The Discovery That Changed Aesthetic Medicine with Dr. Jean Carruthers

In this special episode of Skin Anarchy, Dr. Ekta Yadav sits down with Dr. Jean Carruthers MD, FRCSC, FRC(Ophth), the pioneer of cosmetic botox, world Renowned cosmetic surgeon & award winning researcher. What began as an unexpected patient interaction ultimately changed the way the world thinks about facial aging, leading to the development of cosmetic botulinum toxin treatments that continue to shape the field today.

Dr. Carruthers reflects on the remarkable journey from treating patients with functional eye disorders to recognizing an entirely new application for botulinum toxin. At a time when cosmetic options for expression lines were limited, the idea of selectively relaxing muscles to soften wrinkles represented a completely new approach. Yet the path from observation to acceptance was far from easy. Early presentations were met with skepticism, and it was rigorous research, clinical evidence, and persistence that ultimately transformed a controversial idea into one of the most extensively studied treatments in aesthetic medicine.

Throughout the conversation, Dr. Carruthers emphasizes the role of curiosity in scientific discovery. Many breakthroughs, she explains, emerge not from certainty but from paying attention to unexpected outcomes and asking better questions. That mindset continues to guide her perspective on the future of aesthetics, from preventative treatments and regenerative medicine to emerging technologies that may change how outcomes are measured and understood.

More than a history lesson, this episode offers a rare glimpse into the mindset behind true innovation. Listen to the full episode to hear Dr. Jean Carruthers share the story behind the discovery that revolutionized aesthetics, her perspective on the future of regenerative medicine, and why the most important tool in science may be an open mind.

Read about Dr. Jean Carruthers

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Transcript

Welcome And A Dream Guest

SPEAKER_00 0:00

Hi guys, welcome back to Skin Anarchy. Today's episode is very, very special to me. This is literally my my dream guest for the show, and I am so incredibly honored and humbled to have her here with us today. So uh without further ado, please welcome Dr. Jean Cruthers, who many of you might uh recognize from her revolutionary work in uh aesthetics that has really uh framed modern aesthetics as we know today. And the discovery continues to frame so many conversations, so many discoveries that are still coming out. So without further ado, please welcome Dr. Cruthers. I'm so honored to host you.

SPEAKER_01 0:34

Well, thank you so much. I am honored to be on your famous podcast. It's a thrill for me too.

SPEAKER_00 0:41

Thank you so much. Uh, I really would love to start, you know, from the beginning. I know that um yourself and Dr. Alistair Cruthers, you both um really collaborated, you know, to bring this discovery forward. And I would love if you could walk us down memory lane and talk about that moment where you realize that, you know, neurotoxin could be that next frontier for aesthetics.

SPEAKER_01 1:03

Oh, thank you. I will, you know, I was very blessed uh to have such an intelligent and uh and uh thoughtful and open-minded husband. Uh, and it was really when the aha moment was actually when one of my blephrospasm patients got angry at me. Now I have to frame this, and I use your word frame, um, because all the blephrospasm patients were given back their life with botulinum toxin injections. They couldn't open their eyes to cross the street or earn a living or drive a car, and suddenly they were back being normal people again. So when one of them got angry, that was really um that was a big flag. So I really listened. And she said, you didn't inject me here, injecting her medial, pointing to her medial brows. And it just so happened with Alistair being a dermatologist, he had been trying to treat frown lines

The Patient Moment That Sparked Botox

SPEAKER_01 2:05

for his cosmetic patients uh using collagen, fibrel, and autologous fat, none of which gave a nice result when the face was in motion, only when it was relaxed. So I apologize to that patient and for not injecting her in that area. And um, you know, I owe her a big vote of thanks for educating me because I hadn't really seen that as an issue before. Because in those days I was not an aesthetic physician, I was a strabismus surgeon, ophthalmologist, functional. So I went home that night and we have three sons, and over dinner and the chaos, I said, you know, we should we should really talk about using my botulinumotoxin and was doing the study with Alan Scott on your wrinkle patients, because there could be a great synergy. And instead of saying, Oh, don't be silly, you've got that terrible poison, he said, Oh, that's a great idea. And so that's how we started uh working together. And until that time, we'd always been husband and wife and parents together. But this was the start of a whole new world.

