Alastair Carruthers, 79, dies; pioneer in cosmetic employ of Botox

“Pretty poison” was what newspapers called it in the mid-1990s, when the deadly neurotoxin that causes botulinum toxin began appearing in headlines as a transient wrinkle-smoothing agent.

Botulinum toxin was 100 times more virulent than cyanide. For years, starting in World War II, the Defense Department had hoped to develop it as a chemical weapon. But decades later, when Dr. Alan Scott, an ophthalmologist, refined it into a drug after discovering its potential to treat conditions such as strabismus and blepharospasm (involuntary twitching and tightening of the eyelids), an unlikely byproduct of his treatment was a cosmetic: baby-smooth eyebrows.

But it wasn’t Dr. Scott who pioneered Botox, as it was later called, as a cure-all for aging. It was Dr. Alastair Carruthers, a Canadian dermatologist, and his wife, Dr. Jean Carruthersophthalmologist who joined forces to investigate its employ in cosmetics across hundreds of peer-reviewed studies.

While Dr. Scott became known as the “Father of Botox,” the Carrutherses were considered his godparents. Dr. Alastair Carruthers died on August 19 at his home in Vancouver, British Columbia. He was 79.

Dr. Carruthers, who suffered from advanced Parkinson’s disease, died thanks to Canada’s medical assistance in dying law, his wife said.

In the early 1980s, as skin cancer rates soared, Dr. Carruthers left Vancouver to begin a fellowship at the University of California, San Francisco, where he focused on Mohs surgery, then a up-to-date treatment for skin cancer.

Dr. Scott, who died in 2022, also lived in San Francisco, and Dr. Jean Carruthers applied for a fellowship to join him in his botulism studies. The couple had three teenage children and didn’t want to be apart. When the Carrutherses moved back to Vancouver, she continued Dr. Scott’s work. One day, one of her subjects complained that the soft forehead she had seen after botulism treatment hadn’t materialized in one case.

“’You didn’t treat me here,’” Dr. Jean Carruthers recalls, pointing to a spot just above her eyebrows. “’Every time you treat me here, I have this wonderful, peaceful look on my face.’”

“Then it dawned on me,” Dr. Jean Carruthers said, and over dinner that night she suggested she and her husband investigate the brow-smoothing effects of botulinum toxin. At the time, her husband had been treating his cosmetic patients’ frown lines with substances like their own fat or bovine collagen, neither of which were ideal. When the patient frowns, the wrinkles come back.

The couple’s receptionist, Cathy Bickerton Swann, then 30, was their first target. She had had a frown—a deep V above her brow—since she was 12. It didn’t bother her, she said, but she was willing to experiment.

For years, Dr. Jean Carruthers explained, Ms. Swann had seen blepharospasm patients walk through her office and noticed that Botox treatments not only relieved their often crippling symptoms—some spasms were so severe that patients were unable to drive or work—but also smoothed their faces. Ms. Swann felt confident that the treatment was protected and happily accepted the role of “patient zero.” One injection was enough to clear up her forehead.

The Carruthers’ first peer-reviewed study, on what they call “Elevens” lines—an anatomical term for glabellar lines—included 18 patients. Before they began, Dr. Alistair Carruthers injected his wife with something so she could model the procedure.

As she often said, “I haven’t frowned since 1987.” Her husband followed suit shortly thereafter. In photos from across the decades, his brows remained as soft as hers.

That first study “was a huge hit,” Dr. Jean Carruthers said. “It was spectacular.” She eventually closed her ophthalmology practice, trained in plastic surgery, and joined her husband in his dermatology practice.

The pair conducted hundreds of studies. After the glabellar lines, they focused on the frontalis muscle, which can cause horizontal forehead lines. Then they tackled the orbicularis oculi, which causes crow’s feet; the orbicularis oculi, which causes vertical lines above and below the mouth; the mentalis, the muscle under the chin that helps with pouting, causing wrinkles; and the latissimus dorsi, which runs from the collarbone to the jaw and, when contracted, causes neck wrinkles and a loose jawline.

