Vale Dr Alastair Carruthers: Pioneer of Botox for cosmetic use

The birth of botulinum toxin

Although the cosmetic effect of botulinum toxin on wrinkles was first documented by a plastic surgeon from Sacramento, it wasn’t until husband-and-wife ophthalmologist
and dermatologist physicians Jean and Alastair Carruthers from Vancouver, Canada published their research in 1992 that ‘Botox’ for cosmetic use was officially born.

Like many other advances in cosmetic medicine, the birth of Botox was something of an accident. As an ophthalmologist, Dr Jean Carruthers had been using botulinum toxin
type A to treat blepharospasm – an uncontrolled muscle spasm in the eye.

‘One of Jean’s patients complained that she hadn’t been treated in this area,’ Dr Alastair Carruthers told us during an exclusive interview in San Diego, pointing to the region between his eyes where you’d imagine frown lines may exist had he not discovered Botox’s ‘other’ use.

‘“I didn’t think you were spasming there,” my wife replied, to which the patient explained, “But every time you treat me there I get this untroubled, unworried look and my family tells me I look so much better!”’ he recalls.

As a procedural dermatologist, Alastair Carruthers knew first-hand the significance of this flyaway comment. In the late 1980s, his cosmetic toolbox was sadly lacking any weapon capable of improving the appearance of frown lines. ‘We didn’t have anything,’ he emphasises. ‘Collagen was about it.’

It didn’t take long for the husband and wife team to begin their exploration into the cosmetic potential of botulinum toxin type A. ‘The very next day, Jean treated our receptionist, Cathy Bickerton,’ says Dr Carruthers. ‘Cathy had witnessed Jean inject hundreds of clients so she knew it was a reasonable procedure.

‘A few days later, I saw her and remember saying, “Wow”, because I hadn’t seen anything like it before,’ he recalls.

With his cosmetic practice side by side with his wife’s ophthalmology clinic, from that point on, Alastair Carruthers would send his own patients next door for treatment, any time he met someone who wanted to improve the appearance of their forehead furrows.

‘Jean still says, “I haven’t frowned since 1987”,’ he laughs. ‘If Jean would do it to herself, then obviously she thought it was safe, so if I saw someone with lines I’d send them down to Jean. There were still quite a few people, however, who questioned what we were doing.’

Without clinical evidence, the use of botulinum toxin would not be the phenomenon it is today. ‘It took time, but we gradually accumulated a number of people and, in March 1991 we were able to present our data,’ Dr Carruthers says.

The results were impressive, but the timing poor. In 1991, the US Food and Drug Administration (FDA) was in the midst of threatening jail-time for the illegal promotion of the off-label use of Retin-A.

‘And then we come along and tell the FDA we want to inject the most deadly material known to humanity in order to treat wrinkles,’ Dr Carruthers says.

‘Everyone said we were crazy,’ he adds with a sly smile.

Cosmetic doctors the world over started to use it – off-label – to improve the appearance of frown lines, but it wasn’t until 2002, after formal clinical trials, that the FDA approved Allergan’s Botox Cosmetic to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows.

‘It took a while, but with the support of some key dermatologists, including Patricia Wexler, Nicholas Lowe and Arnold Klein, it was as if all of a sudden there was a critical mass
and people started to listen to us,’ Dr Carruthers recalls.

Given that Botox can be considered one of the most successful symbioses in late 20th-century cosmetic medicine, it’s understandable to assume that Jean and Alastair Carruthers went on to become billionaires.

As two people upholding an ethical position, however, they refused to cash in. Although they eventually went on to become consultants with Allergan, the multi-billion dollar company that would launch Botox Cosmetic, and which already owned the formula for medical use, they never patented their discovery.

‘We took advice from a lawyer in Toronto who was supposed to be an expert and said that he did not think this was a patentable idea. We have since learned that it was indeed,’ Dr Carruthers told a Canadian magazine back in 2010. ‘Are there any regrets? I guess so, but not major.’

The Carruthers’ impact on cosmetic medicine is undeniable – an impact that Alastair Carruthers puts down to his fortitude in being able to work alongside his wife for so many years.

‘We’re still floating along at the head of the pack, and I think it’s because there are two of us,’ he concludes thoughtfully. ‘If Jean and I go along and listen to a paper then we’ll discuss it, and we’ll discuss it perfectly honestly. And that’s been a huge advantage for us. I don’t know anyone else who does that.’ AMP