Guest post by Rowena Fletcher-Wood

How do you feel about Botox?

To some, it’s a routine fix, a gift in the battle for eternal youth, found at the tip of a needle. Others, perhaps understandably, feel rather uncomfortable at the thought of injecting their face with a potent neurotoxin, just 50 grammes of which could wipe out all human life.

A man recieving botox treatment – © Shutterstock

But how would you feel to hear that Botox was discovered by accident – that this potent neurotoxin, which acts by paralysing muscles into flaccidity, was at some point injected into somebody without knowing everything it would do? In a marriage between cosmetics and surgery, this is how Botox came about.

Of course, people have been looking for something like Botox – and for a long time too. Back in the 16th century, women would stir up a white paste of vinegar and lead and plaster it across their faces in the same vein as foundation today. Once the mask had set, they would be unable to make any facial expressions at all for fear of cracking it, but apparently it was still worth it, despite the massive doses of lead that would have been slowly poisoning them, and the rancid unpleasant smell of the vinegar. Slightly less bizarre (but bizarre all the same) was the later introduction of uncooked egg white glaze to the same result. This at least didn’t poison anybody, assuming the eggs were healthy.

Then, in the 1820s, there came ‘wurstgift’. This was not a cosmetic face paint, but the first discovery of botulinum, found by German scientist (and apparent masochist) Dr Justinus Kerner, who isolated it from sausages that were past their best. He was investigating the deaths of several Germans at the hands of blood sausages, and his analysis of the toxin included going as far as injecting it into himself to observe its effects. Dr Kerner was, in fact, the first recipient of botulinum toxin, or Botox.

Despite its extreme toxicity – and it is extreme: scientists believe botulinum toxin, produced by Clostridium botulinum bacteria, may be the most toxic substance known to man – treatment with Botox is actually less risky than anaesthesia. Why? Two reasons. To start with, diluted botulinum toxin is injected into specific muscles. It doesn’t travel out of these muscles very easily, so it doesn’t spread throughout the body to cause wider paralysis. It’s good at staying still. It causes paralysis where you put it, and only very rarely does it escape, get into our respiratory muscles, and initiate fatal respiratory paralysis. The second reason is that botulism, poisoning by botulinum toxin, is a slow process with distinctive symptoms: muscle-loosening, double vision, loss of facial expression and ability to talk or eat. In fact, the symptoms are distinctly like those of stroke, leading to rapid medical attention, diagnosis, and treatment. Botulism is treated by injecting a patient with antibodies that block the toxin whilst supporting functions such as breathing and blood pumping using external machines if necessary. Not a fun day, but no need to be fatal.

Dr Kerner’s descriptions of the effects (which did not kill him), were interesting enough to capture other scientists’ attention. The toxin was purified and explored as a bio-weapon for war or medicine for therapeutic application. In 1953, the physiologist Vernon Brooks determined that botulinum toxin blocked the release of acetylcholine from motor nerve endings, and introduced the toxin for local medical application. The drug was to become used for cerebral palsy, incontinence, migraine, tinnitus, stroke rehabilitation and muscular spasm.

Although still a new treatment, one up and coming ophthalmologist, Jean Carruthers, decided to use it in her eye surgery to treat a muscular spasm of the eyelid, known as blepharospasm. Sometimes, blepharospasm spread to the surrounding area, and she might inject a patient’s eyelids, eyebrows, or even forehead. Although it has a distinct effect, Botox is not everlasting: after 6 months, or sometimes more rapidly, it can stop working and the patient has to return for another measure. It was through re-treating one such patient in 1987 that Carruthers’ attention was drawn to the potential cosmetic application of Botox. Happily returning for her repeat injection, a patient requested that her forehead, which was not in spasm, be injected. When questioned as to why, she admitted that the Botox took away her wrinkles.

Now, it just so happened that Carruthers shared her practice with her husband, dermatologist Alastair Carruthers. For many years, he had been plagued with the problem of glabellar lines between the eyebrows – and specifically, how to get rid of them. The potential was recognised, place for it found, and in just a few years – disregarding a few wrinkles along the way – Botox would become one of the world’s number one cosmetic surgeries.

To learn more about killer sausages and ditching twitches, see our podcast:

http://www.rsc.org/chemistryworld/2013/07/botox-botulinum-toxin-botulism-podcast

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