SPEAKER_00 3:22

That's so fascinating. And you know, this, I mean, the whole discovery and in the story, you know, behind it really reminds me so much about what we I think are taught even in school, right? About science, how it can translate and it we can discover something in one area and it will really revolutionize so many different areas of medicine and science. And I would love to get your you know, just your take on this and and the idea of true discovery in science, you know, like what are your thoughts around that whole philosophical concept?

SPEAKER_01 3:54

I think um, I think we have to use the parachute analogy

Humility As A Discovery Skill

SPEAKER_01 4:00

that a mind is like a parachute, it doesn't work unless it's open.

SPEAKER_00 4:05

Yeah, yeah.

SPEAKER_01 4:06

So I think that we have to be humble and we have to be listening uh to our patients and to our colleagues. Because I think if you think you know everything, you're never going to have a discovery. But if you stay humble and you work hard, uh things will fall into your into your lap that you never thought of. So I think it's an attitude thing, the science and discovery thing that I think people who discover, like for example, um the discovery of microwaves being for cooking. Yeah, you know, it was an accident. But the gentleman had an open mind and could see, oh, if we can pop corn, what else can we do? Yeah. So I think it's an attitude thing. I think uh there was a study done in um the in the eastern states, I think it was an insurance uh study, and they did everybody's IQ, and then they taught them, and then they examined them. Uh, and the other thing they did ahead of time was to check on their attitudes. And the correlation at the end was the people who were arrogant got the worst marks. Wow. People who were humble had the best marks because they had, you know, they're allowing their minds to be open.

SPEAKER_00 5:31

Yeah. Wow. No, that's really um it makes you think. I mean, no one ever speaks about that. The humility component in science. I think right now, the way that academia has evolved over the years, at least in in my, you know, uh like understanding, it's like everybody's got such a big ego these days. So it's it's hard to you know get through that sometimes. But yeah, when I look at discoveries such as yours across the board, I see what you mean. You know, there is a level of humility in every scientist there that's done it. So it's very fascinating. Um, I want to ask you though, because I mean, obviously, Botox has now been applied across the board. There are so many areas that have benefited, right? And and this understanding, it

First Cosmetic Study And Earning Trust

SPEAKER_00 6:10

just continues to expand every single day. You know, did you know that when you first discovered um the benefits, you know, in the aesthetic field? Did you think that this would go beyond and start dealing with things like migraines and you know all of the different applications we see today?

SPEAKER_01 6:25

I know. I did that's easy to answer. Uh it was pretty amazing to find a treatment that worked, and you could see on an N of one that it worked. Our very first patient in our study, the one we did together, uh, which we published in the Journal of Durham Surgery, and uh um it was uh our receptionist. Now you have to imagine what it's like back then in 1987, because I've been treating patients now in Alan Scott's NIH study uh sh for since uh 83 when I got approval from Health Canada. So four years I've been treating all these people for uh uh dystonias and strabismus. And the one person in the world who could see that all of these people were happy, well looked after, healthy, doing well, doing better, uh, was our receptionist. And our receptionist Kathy had wonderful frown lines. And so we needed a first person for our study, and so we said to Kathy, who unique person on the planet, because every other one of the 8.1 billion people on the planet, except for Alan Scott and a few other um notables in the United States and Canada, thought of botulinum toxin as the most poisonous poison. So to have somebody who was so relaxed about being treated for cosmetic reasons by the most poisonous poison was our receptionist because she'd spent four years seeing all my patients in the research patients. Unusual because everybody else in when we then were recruiting more patients for the study, everybody else would say, Oh no, I don't think so. That's a terrible poison. I don't want to be part of that. Yeah. So I've got Alistair to eject me. And then they'd get to the part where it's oh no, it's a terrible poison. I don't want, and I'd say, Oh, what do you think of this? And I'd show them my photograph from before with my magnificent frown lines, which I used to have, and then they I'd say, Well, what do you think? And they'd say, Oh, do it. Because they could see I was perfectly healthy, and I had the brow that they wanted, and they could see where I had come from, and they also could see it, I was perfectly healthy and um engaged with this. So it's a it's a big learning point too. And in discovery, uh, maybe you have to do something yourself before other people will believe you.

