History of Cosmetic Botox (botulinum toxin) treatment.

Richard Clark and Craig Berris, plastic surgeons from Sacramento, California, were the first to document the use of Botox (botulinum toxin) to reshape the eyebrow.

Their patient had an injury to the left frontal branch of the facial nerve caused by a cosmetic facial surgery. This resulted in paralysis of the left-sided of the forehead.

Clark and Berris were of the opinion that the injured nerve could possibly regenerate over a 24 month period. Consequently, they recommended deferring definitive surgical treatment during this period of potential recovery. Clark and Berris injected Botox into the right forehead of their patient to smooth the wrinkles on that side to match the patient’s paralyzed left forehead. These surgeons published this case study in 1989.

In a 2005 follow-up paper, these authors confused the brow reshaping treatment they performed for their disfigured patient for cosmetic treatment. They wrote: “It appears that Carruthers and Carruthers have been erroneously credited for originating the use of botulinum treatment of forehead wrinkles because they treated a secretary’s wrinkles once in 1987.”

These reconstructive surgeons mistook their restorative procedure as a cosmetic service. It was not and their paper did not anticipate the cosmetic use of botulinum toxin as developed by the Carruthers. The Carruthers are not credited with this invention because they treated a secretary’s wrinkles in 1987. Clark and Berris failed to accurately convey the facts in their 2005 follow-up paper.

Jean and Alastair Carruthers observed that blepharospasm patients who received injections around the eyes and upper face also enjoyed diminished facial glabellar lines (“frown lines” between the eyebrows).

Alastair Carruthers reported that others at the time also noticed these effects and discussed the cosmetic potential of Botox.

Unlike other investigators, the Carruthers did more than just talk about the possibility of using botulinum toxin cosmetically. They conducted a clinical study on otherwise normal individuals whose only concern was their eyebrow furrow.

They performed their study during 1987-1989 and presented their results at the 1990 annual meeting of the American Society for Dermatologic Surgery. Their findings were subsequently published in 1992.

It is for this reason that the Carruthers are acknowledged as the inventors of Cosmetic Botox treatment.

In 2002, the FDA approved the use of Botox for a cosmetic treatment for moderate to severe frown lines between the eyebrows. It was approved by the FDA for treatment of wrinkles around the corners of the eyes (crow’s feet) in 2013.

According to a 2016 clinical study, Botox is a simple, safe, and effective treatment for reduction of forehead wrinkles.

A study, from the American Society of Plastic Surgeons, found that Botox injections became the most popular non-invasive cosmetic procedure in 2020, with 4.4 million procedures.

This type of procedure is the number one non-surgical cosmetic procedure in the United States.