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title Don't worry, it's just poison

MEDICINE
July 22, 2002 Issue Full Text

Meet the Vancouver doctor whose inadvertent discovery of cosmetic Botox froze a million faces

by Colby Cosh

IN the run-up to March 24's Oscar ceremony, only one word was on everybody's lips. No, not "Halle" or "Denzel," but "Botox." In Hollywoodland's clinics, celebrities were trampling one another to get last-minute touch-ups of the popular cosmetic injection. Although few celebs will confess outright to getting Botoxed, the drug has been connected--in whispers--with stars from Michelle Pfeiffer to Tom Cruise to Madonna. According to manufacturers Allergan Inc., Botox sales have increased 46% since 2000, and it is now the number one non-surgical cosmetic treatment in the United States. But the U.S. is not where it all began.

The cosmetic use of Botox, or botulinum toxin type A, may just be the most influential Canadian medical discovery since insulin. For decades, the anaerobic bacterium Clostridium botulinum was one of mankind's deadliest enemies, randomly killing consumers of improperly canned food. Paralyzing muscles by attacking the nerves leading to them, botulinum poison remains the strongest known: Allergan sells it in amounts on the order of one-billionth of a gram. But by the 1980s it had come to be a valuable weapon against involuntary muscle spasms in the eye, like blepharospasm or strabismus, which leave sufferers prone to sporadic attacks of blindness. Vancouver ophthalmic surgeon Jean Carruthers had learned the delicate art of injecting it into the face, but neither she nor anyone else really dreamed of new horizons for the drug.

"It was actually one of my blepharospasm patients who first mentioned it," she says today. "She said, 'Why don't you inject me between the eyes?' 'I didn't think you had been having spasms there,' I told her. 'I don't,' she said, 'but when you injected me there before, I got the most beautiful, untroubled expression on my face.'" Dr. Carruthers might never have followed up on the woman's comment, but she happened to report it to her husband Alistair, a dermatologist. He told her that many patients were annoyed at having permanent, deep frown furrows in their brows, and that there was not much anyone could do for them. "That," says Jean Carruthers, "is when we put two and two together."

Colleagues called the pair crazy, but they designed a study and injected 30 brave patients; the first was their own receptionist. In 1991, they reported positive results with the first-ever cosmetic usage of the paralyzing toxin. Seeking out the "untroubled" Botox face became a popular off-label use of the drug, but only on April 15 of this year was it formally approved by the U.S. Food and Drug Administration for use in treating "moderate to severe glabellar lines" in the brow. After years of experience, the drug is known to be largely safe, and as a lunch-hour outpatient alternative to facelifts, it offers a great net medical (and economic) benefit to society.

But Botox's wild popularity has a dark side, as Dr. Carruthers is the first to point out. She is "appalled" by phenomena like celebrity "Botox parties," at which aging beauties invite physicians into their homes and line up with friends to get Botoxed. "As a cosmetic physician, my first job is to sit down and listen to my patients, to try to understand what they really want and expect," she says. "And I give myself time to study their anatomy, because there's a surgical aspect to this treatment. When I see surgeons who aren't wearing gloves administering Botox in a place where alcohol is being served, to me that's very bad news...There's no informed consent, there's no documentation of the procedure and there's no appropriate design of the treatment."

She points to a recent story in the Times of London, where a botched drugstore Botoxing left a woman with a comically arched eyebrow for four to six months. "Your face, and the expression on it, is the medium through which you interact with other people," she says. "It's easy to underestimate the consequences if something goes wrong."

But don't think Dr. Carruthers has any regrets. She is not just the originator of cosmetic Botox: she is also an enthusiastic consumer. "Are you kidding? It's incredible stuff," she says when asked the delicate question. "There's a momentary sting, like that of a bee, and over the space of a day you find you're suddenly not able to frown anymore." Movie directors have started complaining that their Botoxed actors have no emotional range: does the doc herself ever miss being able to register disapproval? "Never," she says. "If I were a man, frown lines would enable me to convey leadership, compassion, mastery--positive stuff. But I'm afraid that, for a woman, they just mean you're tired, you're not coping well--in short, you're a b--h."


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