How Botox Re-Shaped the Face of Beauty

Nothing has changed the face of mankind quite like Botox.

It's safe to say that the original injectable, first introduced to the market in 1989, has not only re-shaped society's beauty ideals but revolutionized the skincare industry with its ability to interrupt the aging process, giving people a youthful appearance—at least to the naked eye.

"It's really helped people look and feel younger," Dr. Rahi Sarbaziha, a board-certified integrative medicine doctor and aesthetics specialist, told E! News in an exclusive interview. "It's given us a different standard of what beauty is, and when you compare someone from the 1950s vs. someone from 2023, 40-year-olds look drastically different."

And the demand for Botox isn't slowing down, as it continues to be the number one minimally-invasive cosmetic treatment doctors administer, according to a 2022 statistics report by the American Society of Plastic Surgeons.

But how did Botox earn its top ranking? Well, it's gone through its own nips and tucks over the years, with many transformations of its medical and aesthetic capabilities since it was discovered in the early 1960s that it could temporarily paralyze the muscles.

So, let's lay it all on the table by looking at the evolution of Botox, its in-demand results and lasting power.

What is Botox?

First things first, Botox is a brand name. Yes, you read that correctly! It was made by Allergan, Dr. Sarbaziha said, "They were the first on the market and have the most FDA approvals for their product." However, Botox has become a deonym for various neuromodulators (a fancy way of describing wrinkle-relaxing injections of botulinum toxin, which we'll soon touch on) such as Xeomin, Dysport, Jeuveau, Daxxify, among many others.

Moreover, Botox is a form of botulinum toxin type A. Botulinum toxin is considered one of the most poisonous biological substances and is derived from the bacterium Clostridium botulinum, which is the same toxin that causes life-threatening food poisoning, per the National Library of Medicine. But before you shriek in horror, there's a reason so many people have given it a shot.

"Yes, it is a toxin," double board-certified facial plastic surgeon Dr. Heather Lee explained in an exclusive interview with E! News, "Yes, it can be worrisome when you think about it like that. But you could say that for a lot of medications and drugs, it's what we've learned about it and how we use it that imparts our comfort and safety with it."

What is Botox used for?

Medicinally speaking, it's FDA-approved to treat overactive bladder symptoms, chronic migraines, cervical dystonia, strabismus, blepharospasm, upper and lower limb spasticity, severe underarm sweating and also to increase muscle stiffness. For aesthetic purposes, Botox is used for forehead lines, crow's feet and the glabellar lines—commonly called the "11s" between the frown lines and eyebrows.

"The typical length of Botox," Dr. Lee added, "is three to four months." And while the results are temporary, the facial plastic surgeon pointed out there are downsides to getting frequent injections.

"When you go more often," noted Dr. Lee, who practices at The Quatela Center for Plastic Surgery in New York, "you're just re-paralyzing it and you could potentially get a heavier look because you're dosing too early and too much."

And like any drug, it comes with potential side effects such as blurred vision, drooping eyelids, loss of bladder control, swallowing, speaking and breathing, per Botox's website. Dr. Sarbaziha also said that when you use Botox to the point of looking frozen, it could potentially lead to muscle atrophy or a decrease in muscle tissue.

How has Botox evolved?

The most noticeable enhancement of Botox is its results. The injectable—which received FDA approval as the first aesthetic treatment on April 15, 2002, 13 years after it hit the market—has received a major facelift in recent years. 

That's not to say that gone are the days of a stiff appearance, but Dr. Lee shared practitioners take more artistic liberties than before.  

"When we started using Botox," she continued, "we probably had a different look than we have now because we realized there are things you can do with the concentration and the location—and it allows providers to be creative with it."

How does Botox go beyond beauty?

If you look back at the history books, between 1817 and 1822, German poet and physician Justinus Kerner published the first comprehensive study of what we now know as botulism, per the National Library of Medicine. By 1897, Belgian bacteriologist Emile van Ermengem made the connection that the bacterium was responsible for botulism after studying a deadly outbreak of contaminated ham served at a funeral.

Fast forward to the 1960s, when Dr. Daniel B. Drachman uncovered botulinum toxin was capable of paralyzing the muscles of a chick, therefore, inspiring ophthalmologist Allan Scott to research it for strabismus. His studies in the 1970s led to FDA approval for conducting human research for treating the eye condition.

Dr. Lee summed up the injectable's lasting power best, saying, "Botox revolutionized medicine in a lot of ways."

But it's also been a huge game-changer for the beauty industry. "It has really transformed aesthetics because it made it attainable," she added. "The use of plastic surgery or procedures was for a certain subset of patients or type of person, but it brought aesthetics to the everyday person."

Dr. Sarbaziha echoed similar sentiments, sharing, "I don't think there will ever be a decline in Botox. Even people that you think wouldn't want to get Botox, get Botox."

So, what's the takeaway?

While Botox has proved to be a force in the beauty space, Dr. Lee shared an important reminder.

"These are all tools," she said. "Just like when you find a hairstylist, a makeup artist or somebody that sees your aesthetic, you want somebody that can understand what you're trying to achieve."

Don't be afraid to ask your provider questions and have a conversation about your desired results. "You want somebody that will tell you more is not always better," Dr. Lee added. "I think that's one of the backlashes. You want to make sure that whatever you're trying to accomplish, the person is on the same page with you."