I invented Botox – now aged 76 I’ve no wrinkles. Here’s how I do it and the stunning age I imagine you must begin utilizing it – and the celeb who’s acquired it improper

With three young sons and busy lives as doctors, the only time Dr Jean Carruthers and her husband Alastair could catch up was at the dinner table.

So, it was over a home-cooked casserole that Jean first suggested using one of the world’s deadliest poisons as a cure for frown lines. Not surprisingly, her husband’s jaw dropped.

It was 1987 and Jean had accidentally stumbled on Botox, now the world’s most popular cosmetic procedure and the inspiration behind a new generation of fillers and other anti-ageing therapies.

An ophthamologist, trained to use diluted botulinum toxin, which temporarily paralyses muscles, for eye disorders such as squints, Jean had been surprised earlier that day when a woman suffering from blepharospasm – debilitating eye-twitching – became irate that her brow wasn’t being injected.

The patient pointed out that at her last appointment, Jean had injected the area to help her twitching, and the treatment had given her a ‘beautiful, untroubled expression’.

‘That was when the penny dropped. I was married to a dermatologist who wasn’t happy with the treatments available at the time for glabellar lines,’ Jean recalls, referring to the short vertical frown lines or ’11s’ between the eyebrows.

The fillers that were available didn’t last long, were painful and were made using processed fat from patients’ own bodies or bovine collagen.

‘So, I came home, fed the children, and said to Alastair: ‘I think I have the solution for frown lines.’ We were both very excited.’

I am at Jean’s home in a leafy, upmarket suburb of Vancouver, Canada, which she shared with her British-born husband until his death in August, at the age of 79.

The house is filled with reminders of the couple’s 50-year marriage and of their careers as the pioneers of Botox.

Photographs of their three sons and four grandchildren are prominently displayed alongside awards for medical innovation and leadership. There’s also a cushion with the words ‘Botox saved my marriage’, given by a friend as a joke.

With a fashionable blonde haircut, petite figure and smooth visage that she says is topped up with regular, self-administered Botox injections, Canadian-born Jean looks a good ten to 15 years younger than her 76 years.

After Jean’s dinner table revelation, however, the couple was to discover that the road to developing Botox for cosmetic use would not be easy. It took years.

The first step was to enlist the help of Cathy Bickerton, the receptionist at their shared medical office, as their ‘Patient Zero’.

This doesn’t seem as strange as it sounds because Cathy, then aged 30 and with a deep ‘V’ etched above her eyebrows, had been working with the couple for years and had already seen how Botox could help patients medically.

‘Cathy had a really deep crevice that got worse as the day went on – by the afternoon she would look fierce,’ laughs Jean. ‘Three days after treatment, she had a smooth forehead, an elevated brow and a refreshed, younger expression. She thought it was great.’

Nevertheless, recruiting other people for trials of a drug that paralyses facial muscles was a problem. No matter how often the pair said the treatment was safe because they were injecting only tiny amounts of Botox – billionths of a gram – people recoiled.

‘They’d say: ‘You want to inject me with the world’s most poisonous poison? No way!’ ‘ laughs Jean. ‘So, we did the logical thing and Alastair started injecting me.’

Jean’s before and after photographs showed the softening of the dreaded ’11s’ – giving rise to her iconic and much-quoted observation that: ‘I haven’t frowned since 1987.’

Even so, they could persuade only 18 people over five years to be participants in trials.

The couple ploughed on and published research in 1991, which was largely ignored.

Their paper on Botox for cosmetic purposes, presented at the 1992 American Society for Dermatologic Surgery convention, went down like a lead balloon. ‘Colleagues came up to us and said: ‘You want to inject people with this deadly poison for something as frivolous as wrinkles?’

‘They thought it was a crazy idea that was going nowhere.’

Jean says she and her husband were undeterred.

‘It fired us up that people didn’t understand how marvellous this was, so we continued our clinical trials and went around the world explaining it to people at dermatology conferences.’

Botox had initially been approved by the US Federal Drug Administration (FDA) in 1989 for the treatment of blepharospasm.

The rights to the drug were sold in 1991, and the new distributor, Allergan, rebranded it as Botox the following year.

It was not until 2002 that it gained approval for cosmetic use.

Slowly, during the 1990s, the benefits of Botox became widely recognised, spread by word of mouth, with ophthalmologists, dermatologists and plastic surgeons taking notice and adding it to their cosmetic armoury.

Today, the British Association of Aesthetic Plastic Surgeons (BAAPS) estimates 900,000 Botox procedures were carried out in this country in 2023, while more than 8.8 million injections were performed globally. 

And it’s not just used for frown lines, crows’ feet and wrinkles. It can be used to treat excessive sweating of the armpits and hands, incontinence, migraines and foot pain. It may help premature ejaculation and pelvic floor dysfunction that can lead to painful sex, as well as irregular heartbeats.

It can also help relieve muscle stiffness in people with spasticity, along with drooling and hair loss.

One of the most exciting developments, says Jean, is the discovery that forehead injections of Botox can treat depression, according to a number of studies.

‘Around two weeks after you have the treatment in your glabellar, the area between the eyebrows and nose, many people feel less social anxiety,’ she says. ‘Studies have shown that up to 90 per cent of patients become less depressed.

‘We thought people were feeling happier because they looked so much better. But we subsequently learned that Botox doesn’t stay in the face – it goes into the brain and alters the amygdala, the part of the brain that processes fear and anxiety. So, you have this lovely effect we hadn’t understood initially.’

Jean and Alastair, who was born in Cheshire in 1945 and read medicine at Brasenose College, Oxford, first met in Vancouver in 1970.

They were introduced through mutual friends, returned to England and married in 1973.