SPEAKER_00 9:26

Yeah, no, that's really fascinating that you say that, you know, because I was gonna actually, that was one of my biggest questions because when you think about it, I mean, it must have been so shocking for everyone involved back then that this is a toxin. You know, how can we bring this forward in a therapeutic way? And I I would love your thoughts on like just what you see now because I feel like it's happening again, where people are trying to discover something truly novel, right, in aesthetics. Like, for example, exosomes are super, you know, on the front line right now. But again, you see that same kind of critique coming up where it's like, this is absurd. Like, how could this possibly work? You know, so what were some of the things you had to push through from the scientific side as well as convincing, you know, your colleagues and and the prominent researchers of the time that no, this is the real deal, you know?

Skepticism And Proving It With Science

SPEAKER_01 10:16

Yeah, that's that's actually the question. And uh that was the question. And the only way we had to confront the horror of our colleagues. When I gave the first paper at the American Society for Dermatologic Surgery meeting in uh 1990, um there was dead silence in the room. And normally after I give a talk, people ask some questions, we have some discussion, you know, like anybody else. But there was dead silence. But they came up afterwards and they said, How could you use that terrible poison on something so frivolous as wrinkles? First of all, it's not a poison if you know what you're doing with it. Paracelsus, the famous Swiss physician, everything is a poison, it's the dose that matters. And so that's one realization. And also, to be fair, they hadn't been involved with Alan Scott's research project program for four years. So they hadn't had the experience of using this incredibly new exciting material uh in a research way, so they didn't understand about that the fact that it had been used uh by many other people other than me all through uh this the four years of the study. And uh the other thing was that was really would never fly today. There is nothing frivolous about a wrinkled yeah, because wrinkles are self-esteem, and there is the most important thing for people is their self-esteem. So there were so many, so many misconnects in the messaging. So that was really what we had to deal with. But how do you deal with that with people who've got a certain mindset and are not happy to consider another to open their minds to another use? So what we had to use was the scientific method, because everybody understands the scientific method. Uh, it's it's cast in stone how you do things to be believed. And so we used that. So that was how, and then gradually uh we kept, we were so busy. We did we would do you know 17 meetings in a year, uh, you know, trying to get the message out, and then gradually we got invited all over the world to talk about what we did, and gradually they start getting, oh well, I could do that, I could do my own research projects on that. So pretty soon now you start seeing we've got, I think there's over 6,000 peer-reviewed scientific articles in the literature on botulinum toxin and its uses cosmetically. Really amazing. It's probably the best studied of many drugs, uh, and studied with great science.

SPEAKER_00 13:17

Yeah, yeah. No, this it's really, I mean, it's fascinating what it did for an entire field, you know. And I think this is where the idea of a ripple effect really comes front and center in science, is that, you know, and I get very confused by some of the critique I see, right, in the scientific community when somebody is trying to really revolutionize, and maybe the all of the pieces aren't there yet, but there's enough to where they're like, no, this is something worth talking about, you know. And that's why I asked you that, because we see so much of that critique now, you know, before things even they start blossoming at all, you know.

SPEAKER_01 13:53

So yeah, yeah, it's a steep curve. Yeah, it's really, really hard to make progress. But then once it gets flying speed, look out. I mean, look at how many indications there are around the world, it's in every country. It's uh it's it's a great idea. And I think it's also fueled a whole other thing that if you feel good, you're going to do better in your life. And so it's created this whole new avenue, as you were pointing out, with exosomes and other approaches to general wellness.

SPEAKER_00 14:31

Yeah, yeah, absolutely. No, it's I mean, it's remarkable like what it's done for for the field of you know, aesthetic medicine, but also beyond. I mean, it's it this is the kind of stuff that I think when you look at it from the lens of like science and creativity, it makes you really think like, yeah, this opens doors to people's minds and like how you think and how you interpret the data that we're seeing in a lab, you know, and it really is like the spotlight on truly what translational medicine actually means, you know. And that's why for me personally, as a young, you know, person in science, it means so much to watch this work evolve even

GLP-1 Drugs And Faster Wear-Off

SPEAKER_00 15:05

now. Um, and on that note, I would love to talk about your recent paper. Um, you discussed and showed that like drugs like Ozempek and the GLP1s, um, they make the neurotoxin wear-off faster. Can you talk to us about that and and what you're really finding in that realm?

