Botox is something that many people associate uniquely with the cosmetic treatment of wrinkles. Although it is indeed used for that purpose, botulinum toxin (Botox) is a highly versatile agent used for treatments such as crossed eyes (strabismus), uncontrolled blinking (blepharospasm) and excessive sweating (hyperhidrosis).
The story of Botox and how we came to use it to treat wrinkles in the modern day is very intriguing.
Botox is a drug made from the toxin produced by the bacterium Clostridium Botulinum. This toxin can cause a life-threatening type of food poisoning called Botulism.
The first discovery of Clostridium Botulinum was made in 1895 by a Belgian scientist called Emile Pierre van Emermengem in response to a Botulism food poisoning outbreak in Belgium, a fatal illness whose symptoms included weakening the eye muscles and droopy eyelids.
It was over a decade later, in the 1920s, that scientists at the University of California were the first to isolate the Botulinum Toxin from Clostridium Botulinum. However, it took a further 20 years for Dr Edward Schantz to isolate Botulinum Toxin in crystalline form.
Dr Edward Schantz worked in the US military as a scientist during World War Two and experimented to see if the military could use it as a bioweapon for warfare. The toxin was highly poisonous, and even small quantities could cause muscle paralysis and death.
Later in the 1960s, at the Smith-Kettlewell Eye Research Institute in San Francisco, Dr Alan Scott was conducting research on botulinum toxin, bearing in mind the paralyzing effect of the poison on the muscles. The research led Dr Alan Scott to predict that it’s possible to safely use a purified form of the Botulinum Toxin to treat medical eye conditions such as strabismus, blepharospasm and twitching.
He obtained samples of the Botulinum Toxin from Schantz and tested a therapeutic form on monkeys, which proved his theory. This compelled Dr Scott to start the company, Oculinum and produce a drug by the same name, which the FDA approved in 1989 to treat strabismus and blepharospasm. In the UK Laboratories in Porton Down were one of the first in Europe to produce it commercially for medical purposes, under the name of Dysport.
Mr John Lee of Moorfields Eye Hospital worked with Dr Scott and introduced medical toxin expertise to the UK, using Dysport. He taught many UK trainee Ophthalmologists how to use minute amounts of the toxin to correct double vision, other types of strabismus (squint) and to lower eyelids to protect the cornea. Ms Jane Olver of Clinica London trained with Mr John Lee over several years at Moorfields Eye Hospital. She continued using the toxin for thyroid patients with angry glabella lines and for lid lowering, and subsequently for aesthetic crow´s feet and forehead lines in her current practice at Clinica London.
More on aesthetic history of Botox below!
In 1991, Allergan, a pharmaceutical company, purchased Oculinum and renamed it Botox. By then, physicians had began noticing a trend in their patients that surprised them. The physicians saw that the Botox treating their patient’s eye conditions also caused some lines and wrinkles to disappear. In the early 1990´s Dr Jean Carruthers and her husband in Vancouver are to be thanked for popularising to the world the cosmetic uses of Botox.
Even Dr Scott was surprised at this unexpected effect. Dr Scott told an interviewer on CBS “Sunday Morning” in 2012. “Some of these patients would kind of joke and say, ‘Oh, doc, I’m coming to get the lines out,’ and I would laugh.” How right those patients were! It just shows that physicians must always listen to their patients.
Dr Alan Scott deserves to be remembered as the Grand Father of Botox. He passed away from natural causes in late 2021 aged in his 90´s.
Botox works by blocking the release of acetylcholine; this is the compound that makes muscles contract. The relaxed state of these muscles lasts several months before new receptors grow back, which results in patients’ wrinkles disappearing when injected into the glabella and forehead.
Research and use of Botox continued and it was eventually approved for cosmetic purposes by the Food and Drug Administration in 2002.
Over the years, doctors and researchers discovered that Botox could be used to treat migraines and cervical dystonia, a condition that affects the muscles. It is also used to treat muscle spasticity in people who are suffering from cerebral palsy. It can be used for conditions affecting the vocal cords, the urinary sphincter, and many other locations where it is necessary to relax the muscle for medical purposes.
The Botox journey is one of bizarre findings and consequences. From deadly toxin to the dream of the beauty world. From a toxin that was acknowledged to be one of the most poisonous on earth and one that was developed for use against the enemy in the Second World War (although no evidence is easily available to suggest it was actually used) to a well-known cosmetic treatment for wrinkles and other medical eye disorders, Botox has a weird and fascinating history.
If it weren’t for Dr Alan Scott’s research and others´ subsequent medical research, Botulinum would likely still be as lethal as it was when it was first discovered. And we would all be wrinkly.
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