The Past and Future of BOTOX: Tucson’s Ironwood Dermatology Team Explains

The most popular cosmetic treatment in the world is BOTOX®. Tucson’s Ironwood Dermatology team uses the injectable muscle-relaxer to help women and men achieve a younger, less stressed look—an option also enjoyed by millions of people who choose the treatment around the world each year, according to annual studies and research performed by medical professionals.

While the top choice is actually a broader category that includes all botulism-based injectables, in this world of cosmetic treatments, BOTOX^® is the leader and headline-maker. October 2017 saw media reports carrying word of a new U.S. Food and Drug Administration-approved use: treating forehead lines. This announcement came 15 years after it first broke into the public eye in 2002, which is when it first received FDA approval for treat glabellar lines that appear between the eyebrows. The cosmetic development marked the injectable’s first serious time spent in the spotlight, but its history extends back years—almost two centuries, actually—prior to that.

In the 1820s, a man named Dr. Justinus Kerner performed experiments as part of his research into the causes of food poisoning—specifically from bad sausages. His studies led him to identify botulism, while the bacteria that causes the problem was linked to the effects about 50 years later.

Another 80 or so years went by before serious inquiry into the bacteria’s potential medical uses took off. The early 1950s brought with them the discovery that purified and crystallized botulinum toxin type A could be selectively applied to certain muscles to temporarily relax them. Injections and experiments grew out of this realization, ultimately leading to FDA-approved human trials in the late-’70s, with doctors seeking to use the chemical to address chronic eye-crossing, known as strabismus.

After finding that it effectively and safely treats involuntary muscle action by preventing contractions, that FDA approved it in 1989 for treating both strabismus and blepharospam, which is uncontrolled eyelid fluttering. It was also given a name: BOTOX^®.

The ’90s saw an increase of research into the beneficial uses of BOTOX^®, with medical studies exploring a variety of applications. This is when a wife-and-husband ophthalmologist and dermatologist, respectively, noticed that injections to relieve eyelid spasms also tended to smooth out frown lines. An off-label cosmetic application was born.

Off-label uses are applications not officially endorsed by the FDA, which awards approvals that primarily govern how medicines can and can’t be marketed around the United States. Many experienced doctors find that other uses become apparent throughout the use of a product, such as the discovery that led to the research of cosmetic applications of BOTOX^®.

Since that initial finding, the FDA has approved three cosmetic uses for BOTOX^®: treating glabellar lines, crow’s feet, and forehead lines. The first came in 2002, providing an option for patients who wanted to smooth out wrinkles that appeared between their eyebrows. The approval for crow’s feet—known technically as lateral canthal lines—came in 2012. As noted above, the most recent approval was announced in October 2017.

Off-label, BOTOX^® is frequently used to address vertical lips lines (also known as “smoker’s lines), marionette lines that extend from the corners of the mouth down toward the chin, and a slightly drooping nasal tip, among other conditions.

As for medical uses, BOTOX^® is approved for more than strabismus and blepharospasms. Over the years, it also garnered an FDA green light for the neck-twisting cervical dystonia, excessive sweating (hyperhidrosis), chronic migraines, bladder hyperactivity, and both upper and lower limb spasticity. Research is continuing into a host of other uses, including treating depression.

To learn more about cosmetic applications—both on and off label—of BOTOX^® in Tucson, contact Ironwood Dermatology at 520.618.1630 or visit the practice’s “contact us” page.