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Patient inspiration: 'Beautiful, untroubled expression' launches aesthetic empire


The co-pioneer of Botox Cosmetic (botulinum toxin A, Allergan) traces the inspiration for the product back to one testy patient's plea.

Key Points

In 1987, "One of my blepharospasm patients was angry with me because I hadn't treated her between the brows," says Jean D. Carruthers, M.D., clinical professor of ophthalmology, University of British Columbia, Vancouver.

Dr. Carruthers apologized and said the patient wasn't spasming there.

Dr. Carruthers' husband, Alastair Carruthers, M.D., a dermatologist, had been using fillers to treat glabellar lines, she says, "but none of the fillers that were currently available were satisfactory. They didn't last long enough, caused too much pain" or, in the case of fat, couldn't be injected near the eye, because fat embolisms can cause blindness.

However, Dr. Carruthers says, it took three years to recruit her initial 30 patients ,because injecting a toxin cosmetically was "such a fringe idea. Patients would say, 'You want to inject what into my forehead? Isn't that a deadly poison?'"

She says she patiently explained that minuscule doses of botulinum toxin weren't harmful. But for the most convincing argument, "I treated myself. People would ask if it was safe, and I would lift my bangs and say, 'What do you think?'"

Botox earned Canadian approval for treating glabellar lines in 2001, then U.S. Food and Drug Administration approval for this indication in 2002.

This year, Allergan projects Botox sales worldwide will reach $1.15 billion to $1.19 billion, according to a quarterly earnings report released Feb. 4.

When Dr. Carruthers presented her first paper on glabellar Botox injections in 1991, she says, "Everybody said, 'That's a crazy idea. That will go nowhere.' Now they're all using it."

Disclosure: Dr. Carruthers is a consultant for Allergan and a principal investigator on a lower-face study of Botox and Juvéderm (hyaluronic acid, Allergan), but owns no Allergan stock.

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