The Evolution of Botox: Science, Safety, and Staying Power | As Seen in Cincinnati Magazine
Jessica Watkins, PA-C, shares how the world’s most popular cosmetic treatment, Botox, was discovered by accident, and why it has continued to be a provider and patient favorite over two decades later, featured in Cincinnati Magazine.
How was it discovered?
The history is quite interesting. The effects of botulinum were first noted in the late 1800s by a German scientist after a small outbreak of foodborne illness. While noting that the poison in high enough doses can prove fatal via its weakening actions on the nervous system, Dr. Justinus Kerner also recognized its paradox. Perhaps there exists a therapeutic potential for treating muscle hyperactivity. Over the years, scientists eventually isolated the causative bacterial strains, Clostridium botulinum. They learned to purify the toxin produced by the bacteria so that it could be more closely studied. By the 1970s, the toxin was first used in humans during experimental treatments for eye muscle disorders.
The results were amazing. Using just a tiny amount, the target muscle was affected with good duration and no adverse side effects. By 1989, the FDA possessed enough data from 240 investigators to approve Botox for blepharospasm (eye twitching) and strabismus (crossed eyes).
How did it become a cosmetic treatment?
Dr. Jean Carruthers, an ophthalmologist using Botox on her blepharospasm patients in the early 1990s, noticed the cosmetic potential of the treatment. Her patients had (gasp!) decreased frown lines! She worked with her late husband, dermatologist Alistair Carruthers, to research the cosmetic use of Botox. By 2002, the world’s most popular cosmetic treatment was born. It is now used by over 2.5 million people per year and has remained the top non-surgical treatment for over two decades.
What can Botox treat?
Botox Cosmetic has four FDA-approved treatment areas: Glabellar (frown) lines, crow’s feet, forehead lines, and the latest indication, jawline and neck lines. There are also 12 medical FDA-approved indications that help people every day for debilitating conditions. This includes chronic migraines, excessive sweating, severe muscle spasms, and urinary incontinence. Now that we have robust clinical research, data, safety, and clinical experience in the real world, health care professionals across many cosmetic and medical specialties use Botox for a myriad of other “off-label” uses. I regularly treat the chin, D.A.O., bunny lines, masseter, lips, and gummy smile.
What trends do you anticipate in the future?
As a cosmetic dermatology PA who has been treating patients with Botox for 10+ years, I can say without a doubt that Botox is here to stay. Researchers have described Botox Cosmetic in more than 792 peer-reviewed articles in scientific and medical journals. This puts it in a league of its own, especially compared to other cosmetic treatments. With Botox paving the way, we have also seen an expansion of the toxin market. Other competing brands include Dysport, Daxxify, Xeomin, and more.
A typical appointment by an expert injector takes less than 10 minutes, has no downtime, and produces rapid, natural-looking results. It’s no wonder that neurotoxin patients are repeat customers regardless of age demographic. Pairing that with ever-expanding medical uses, the Botox demand will certainly continue on its meteoric rise! A new fast-acting Botox is even on the horizon and will hopefully make its appearance in late 2026. Jawline and neck Botox has boomed since its 2024 FDA approval and will only continue to grow in popularity. Botox is also increasingly being used as part of other treatments. For example, mixing with hyaluronic acid serums in AquaGold facials. Using concentrated Botox injected into post-surgical scars has interesting utility. I think we will be seeing more of this in the future.