SPEAKER_01 15:20

We we don't really know that. Uh, this is uh this is uh computational modeling. Okay. And so uh the FDA has used computational modeling for over 30 years. Uh, and it's a great way using mathematics to decide whether it's worthwhile going ahead and putting research subjects through a trial because you can actually using information that's publicly available and using uh various algorithms, you can compute whether something is likely to work or not.

unknown 15:56

Yeah.

SPEAKER_01 15:57

And so it's used all the time now in discovery for cancer drugs uh and starting to be used more for other drugs. Uh and uh I think I don't know for sure, but I think with the weight loss drugs, they've probably been uh using it as well. But the weight loss drugs are uh a really fantastic new wave because if you look at the United States, it's 12.5%, which is like 44 million people. And I bet you that's an underestimate uh of how many people are using because it's so good for your mental health, for your inflammation, for your lungs, for your heart, for your kidneys. It's not so great for your skin. Uh, I'm just doing a study on that at the moment, looking at a group of women who are on trzepatide, 20 of whom are getting treatment with a skin shrinking device called Softwave. Uh, it's an ultrasound device at the beginning when they start their trzepatide versus the other group that are going to get it at six months when they uh have had their trzepatide for six months, asking the question is it better to think like a millennial and prevention is better than cure? I suspect, but I don't know until the end of this study.

SPEAKER_00 17:22

That's very fascinating. I can't wait to see the results of that. I mean, that's I it's really you know interesting because you know, and this is what I wanted to ask you really was what was the most interesting, like kind of side, you know, revelation that happened after botulum toxin really came to the forefront and people started studying it more for you personally. Like, what was that one like application where you're like, oh, you know, I never even thought that we could use it like this?

Surprising Synergy With Energy Devices

SPEAKER_01 17:48

You know, it was um I I saw the benefit with fillers in uh because I published on that. Yeah, but what really blew me away was how great it was with energy-based devices. Uh, for example, one study I did was on intense pulse light, and I was treating the patients for their crows' feet with uh with Botox. And what staggered me was how much the pigmentation that they had, how much better they responded to the IPL in the group that got Botox.

SPEAKER_00 18:23

Oh.

unknown 18:24

Wow.

SPEAKER_01 18:24

That's fascinating. Why is that? You know, it obviously has other ramifications that we just don't understand yet.

SPEAKER_00 18:32

Yeah, yeah. No, that's really, I mean, I think that's what I get very fascinated because so many dermatologists are now educating on this, where it really improves the quality of your skin over time as well. And, you know, I would love for you to speak on this because I think recently there has been some fear-mongering um, you know, amongst consumers and you know, about oh, what you know, too much Botox, like when do you start? And like, is there such a thing as starting too early? What are your thoughts on that in terms of um true patient education around the use of Botox for you know your lifetime?

Baby Botox And When To Start

SPEAKER_01 19:06

Well, that's a great question because I am not a millennial, but I think millennials rock because I love their attitude. Uh and I agree, I mean, there's with their attitude that if you can prevent something going down the wrong road, why don't you do that? Yeah. And for example, millennials uh in their early 30s will notice that they're starting to get frown lines or horizontal forehead lines and start with what's called baby Botox. But you know, small doses, preventative doses. Uh I think that the question of when should you start is when it starts to bother your self-esteem. Now, given that in society, uh largely we don't approve of people doing things independently till they're at least of age 18. In some jurisdictions, it's 19. But I I think that that's the the thing. There is a tremendous tie-in between how you feel and how you look.

SPEAKER_00 20:15

Yeah. No, that's I yeah, I couldn't agree more. I mean, even like when I look out into you know social media and stuff, I mean, I'm always in the media space. It's always so apparent that, you know, it's not about the aesthetic procedure that someone's getting, it's more about like where was your mind when you went in for that and where is your mind now after you got it, you know? So that's I I hear you when you say that about the mindset part. Um, you know, but I I really want to know, like in your mind, like where do you think we're headed as an entire field, like the aesthetic medicine at large? Do you think it's going to be more like device-based, like you know, going into the future, or do you think these topical applications are also very viable for real changes?

