The discovery of Botox: the wonder product that turns back the clock - happened by accident.

In the 1820s, a German doctor, Justinus Kerner began experimenting with Botulinum toxin; a toxic protein produced by the bacterium, Clostridium botulinum, which causes botulism (a deadly form of food poisoning, that thrives in home-canned food and has caused many deaths through the centuries).

But Kerner wanted to make use of the bacterium’s muscle-weakening qualities for therapeutic use. His work laid the foundation for the discovery that the toxin could be used to relieve muscle spasms –specifically, by blocking the release of acetylcholine, a neurotransmitter that tells muscles when to contract.

Inspired by this discovery, a dermatologist and ophthomologist, Alistair and Jean Carruthers, began injecting patients mainly for muscular disorders of the eye, and the results were successful. When her assistant suggested she inject her pronounced frown area, between the eyebrows, above the nose (referred to as ‘glabellar lines’). A phenomenon was born.

At first people were horrified that a poison would be used to take away their wrinkles. What were the risks? What needs to be clarified is that you’re injecting a product of the botulism bacterium in the same way that penicillin is a product of a mold. Most antibiotics are natural products of other micro-organisms, and Botox is no different.

In 1989 the U.S. Food and Drug Administration had approved Botox® for treatment of crossed eyes and uncontrollable blinking (Blepharospams) and in 2000 for a neurological movement disorder known as cervical dystonia. In 2002 it was approved for a single cosmetic procedure: reduction of glabellar lines (frown lines).

Botox® works for three to six months depending on the dosage and physiology. But in tiny quantities, the toxin acts as a muscle-relaxing agent by blocking the release of acetylcholine in the nerve endings. It is administered by units, each equaling precisely the dose it takes to kill a mouse. A typical cosmetic treatment is 20 units per ‘site’.

Although, treating glabellar lines constitutes the only cosmetic use indicated by the FDA and Allergan, doctors routinely inject other facial areas: crow’s feet around the eyes, laugh lines, and creases near the nose. Once injected, practitioners contend, the toxin ‘spreads’ by no more than a quarter-inch.

Products And Uses

Botox® for aesthetic use is marketed as Botox/Botox Cosmetic or Vistabel® depending on the country of approval.

As of March 2006, Botox® from Allergan, Inc. (Irvine, Calif., U.S.) received approval in the U.K. for cosmetic use (glabellar/frown lines) and will be marketed as Vistabel®, following in the footsteps of other European countries including France, Italy, Spain, Switzerland and most recently Germany as well. Botox® or Vistabel® has cosmetic approval in 30 countries worldwide.

Another development that is heating up among neurotoxins, is the introduction of Xeomin® (Merz Pharmaceuticals), another botulinum toxin type A, currently approved across Europe for blepharospams (a debilitating condition that causes patients to have uncontrolled eyelid twitching and blinking) and cervical dystonia (sustained contractions cause abnormal posture of the head and neck, while periodic spasms produce jerky head movements. The severity may vary from mild to severe.) Xeomin was introduced in Germany in July 2005. There is also an assortment of preparations from China and Korea flooding the market.

Myobloc® from Solstice Neurosciences (Malvern, Pa., U.S.) which is botulinum toxin type B is currently approved in the U.S. and Canada for the treatment of cervical dystonia. It is marketed in Austria, France, Germany, Ireland, Italy, Portugal, Spain and United Kingdom as NeuroBloc®. Although considered effective, it has a more rapid onset of action and a shorter duration of effect and is not widely used for cosmetic uses.