It’s impossible to write about cosmetic dermatology and the dawn of the minimally invasive revolution in aesthetics without first paying homage to the late Alastair Carruthers, FRCPC, a Canadian Dermatologist, and his wife, Jean Carruthers, MD, FRCSC, FRC (OPHTH), an Ophthalmologist.
The Carruthers pioneered the cosmetic use of botulinum toxin type A.
When Jean used a dilute solution of botulinum toxin to treat a patient’s uncontrollable blinking, she and her husband discovered the toxin’s wrinkle-smoothing effects. They first presented their findings at a medical meeting in 1991. Fast forward 11 years, and onabotulinumtoxinA (Botox Cosmetic, Allergan Aesthetics) scored its first nod from the U.S. Food and Drug Administration (FDA) for the temporary improvement of moderate-to-severe glabellar lines.
The rest, as they say, is history. Since that time, this neuromodulator has received FDA approval for the improvement of moderate-to-severe glabellar lines, crow’s feet, forehead lines, and platysma bands, effectively reducing wrinkles.
“It was the game-changer, and the discovery that started the non-invasive cosmetic world,” Dr. Carruthers tells The Dermatology Digest.® “It flicked on the light and illuminated all of these other possibilities.”
Here’s what else she had to say about the evolution of Botox Cosmetic and what’s to come.
TDD: What are some of these other possibilities that have been illuminated?
JEAN CARRUTHERS, MD, FRCSC, FRC (OPHTH): Botox works so well. Monotherapy is great, but certain combination treatments are also increasingly effective, such as the use of Botox Cosmetic plus intradermal hyaluronic acid fillers around the eyes or with energy-based devices like Sofwave on the brow.
TDD: They say imitation is the highest form of flattery, but in the case of counterfeit Botox, it can also prove dangerous. Any tips on how patients and providers can avoid fake Botox and its risks?
JEAN CARRUTHERS, MD, FRCSC, FRC (OPHTH): Make sure you know who is providing the neuromodulator and that the toxin comes from an accredited company. Don’t buy secondhand toxins. If you purchase pirate Botox, you don’t know what is in that vial. Patients should do their research. Most accredited companies have lists of the practitioners who have been vetted, are active, and are above-board to choose from. Using an FDA or Health Canada-approved product is really important. Ask to see the vial to know for sure.
TDD: There’s a lot of excitement around TrenibotE (EB-001 or type E botulinum neurotoxin). What can you tell us about it?
JEAN CARRUTHERS, MD, FRCSC, FRC (OPHTH): Type E is very different from type A. It works today, and its effects will be gone in two weeks. It solves the problem of leaving treatment to the last minute. It can also serve as a trial before committing to longer-term treatment with type A.
TDD: What’s next for Botox?
JEAN CARRUTHERS, MD, FRCSC, FRC (OPHTH): We will probably be able to inject it in the face in a way that we don’t go deep into the muscles to improve acne, rosacea, or redness. The toxins seem to enter the precapillary sphincter to cut down blood flow to that area, reducing the redness. We will also likely find more uses for different dilutions of the toxin in the future, resulting in more focused and longer-lasting results.
TDD: What can you tell us about some of the buzzy terms out there, such as Baby Botox and Micro Botox?
JEAN CARRUTHERS, MD, FRCSC, FRC (OPHTH): “Baby Botox involves using a less-than-the-regular dose of the toxin in the glabella and is popular among millennials. This age group has a different mindset from the boomers. Baby boomers tend to see something wrong and fix it, while millennials intervene before something goes wrong to prevent it from happening in the first place. Micro Botox involves multiple injections of a diluted solution of botulinum toxin into the superficial layers of the skin to improve skin texture, reduce pore size, and control oil production. It works incredibly well, but not everyone can tolerate all of those shots.
DISCLOSURES
Jean Carruthers, MD, FRCSC, FRC (OPHTH), is a consultant and investigator for Acorn, Appiell, AbbVie, Avari, Bonti, Del Nova, Evolus, Fount Bio, In Mode, Inverse Genomic, Jeune Aesthetics, Merz, Object Pharma, Revance, and Sofwave.