SPEAKER_01 20:56

Oh, I think a combination, uh, because the aging process affects every single tissue layer from our bone out. You could say it affects our brains as well, but we aren't going there, except for the emotional side. Um, but uh I think that there's if we can find ways that in a non-invasive and safe way we can help people prevent the aging changes and allow them to be productive, happy members of society for longer, why not?

SPEAKER_00 21:27

Yeah, yeah.

Exosomes Marketing Versus Real Evidence

SPEAKER_00 21:28

No, that makes sense because I I brought up exosomes earlier, and that's what I I would love to like. I mean, how do you feel about exosomes? Like in these like regenerative ingredients that are kind of popping up now.

SPEAKER_01 21:39

I I don't see um there's a lot of marketing with exosomes, yeah, and there's also getting to be much more science. But I think it could be said truly in the last two years, the marketing was ahead of the science. Yeah, but there is one uh company in Toronto uh called Acorn, uh pluck 50 hairs from your head and then use the hair bulbs to grow your own secretosomes so your own personalized exosomes and they they make the product for you and store it uh that and then you can use it for facial rejuvenation or hair growth or whatever and I can see the point of using your own product on you that makes so complete sense to me I'm not so sure about using plant uh plant products on us yeah um I'm not so sure about using uh other people's adipocytes uh as the uh exosome source but there's so many different sources of exosomes but truly I think uh topical topical exosomes if they're your own that's the sweet spot yeah no that's I'm glad you brought that up because yeah I know about acorn actually very fascinating stuff that they're doing yeah really really cool company and you know it makes me really wonder like about the the customization of aesthetic medicine as we go into the future you know um I mean what are your what are your thoughts on that and your take on in terms of like bringing dermatology almost like home for people you know I always wonder about that aspect because it's the one field of medicine that so many are interacting with but it's like that part of you that feels like like I can do it at home kind of how we do IVF these days where you can do your own injections at home.

SPEAKER_00 23:32

What are your thoughts around that?

At-Home Trends And Counterfeit Dangers

SPEAKER_01 23:35

Oh I think it's the future yeah because uh you live in your skin uh you can buy virtually everything on the internet I love it the red light masks you know stimulating your your mitochondria uh I think that's great there are people who do their own little microneedling things at home the one thing I'm scared about with the at-home is self-injecting botulinum toxin uh Dr. Andy Pickett who's a famous researcher in England sourced five vials from the internet of so-called Botox and he analyzed each vial and he found between zero and 280 units of botulinum toxin in each vial. Wow so you don't know what that little white powder is first of all it could be bleach uh you don't know how much what and the units I mean how strong is it what you're injecting and then there are people who've used sourced um uh neuromodulators on the internet uh a year or so ago in the United States there was an epidemic or a localized epidemic of uh of uh essentially clinical botulism and in Canada we had two ladies um Ditto um this is all totally preventable if you use the approved substance and I couldn't inject uh neuromodulator if I didn't know who made it and where how where it was approved it's just too dangerous.

SPEAKER_00 25:13

Yeah no that thank you for saying that and I I really hope anyone listening out there that has never you know actually gotten it done professionally like you're not planning on experimenting. I I'm so glad you said that and you know I I actually want to ask you about in terms of because you know Botox grew so fast right like it it became a phenomenon and it that's wonderful right to see science grow so quickly and be adapted to so quickly but were you ever concerned at any point like where like where is this being taken and are we going to stay true to the science and I mean were there ever moments like that for you watching it grow and and expand uh not really no because uh my experience was with uh other doctors who were uh cognizant of what what this molecule could do if it was um you know if we didn't use the paracelsus tame it down with the dose uh I I didn't have that worry uh I do have that worry with people are I don't know where they're making it but they're putting the vials out there I do worry that people like just happened in Canada will have an adverse event which could be you know they could lose um well it's I think the first one I was aware of was 2004 in Florida where an unfrocked osteopathic physician injected 20 million units of Botox it wasn't really Botox it was uh it was from it was a research grade neuromodulator that he bought from a lab in California and injected it into four people one of whom was himself and the reason all these people survived was because of the fabulous skills of the intensivists in the hospital in Florida but that was such a shock that it killed the cosmetic uh Botox business in Florida a good six months maybe longer I think the public are the public understand that it's safe and effective and then the question is if somebody says well this the here's another one I got it on the internet it's the same but it's only you know a tenth the price if something is too good to be true it probably is not true. Exactly yeah you know I think we have to have common sense out there too yeah no that's really that's interesting I didn't know about that that 2014 I mean that's exactly like what I like it really just it confuses me in aesthetic medicine because for some reason we see it so much in that field of medicine you know it's like um even with you know I know you had brought up like the at-home microneedling devices I feel like they've evolved now you know in the recent years but I remember people were just like going crazy with it you know and they had these terrible injuries and for some reason in aesthetic medicine we love to take it into our own hands and say well we can do it you know and you don't need a professional to to really guide you which I I will never understand you know yeah I know I know it's uh it's it's amazing yeah no what is um what excites you the most

