Editing Botulinum toxin (section)

===Cosmetics===
[[File:Doctor performing Botox injection.jpg|thumb|Doctor performing Botulinum toxin injection]]
The effect of botulinum toxin type-A on reducing and eliminating forehead wrinkles was first described and published by Richard Clark, MD, a plastic surgeon from Sacramento, California. In 1987 Clark was challenged with eliminating the disfigurement caused by only the right side of the forehead muscles functioning after the left side of the forehead was paralyzed during a facelift procedure. This patient had desired to look better from her facelift, but was experiencing bizarre unilateral right forehead eyebrow elevation while the left eyebrow drooped, and she constantly demonstrated deep expressive right forehead wrinkles while the left side was perfectly smooth due to the paralysis. Clark was aware that Botulinum toxin was safely being used to treat babies with strabismus and he requested and was granted FDA approval to experiment with Botulinum toxin to paralyze the moving and wrinkling normal functioning right forehead muscles to make both sides of the forehead appear the same. This study and case report of the cosmetic use of Botulinum toxin to treat a cosmetic complication of a cosmetic surgery was the first report on the specific treatment of wrinkles and was published in the journal ''Plastic and Reconstructive Surgery'' in 1989.<ref name="Clark_1989" /> Editors of the journal of the American Society of Plastic Surgeons have clearly stated "the first described use of the toxin in aesthetic circumstances was by Clark and Berris in 1989."<ref name="Rohrich_2003">{{cite journal |vauthors = Rohrich RJ, Janis JE, Fagien S, Stuzin JM |title = The cosmetic use of botulinum toxin |journal = Plastic and Reconstructive Surgery |volume = 112 |issue = 5 Suppl |pages = 177S–188S |date = October 2003 |pmid = 14504502 |doi = 10.1097/01.prs.0000082208.37239.5b }}</ref>

Also in 1987, Jean and Alastair Carruthers, both doctors in [[Vancouver|Vancouver, British Columbia]], observed that blepharospasm patients who received injections around the eyes and upper face also enjoyed diminished facial glabellar lines ("frown lines" between the eyebrows). Alastair Carruthers reported that others at the time also noticed these effects and discussed the cosmetic potential of botulinum toxin.<ref name="Carruthers A 2003">{{cite journal |vauthors = Carruthers A |title = History of the clinical use of botulinum toxin A and B |journal = Clinics in Dermatology |volume = 21 |issue = 6 |pages = 469–472 |date = Nov–Dec 2003 |pmid = 14759577 |doi = 10.1016/j.clindermatol.2003.11.003 }}</ref> Unlike other investigators, the Carruthers did more than just talk about the possibility of using botulinum toxin cosmetically. They conducted a clinical study on otherwise normal individuals whose only concern was their eyebrow furrow. They performed their study between 1987 and 1989 and presented their results at the 1990 annual meeting of the American Society for Dermatologic Surgery. Their findings were subsequently published in 1992.<ref name="Carruthers JD 19922">{{cite journal |vauthors = Carruthers JD, Carruthers JA |title = Treatment of glabellar frown lines with C. botulinum-A exotoxin |journal = The Journal of Dermatologic Surgery and Oncology |volume = 18 |issue = 1 |pages = 17–21 |date = January 1992 |pmid = 1740562 |doi = 10.1111/j.1524-4725.1992.tb03295.x }}</ref>