years old. His death came from advanced Parkinson’s disease, and he availed himself of Canada’s medical assistance in dying program.
From skin cancer treatment to the discovery of the cosmetic potential of botox
In the early 1980s, with skin cancer rates on the rise, Dr. Carruthers left Vancouver for a fellowship at the University of California, San Francisco, to learn Mohs surgery, a new technique for treating the condition.
Dr. Scott, who passed away in 2022, was also based in San Francisco at the time. Dr. Jean Carruthers applied for a fellowship to join his botulinum toxin studies, but the couple had young children and didn’t want to be separated. Upon returning to Vancouver, she continued Dr. Scott’s work.
One day, a patient receiving treatment for involuntary eye twitching complained that her forehead wasn’t as smooth as usual after treatment. This sparked a conversation between Dr. Jean Carruthers and her husband about the potential cosmetic use of Botox. At the time, Dr. Alastair Carruthers was treating frown lines with temporary fillers, which weren’t ideal.
The first “patient zero” of cosmetic botox
Their receptionist, Cathy Bickerton Swann, then 30 years old, became their first subject for cosmetic Botox. She had a deep furrow in her brow since childhood but wasn’t bothered by it. She was happy to participate in the experiment.
As Dr. Jean Carruthers explained, for years Ms. Swann had observed blepharospasm patients in the clinic whose botulinum toxin treatments not only relieved their symptoms but also smoothed their wrinkles. Ms. Swann felt confident in the treatment’s safety and embraced her role as “patient zero.” A single injection eliminated the furrow in her brow.
From frown lines to a multi-billion dollar industry
The Carrutherses’ first peer-reviewed study focused on frown lines, technically called “glabellar lines.” Before starting, Dr. Alastair Carruthers injected his wife to demonstrate the procedure. As Dr. Jean Carruthers often said, “I haven’t frowned since 1987,” referring to the injection she received as part of their study. Soon after, her husband followed suit, and their photos throughout the years show consistently smooth brows.
Their initial study was a success. Dr. Jean Carruthers eventually closed her ophthalmology practice, trained in cosmetic surgery, and joined her husband’s dermatology practice.
The couple went on to conduct hundreds of studies, investigating the use of Botox for horizontal forehead lines, crow’s feet, wrinkles around the mouth, chin dimpling, and neck lines.
Botox boom and ethical debates
The Carrutherses weren’t the only doctors offering Botox for cosmetic use, then considered “off-label.” Demand soared, while some criticized it as a superficial indulgence in a culture obsessed with youth. Movie directors worried actors would lose their expressiveness, while lawyers saw it as a tool to maintain a poker face during negotiations.
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