From Deadly Toxin to Beauty Blessing: The Doctor Pioneering Cosmetic Botox

In the mid-1990s, a deadly neurotoxin known to cause 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 after World War II, Dr. Alan Scott, an eye doctor, saw promise in treating involuntary muscle spasms and crossed eyes. One surprising side effect: Patients’ eyebrows became as smooth as a baby’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 investigating its cosmetic applications.

Dr. Carruthers passed away on August 19, 2024, at his home in Vancouver, British Columbia. He was 79 years old. He died from advanced Parkinson’s disease and availed himself of the Canadian Physician Assisted Suicide Program.

From curing skin cancer to discovering the cosmetic potential of botox

In the early 1980s, with skin cancer rates rising, Dr. Carruthers left Vancouver for a fellowship at the University of California, San Francisco, to learn Mohs surgery, a new technique for treating the disease.

Dr. Scott, who passed away in 2022, was also living in San Francisco at the time. Dr. Jean Carruthers applied for a fellowship to join him in his botulinum toxin studies, but the couple had young children and did not want to separate. Upon her return to Vancouver, she continued Dr. Scott’s work.

One day, a patient undergoing 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 thirty, became their first subject for cosmetic Botox. She had had a deep furrow on her forehead since childhood, but it didn’t bother her. She was happy to participate in the experiment.

As Dr. Jean Carruthers explained, for years Ms. Swann had seen patients with blepharospasm in the clinic whose botulinum toxin treatments not only relieved their symptoms but also smoothed out their wrinkles. Ms. Swann felt confident in the safety of the treatment and embraced her role as “patient zero.” A single injection eliminated the furrow on her forehead.

From forehead wrinkles to a multi-billion dollar industry

The Carruthers’ first peer-reviewed study focused on frown lines, technically called “glabellar lines.” Before they began, Dr. Alastair Carruthers gave his wife an injection 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 did the same, and photos of them over the years show consistently smooth brows.

Their initial practice was a success. Dr. Jean Carruthers eventually closed her ophthalmology practice, specialized in cosmetic surgery, and joined her husband’s dermatology practice.

The pair went on to conduct hundreds of studies, examining the use of Botox for horizontal forehead lines, crow’s feet, wrinkles around the mouth, chin dimples, and neck lines.

Botox Boom and Ethical Debates

The Carruthers weren’t the only doctors offering Botox for cosmetic use, then considered “off-label.” Demand skyrocketed, while some criticized it as a superficial indulgence in a youth-obsessed culture. Film directors feared actors would lose their expressiveness, while lawyers saw it as a tool to maintain a stony face during negotiations.