Botox has become the most popular cosmetic tweakment in the world, but did you ever wonder how people began injecting their wrinkles with something derived from a lethal poison?
It’s all due to one woman, Dr Jean Carruthers, whose story begins more than 30 years ago with a combination of chance and medical brilliance. Oh, “and a husband who listened to me!” smiles the woman who’s been called “The Godmother of Botox”.
Today, an estimated 900,000 Botox facial jabs are performed each year in the UK alone. But the treatment certainly hasn’t been an overnight success story for Jean, 74, and her husband Alastair, a cosmetic dermatologist who co-researched her idea.
The Vancouver-based couple were initially derided for the “crazy” notion of using botulinum toxin as an aesthetic medicine. “People just said, ‘That’s a poison, isn’t it?’,” she recalls.
Yet despite what you might assume, Jean is no quack or experimental risk-taker. In the 1980s, she was a respected ophthalmologist.
She became fascinated with the work of Dr Alan Scott, who had discovered that injecting tiny amounts of botulinum toxin could block the muscle causing eye misalignment, correcting squints without surgery. After training with him, she returned to Canada to became part of a global trial on the technique.
“Botulinum is not a poison if you know what you’re doing with it and you give a tiny measured dose. It was a very successful trial,” she explains. “But then one patient got angry with me. She pointed to her brow and said, ‘You didn’t treat me here!’”
“‘Oh, I’m sorry,’” I told her. ‘I didn’t know you had spasms there.’ And she replied, ‘Oh I know I’m not spasming there. But every time you treat me there, I get this beautiful untroubled expression…’ And that was the moment the penny dropped.”
By lucky coincidence, Jean’s husband had been expressing his frustration that nothing really worked for his patients’ frown lines. “So I went home to Alastair and said, ‘I think we could use my botulinum treatment on your wrinkle patients.’ And we decided to do a study together on it.”
Unsurprisingly, few people were keen to be injected with the substance, so Jean volunteered as the study’s first patient. “If you believe in it, you’ve got to do it on yourself, right? It wasn’t scary because I had been using it for blepharospasm [eyelid muscle spasms] for years, so I knew the doses and I told Alastair where to put it.”
Within a few days, Jean’s “lovely deep frown lines” had melted away. “It was just wonderful to be able to show [prospective volunteers] my picture and say, ‘This is what I looked like before.’ After that they were keen on it! And that’s how we got our first 18 patients.”
Jean remembers their reaction as “thrill, absolute thrill, because they hated those frown lines”. But the wider world disagreed.
“We put it all together as a paper and I presented it to the American Society for Dermatologic Surgery in 1991. It was a disaster. The room went dead with silence. A colleague came up to us afterwards and said, ‘That’s a crazy idea that will go nowhere.’”
The problem, says Jean, was one of perception. “The reaction was, ‘Really? You use that terrible poison on something so frivolous as wrinkles?’ But there is nothing frivolous about wrinkles. Wrinkles are self-esteem.”
Despite that, Botox – as the treatment was eventually branded after Dr Scott sold the rights to pharmaceuticals giant Allergan – began to take hold among dermatologists seeking scalpel-free results.
“Having a scientific method is what convinces doctors. So pretty soon, people started inviting us all over the world to teach it,” says Jean. Then, in 1997, ABC News filmed a report on the Carruthers’ work, and the secret was out.
“People usually feel five to seven years younger from Botox,” says Jean. “When it’s done well, people just look the absolute best version of themselves. Their brows are nicely arched instead of sliding down, their crow’s feet are softened and their mouth corners aren’t turned down.”
However, the finger-wagging brigade accused the Carruthers of turning people into frozen-faced zombies, unable to express emotions.
“It’s not true. If your face already has deep frown lines, you’re giving the wrong impression already,” Jean reasons. “You might actually be a very happy, positive person but you’re portraying a bitter, disappointed person to the world. So if you can rebalance that, people don’t have to undo a whole lot of negativity before they can show positive emotion.”
She views Botox as a gift to women to help redress the injustices of ageing, saying, “In society, a frown in a man means they’re leaders. Whereas in a woman, it means she’s tired, she’s not coping well. It’s so unfair. But I think Botox has reduced our worry about ageing.”
Once a guilty secret among baby boomers, Botox is now regarded as mainstream maintenance by millennials.
“For them, Botox has always been there and it’s normal to look after your appearance and to talk about that online,” Jean says. And celebrity fans like the Kardashians have also helped to smash the stigma. “Kim looks amazing – she’s a good ad for it, no question!” Jean smiles.
While not all celebrities are forthcoming about using Botox, Jean believes it’s commonplace among the A-list. “I hesitate to mention names but I think if you look at movie stars today, I would imagine most of them are doing it, and whoever is doing their treatments is doing a marvellous job,” she says.
Is it strange for her to look at a red-carpet event, spotting faces smoothed by the treatment she pioneered? “It’s a great feeling!” she laughs. “It’s like seeing children flourishing.”
Even her one regret – failing to secure a patent for the treatment – doesn’t keep her awake. “It would have been nice, I suppose, to have billions,” she says. “But I’ve had a really wonderful life with this product in so many ways. I think it’s the most amazing molecule in the world.
Botox: what you need to know
• Botox works by reducing activity in the muscles that cause expression lines, from frown lines to crinkly lips.
• Do your research. “Understand what it does, and find somebody with a good reputation.” Jean recommends the British College of Aesthetic Medicine website – bcam.ac.uk – for advice on aesthetics treatments.
• It can be overdone. “Bad Botox is a waxy smooth forehead and angry Spock eyebrows. That happens when somebody doesn’t know the anatomy of the face. But it wears off,” she explains.
• It’s not just cosmetic. Relaxing frowns can have a genuine impact on mental wellbeing, Jean explains. Studies have shown that by relaxing the face’s “grief muscles”, Botox calms the brain’s amygdala region which processes negative emotions. “Depression, PTSD and anxiety all benefit tremendously from a down-regulation of the amygdala. It makes the mood totally improve,” says Jean. “There’s now ten or 11 studies on its treatment of depression and they're all positive.”
Botox and the older face
Jean herself is remarkably well-preserved at 74, thanks partly to a facelift and rigorous sunscreen use – but mostly from three decades of not frowning.
Botox, she believes, is the tweakment that makes the most difference. “I call it the curtain rod because all the other treatments hang on it,” she says. “In the pandemic, when people came back to have their treatments, the only one they wanted to begin with was their Botox.”
That said, she views Botox as just one part of the anti-ageing strategy, especially for older women. “Topicals such as vitamin C and retinoids are important,” she says. “I also use hyaluronic acid fillers and I’m pretty impressed by them. I also use energy-based devices. If you start to sag, you can fill the envelope with fillers at first but you reach a point where you can’t overfill. It's not going to look elegant, so now you have to shrink the envelope – that’s where I use radio frequency and micro-needling.”
Dr Jean Carruthers is a member of The British College of Aesthetic Medicine ( bcam.ac.uk ), a charity promoting safe and ethical aesthetic medicine
