Image: Dr. Jeffrey M. Kenkel, Amy Andrade
Ron Heflin  /  AP file
Botox has a rather lively history considering the whole paralyzed muscle thing.
By contributor
updated 10/22/2007 9:12:49 AM ET 2007-10-22T13:12:49

Ashlee Simpson is getting “Botox at 23!” an In Touch Weekly headline screams. BFFs are vying for a chance to win a trip to New York — complete with a wrinkle-treatment consult — the grand prize in “The Botox Cosmetic Ultimate Girlfriend's Weekend Getaway” sweepstakes. Casting directors are complaining that “robotoxed” actors are no longer able to lower their eyebrows.

Have we all gone insane? How did we get to the point where celebrities actually require emoticons to frown?

It’s been 15 years since researchers first intimated we could eliminate those eye crinkles and forehead wrinkles by injecting ourselves with botulinum toxin and just five years since this beautifying little bee sting received its official government OK.

But the wrinkle-smoothing wonder that is Botox Cosmetic didn’t just spring forth like Athena leaping from Zeus’ ultra-smooth forehead. No, the “little neurotoxin that could,” as USA Today dubbed it in 2003, has a long, illustrious, and surprisingly lively history, particularly considering that whole immobilized muscle thing. Herewith, a few frozen moments in the Botox timeline:

The 1820s — The “wurstgift”
No one really understood the biological basis for food poisoning until Dr. Justinus Kerner began to study a batch of improperly prepared blood sausages responsible for the death of several dozen Germans. Kerner posited that there was something in the spoiled sausages that brought on the disease, something he called “wurstgift” (German for sausage poison).

Ever the dedicated scientist, Kerner even went so far as to inject himself with some of the stuff, but luckily, he didn’t transform himself into a monster like in those 1950s horror films (although he may have felt like it — botulism is pretty nasty business). Instead, his experiments and case studies led to a better understanding of the neurological symptoms of food-borne botulism (drooping eyelids, difficulty swallowing, muscle weakness, and if left untreated, paralysis and respiratory failure).  He also offered up suggestions for treatment and prevention of food poisoning, and paved the way for today’s therapeutic use of the toxin.

The 1890s — Deadly funeral
More than 70 years after Kerner conducted his experiments, Dr. Emile Pierre van Ermengem of Belgium was asked to investigate an outbreak of botulism following a funeral dinner where three people died and 23 were paralyzed. (Apparently, somebody brought a bad ham.)

Van Ermengem, who had studied under Dr. Robert Koch (the guy who discovered the bacterial causes of anthrax, tuberculosis and cholera), was able to make a connection between botulism and a spore-forming bacterium he named Bacillus botulinus (it was later renamed Clostridium botulinum). A raft of studies followed and seven strains of botulinum toxin were eventually identified (A through G); four of them (A, B, E and F) would be shown to cause illness in humans.

The 1940s — Toxic temptresses
With the outbreak of World War II, the U.S. began researching biological weapons, including botulinum toxin (the nerve toxin produced by Clostridium botulinum), considered to be deadliest substance in the world. One plan, according to a 2004 article in Clinical Medicine (The Journal of the Royal College of Physicians of London), was to have Chinese prostitutes slip tiny toxic pills into the food and/or drink of high-ranking Japanese officers. According to the authors, a batch of gelatin capsules filled with botulinum toxin was produced, but the project was abandoned before the poison pills could be put into action.

Image: Ashlee Simpson
Matt Sayles  /  AP file
Ashlee Simpson denies that her blank gaze has anything to do with Botox as claimed by In Touch Weekly's cover story "Botox at 23!" Click to vote for which celebrities are naturally pretty or shot full of poison!

The '50s and ’60s — Beneficial botulinum?
With the war over, researchers began focusing on the more beneficial aspects of this powerful toxin, particularly after Dr. Edward J. Schantz and his colleagues were able to purify botulinum toxin type A into crystalline form. In 1953, physiologist Dr. Vernon Brooks discovered that injecting small amounts into a hyperactive muscle blocked the release of acetylcholine from motor nerve endings, causing temporary “relaxation.” In the 1960s, ophthalmologist Dr. Alan B. Scott started injecting botulinum toxin type A into monkeys, theorizing its muscle-relaxing effects might help in the treatment of crossed eyes (or strabismus). Before long, botulinum toxin type A became the go-to toxin in research labs around the world (despite fears about its use in “germ warfare”).