Of course, the Carrutherses weren’t the only doctors offering Botox for off-label employ. Patients everywhere clamored for the drug, even as some pundits decried its employ as a way to appease vanity in an ageist culture. Movie directors complained that actors were losing their ability to express emotion; lawyers trumpeted its employ as an aid to keeping a poker face, a boon in negotiations.

Soon, shady doctors emerged, often using illegal Botox that distorted facial expressions and even paralyzed faces. “Frozen Face” replaced “Pretty Poison” in tabloid headlines. Politicians like John F. Kerry were investigated for Botox employ (he denied it); during the 2004 presidential election, some reporters even tried to trick him into grimacing.

Experienced practitioners like the Carrutherses have refined their technique to target more areas with greater precision, augmenting Botox treatments with other substances, such as dermal fillers, making Botox removal more arduous.

After a few decades, Botox employ was no longer something to lie about, nor was it something reserved for movie stars, politicians, and the wealthy. A wrinkle-free face became a sign of professionalism, a necessity for the successful. Botox became a routine of self-care for twentysomethings. More hand-wringing ensued. Botox had become a multibillion-dollar global industry.

“The worst complication of Botox treatment is reduced expression” – Dr. Carruthers he told Maclean’s magazine in 2014.“We first talked to a psychologist who criticized us for promoting the McDonaldization of North America, for limiting expression—that everyone would be walking around looking like zombies. We felt bad for a week or two, until we suddenly realized he was 100 percent right: when we do it well, we facilitate people express themselves better; they don’t look livid/worried/stressed when they’re not livid/worried/stressed. Most people are quite content to limit their ability to frown; if they need to commiserate, they can tell people how they feel.”

James Alastair Carruthers was born on June 4, 1945, in Bebington, England, one of three children of Barbara (Brownless) Carruthers and Dr. Benjamin Carruthers, a family physician. Alastair attended Brasenose College Medical School, Oxford, graduating in 1968. He completed his studies in internal medicine in Vancouver and Liverpool, and in dermatology at St. Thomas’s Hospital and St. John’s Hospital for Diseases of the Skin, London.

He met Jean Elliott while he was training in Vancouver at the University of British Columbia, where she was a medical student. They married in 1973.

Dr. Carruthers retired in 2015 and returned to UBC as an undergraduate, studying European and Middle Eastern history. He could handle a scalpel, his wife said, but had trouble taking notes on a computer. “He didn’t have the typing skills of an average 18-year-old,” she said.

In addition to his wife, Dr Carruthers is survived by sons, Thomas, Robert and Graham, sisters, Gail Cosbie-Ross and Bobbie Lintott, and four grandchildren.

In 1991, Dr. Scott sold the rights to his improved botulinum product, which he called Oculinum, to his distributor, Allergan, for an undisclosed sum, and the company changed its name to Botox. As for the Carrutherses’ fate, “we were kids in the woods as far as patents go,” said Dr. Jean Carruthers. When they first started working, they were dismissed by two patent lawyers who, she recalled, said, “Well, what you’re doing isn’t all that different from working on blepharospasm; it’s not patentable.”

“Terrible advice,” she noted.

In 2002, the Carrutherses received a patent for a single use for their work showing the effects of Botox on the muscles that depress the angle of the mouth, which can cause puckering of the lips. They sold the patent to Allergan for $100,000.

Botox Cosmetic’s global net revenues were $2.7 billion in 2023, up from $1.6 billion in 2021. according to AbbViethe company that acquired Allergan in 2020.

For her part, Mrs. Swann, the former receptionist, he told Newsweek in 2002. that she allowed her forehead to return to its natural state after about half a dozen injections.

“Lifestyles are changing,” she said, “now I’m 45 and married. I’m a little chubby and I have gray hair. And I have a line.”