As an ophthamologist, Jean worked at Moorfields Eye Hospital in London, while Alastair specialised in dermatology at nearby St Thomas’ and St John’s hospitals.

In 1977, deciding to start a family, they moved back to Vancouver for a slower pace of life.

While on an academic fellowship, Jean worked with San Francisco-based Dr Alan Scott who had refined botulinum toxin – 100 times more virulent than cyanide – into a pharmaceutical.

Dr Scott concentrated on medical uses of the drug he called Occulinim (eye aligner), selling it to the eye care products company Allergan, now part of the biomedical company AbbVie. It was renamed Botox and today the company makes billions of pounds every year from its product.

Following their discovery, Jean and her husband both retrained as cosmetic surgeons – Alastair was famous for his smooth forehead and for conquering his own excessive sweating with Botox injections – and the couple set up their own highly successful practice and research institute in Vancouver.

Nowadays, Botox is used by both women and men, but treatments vary for the sexes depending on facial anatomy, muscle strength and different areas of concern, says Jean.

‘The ageing process of remodelling facial bones starts in women at 24 or 25,’ she says. ‘The brows descend, the orbit – the bony box that houses the eyes – gets bigger, the fat pads on your cheeks go south and you get deep nasal labial folds. You start getting jowls because your jawbone shrinks. Gravity wins.’

With men, she adds, that process starts at about 45. ‘Botox works perfectly well for men, but you have to give them higher doses because men generally have larger facial muscles than women.’

While both men and women typically want help with forehead creases and frown lines, women want to soften crows’ feet around the eyes and men are increasingly using Botox to help with excessive sweating.

‘When you look at someone’s face, their authority is in their brows,’ says Jean. ‘Low brows on a man makes them look powerful and confident. A woman with low brows looks tired, intense and angry. That’s where the phrase ‘resting bitch face’ comes from.

‘For women, the power comes from the brow not being too low and not too high, and for men it comes from being a little bit low but not too low.’

There has been criticism of Botox, of course, as an aesthetic tool that encourages vanity, gives people frozen expressions and can cause side-effects such as muscle weakness that can change facial asymmetry.

This is often referred to as the ‘Spock look’ after the iconic character in Star Trek because the brow is pulled up too high and the eyebrows are over-arched.

‘It has to look natural,’ agrees Jean. ‘It’s important for a woman to be able to lift her brows and to be able to frown so she can show interest and compassion.

‘If the only way you can show you are amused is by smiling, for example, it’s too much.

‘What I try to do with my patients is to slightly under-correct them. The moment you step over a certain line, everybody knows you’ve had something done, so it’s a bit of an art to do it properly.

‘The other thing is not to let Botox wear off totally because you lose all the remodelling of the collagen, meaning you prevent any new lines and wrinkles from forming, that you’ve established in three or four months.’

She cites Nicole Kidman as an example of someone who she thinks has had a lot of work on her face. ‘She’s a wonderful actress and a beautiful woman but it’s over-done, nothing moves,’ she says. ‘It must be because she likes it that way.’

Certainly, Jean is her own best advert and there is nothing frozen about her face. She wiggles her eyebrows for me and her forehead has distinct, natural looking horizontal lines.

She is matter-of-fact about other ‘anti-ageing’ treatments she has had: a complete face lift 15 years ago, lid lifts, fillers, skin-tightening and skin-contouring treatments, plus intense-pulsed-light treatments.

She had her last self-administered Botox injections a month ago. ‘I can usually get an appointment with myself,’ she jokes.

She points to various spots on her forehead where she injected herself. ‘I use about 40 units, two or three times a year,’ she says.

Controversially, younger people are getting the treatment these days, but Jean says that she is all in favour of ‘Baby Botox’, which is injected in smaller amounts.

‘Botox in your 20s is smart,’ she says. ‘These are people looking at their own families, seeing what the future is, and realising they can reverse the ageing changes they’re starting to see on their own faces, such as brow droop, with small doses. And then they just keep on doing that.

‘Prevention is the mantra of millennials. And the other thing they’ve done is taken away the stigma of Botox. So, they’re asking each other: ‘How many units did you have?’ They don’t see it as anything you have to hide.’

Given the extraordinary popularity of Botox, one would think that Jean and her husband would have made a fortune from their discovery. Not so.

‘We wanted to patent it for cosmetic use, but a couple of law firms here told us that it wasn’t so different from what Alan Scott was doing. We should have carried on and found lawyers who understood the process better,’ she sighs.

The couple did sell a patent for a Botox procedure that helped alleviate downturns at the corners of the mouth for $100,000, which Jean says was ‘a drop in the bucket’.

‘What would I do with billions, though?’ she wonders. ‘I’m a doctor and Alastair and I were just glad that our work is out there and helping people.’

Alastair retired in 2015 and was diagnosed with Parkinson’s disease the following year. An athletic man who golfed, sailed, skied and ran marathons, he became severely incapacitated and decided to end his life with the aid of Medical Assistance in Dying (MAID), Canada’s controversial new assisted dying law.

He died surrounded by Jean and other family members, in his garden, his favourite place.

Not surprisingly, his widow is still suffering from deep grief and is occasionally overcome by tears.

Referring to his decision to use MAID, she says: ‘It was a blessing for him, to have a peaceful death, to go with dignity and at a time of his own choosing.’

Jean still sees patients three days a week and says she finds satisfaction in her work.

‘Changing Botox’s reputation took 25 years of hard work,’ she says. ‘It’s an amazing drug and has re-defined ageing.

‘Now you don’t have to wait till you’re 50, have a facelift, disappear for a few weeks and then come back, and everyone’s saying: ‘She’s had a lot of work done.’ Now it’s all about maintenance, maintenance, maintenance.’

And maintenance has most certainly worked for her.