The '70s and ’80s — The birth of Botox
In 1978, Scott received FDA approval to inject tiny amounts of botulinum toxin into human volunteers and soon, the results started rolling in. In the early 1980s, the eye doctor published a number of studies including a 1981 paper in the Transactions of the American Ophthalmological Society that asserted botulinum toxin “appears to be a safe and useful therapy for strabismus.” Additional research showed the drug’s benefits went beyond ophthalmology, providing patients with temporary relief from facial spasms, neck and shoulder spasms, even vocal cord spasms. In 1988, drugmaker Allergan acquired the rights to distribute Scott’s batch of botulinum toxin type A (or Oculinum, as it was then known) and a year later, the FDA approved botulinum toxin type A for the treatment of both strabismus and blepharospasm (spasms of the eyelid muscle). Shortly thereafter, Allergan acquired Scott’s company and changed the drug’s name to the compact, catchy “Botox.”

The 1990s — Botox is the new black
As research continued, other potential uses came to light. Bladder spasms, writer's cramp, excessive sweating, even cerebral palsy in kids all were alleviated — at least for a short time — by injections of the neurotoxin. But by far the most earth-shattering discovery came about by accident when Canadian ophthalmologist Dr. Jean Carruthers noticed her blepharospasm patients were starting to lose their frown lines. In 1992, she and her dermatologist husband published a study in the Journal of Dermatologic Surgery and Oncology stating that though temporary, “treatment with C. botulinum-A exotoxin is a simple, safe procedure” for the treatment of brow wrinkles. Dermatologists from Hollywood to Hoboken immediately took note (and took advantage of this “off-label” use) and by 1997, Botox use spiked so high the country’s supply temporary ran out, causing panic among its devotees and prompting the New York Times to announce “Drought Over, Botox Is Back” once a new batch received FDA approval.

2000 and beyond – The good, the bad and the ubiquitous
With the new millennium, FDA approvals continued to roll in. In 2000, Botox got the FDA’s nod for the treatment of cervical dystonia (neck and shoulder spasms); in 2002, Botox Cosmetic (the frown-line fixer) got its official government go-ahead, greenlighting Allergan to begin a multi-million-dollar marketing campaign to boost its already healthy Botox sales, which had reached $310 million by the end of 2001.

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Fast forward a year and the drug had been profiled in nearly 14,000 TV and print stories (in the U.S. alone), end-of-year sales had reached nearly $440 million and Allergan had proclaimed Botox Cosmetic one of the most successful pharmaceutical brand launches in the company’s 53-year-history. In 2004, Allergan received yet another FDA approval, this time for the treatment of severe underarm sweating (hyperhidrosis), but for most people, the therapeutic uses of this nimble neurotoxin were just icing on a pretty, well-preserved cake.

Before long, Botox began to show up at gyms, malls, spas, even cocktail parties; it became a staple of TV makeover shows, a suitable birthday gift for friends and family (especially new moms!), and the beauty secret of both presidential hopefuls and Poughkeepsie housewives. Not surprisingly, its popularity (and high price tag) inspired a number of knockoffs and bargain basement “faux-tox” became a favorite of scam artists and pseudo-medical websites.

By the end of 2006, Botox sales had soared past the $1 billion mark, with cosmetic uses accounting for about half of sales.

But as this wrinkle cure has continued to shoot up in popularity (it’s the No. 1 non-surgical cosmetic treatment in the country), a Botox backlash is also brewing.

The pretty poison has been used as a method of torture in "Nip/Tuck" and a murder weapon on "Law and Order: Criminal Intent." It’s been the subject of at least one addiction study and its misuse and/or overuse has brought new meaning to the words “poker face” and “joker face” and raised concerns about the training and/or technique of the folks who are doling out shots at malls and medi-spas. Even Ashlee Simpson has turned her back on it (Me, use Botox? No way!).

It’s revered, it’s reviled and it’s made us all just a little afraid of Joan Rivers. Yet, despite the occasional side effects (droopy eyelids, slopey eyebrows) and those countless frozen-faced stars, you have to admit — Botox is one remarkable little pinch of sausage poison.

Diane Mapes is a Seattle freelance writer and author of "How to Date in a Post-Dating World."

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