AI, Fake Photos, And Better Measurement

SPEAKER_00 28:30

when you look at um the research being done in but you know in this field now compared to 20 years ago or or so like and what is the most exciting part nowadays nowadays well I think um I think that I'm starting to become incredibly excited by the fact that people are getting data um I think we've we've been very spoiled over the last years uh because uh the FDA and other regulatory agencies have approved before and after photographs and we've been so spoiled but now I can see with AI can you trust those photographs? Yeah yeah and so what's the truth does this really work or all those photos um are are they all shall we say reimagined uh so I think we're going to see the need for more data uh I have just uh developed with my colleagues have just developed a little cell phone app that you can measure your own elasticity in your skin uh with data uh for uh it's called the skin elasticity factor so we're just at the last stages uh before getting it in uh to the Apple App Store and the Google store so it's just that's our feeling that if the AI is going to take away one of this I mean it's it's huge to take away the validity validity of photos that's just enormous that's an enormous blow to our industry yeah we need to have another way we can validate the photos yeah no that's actually I I mean that's a very fascinating take because you're right I mean there are so many now editing apps and so much I mean even before AI I feel like that the face tunes of the you know the app world and stuff I mean it it's a lot and and these days I think there was somebody told me a statistic where you need to see like I think 12 to 14 before and afters before you get convinced as a consumer to go in for a procedure and it just makes you wonder like is that even applicable anymore because that's all we seem to be seeing these days you know is is people online so um it's like a whole new world of uh of evidence uh i'm i'm excited by the the fact that it's going to improve the quality of evidence yeah and maybe somebody can figure out how to tell if a morphed picture is a morphed picture or if it's a real picture. Yeah no I'm I hope we can get there because that would be wonderful.

Advice For Clinicians And Closing

SPEAKER_00 31:10

Um I I would love for you to offer some advice though some words of wisdom to the current um physicians in aesthetic medicine right now and maybe some aspiring ones you know about medicine at large and and staying true to the science and not letting yourself get you know roped into other avenues that maybe dilute that those efforts in the scientific side yeah that's a great question I you know there's a uh there's a feel there's a a saying that advice isn't worth the paper it's not written on yeah yeah but um I think that believe in yourself that's that's probably the best thing uh when you have an idea then think through what you have to do to to follow up on that idea to uh to give it the evidence that you can then share with your colleagues but I think believe in yourself look after yourself no one else will um I think uh make sure and and rule two would be surround yourself with positive people that makes sense I like that I like that a lot no it it's really it's amazing um hearing you talk about the psychology aspect of everything because I just feel like we don't hear that enough you know about like like what you were saying earlier about self-esteem and understanding like what all of that really means in the context of like how medicine applies to real life and you know what results you end up seeing at the end of the day. And I think that's profound to have that kind of mindset. So but Dr. Crothers thank you so much this has been such an honor and I am so grateful for your time. Thank you so much.

SPEAKER_01 32:56

Thank you for thinking of me and I appreciate I appreciate the good things that you're doing with your podcast. Keep doing it it's wonderful.

SPEAKER_00 33:04

Thank you so much. That truly means the world uh coming from you thank you so much and for everyone listening thank you for tuning in