Expert Injectors Reveal Early Botox Memories to Celebrate Its 20-Year Anniversary

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It’s hard to believe that Botox Cosmetic, the miracle injectable that has changed the lives—and faces—of so many has only been available to the public for 20 years. It was on April 15, 2002 that the famed wrinkle relaxer achieved its first U.S. Food and Drug Administration (FDA) approval as a temporary aesthetic treatment since to temporarily improve the look of moderate to severe glabellar lines, located between your eyebrows. Since then, the line smoother has received two additional aesthetic indications—in 2013 and 2017—making it the only neurotoxin approved to improve the look of moderate to severe lines in three areas: frown lines, crow’s feet and forehead lines.

In the past 20 years so much has changed, yet the youth restoring injection remains a standout star of nonsurgical cosmetic treatments. Here, top expert injectors share their first Botox memory, how techniques have changed and the incredible way a neurotoxin protein has changed the landscape of aesthetic medicine.

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“I remember when Botox was approved for cosmetic indications. I had been using it for several years and was pleased that they were finally given approval to use what had become one of the most popular injections in the world. At the time, cosmetic dermatology had little to offer patients and this changed that. We were able to discuss new uses and combine with fillers that were becoming available.”

—West Palm Beach, FL dermatologist Kenneth Beer, MD 

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“The launch of Botox Cosmetic 20 years ago was a complete game-changer in the cosmetic world. Injectable neurotoxins like Botox are consistently the most popular on-ramp to the exciting universe of cosmetic treatments. Over 10 million Americans receive injectable treatments annually—which is more than all other cosmetic treatments combined. Botox was and continues to be the ice-breaker. Once they try it and inevitably love it, they become confident to become regular Botox consumers and then venture into laser and surgical treatments.”

—Dover, OH, facial plastic surgeon David Hartman, MD

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“I was a new attending dermatologist in 2002 with young children in tow and remember thinking that the approval of Botox for cosmetic use was going to revolutionize the industry. I remember that it was also the beginning of widespread use of cosmetic lasers, devices, collagen injections, and Botox where the American public could access such cosmetic procedures on an outpatient basis with little to no downtime.”

—Bloomfield Hills, MI dermatologist Linda C. Honet, MD

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“I’ve been in practice for over 30 years and the only injectable early on was collagen. Botox came on the market in 2002 and was a game changer. Some early stories with patients and Botox included the constant worry that they were going to die of botulism with an injection. In the 1950s defective canned vegetables possibly could lead to botulism and patients wondered how this ‘poison’ could be so beneficial. Early consults often involved a lot of reassurance, but fortunately that concern was short-lived and we all know the rest of the story. Neuromodulators have been a great addition and have given many patients relaxed happiness.”

—Pittsburgh plastic surgeon Leo R. McCafferty, MD

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“My first Botox patient was my mother and she was in her 60s at the time. I remember injecting her in the forehead and seeing the immediate improvement—she was quickly hooked and so was I. The biggest way it changed my industry is that it helped me, as it has for many of my colleagues, make the shift from treating patients strictly for medical skin concerns to a completely cosmetic practice using many nonsurgical treatments like injectables, lasers, chemical peels and all of the other aesthetic treatments we do.”

—New York dermatologist Marina Peredo, MD 

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“At the beginning we were focused on ‘freezing’ peoples foreheads. Now we use Botox to treat and prevent wrinkles without giving an artificial, frozen look. In addition, I am more focused on using Botox artistically to elevate and shape eyebrows. Also, we continue to find so many more uses for it such as treating enlarged masseter muscles, slimming the face, treating gummy smiles, pebbled chins, turning up the corners of the mouth, lip flips and neck lines. We also do ‘Baby Botox’ where we give smaller amounts to younger patients to prevent and treat fine lines.”

—Woodbury, NY office, oculoplastic surgeon David Schlessinger, MD

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“I am very happy to see that the use, understanding and attitude surrounding Botox has really changed in 2022 from 2002 when it was first approved. At this point, the younger generation is using it not to really erase lines, but they very clearly understand that it is a preventative measure and it’s not about freezing the forehead. We all want natural results, we all want movement; we all just don’t want deep lines later in life, and that’s where Botox comes in. I definitely see a shift in the generations that are using Botox. My average patient population is in their 20s now.”

—New York dermatologist Julie Russak, MD

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“I remember when Botox was approved as I was one of the first ones to jump on it in the Chicago area. Many plastic surgeons that were not into nonsurgical options like laser treatments and injectables were very hesitant. Botox was definitely a revolution and I’m glad to offer it, even 20 years later. It really has given patients a great nonsurgical treatment option for wrinkles in certain areas, as well as migraine and excessive sweating relief.”

—Chicago plastic surgeon Sam Speron, MD

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“Twenty years ago, no one trusted it. I would always hear ‘I don’t believe in Botox,’ or that patients were worried that it was a poison. Everyone was hesitant or would keep it a secret from their spouses and friends. Since that time, Botox has been life-changing medically for many patients and the cosmetic use has escalated exponentially, making it the number number-one cosmetic procedure in the world by far. I am excited to see what this generation will look like in the next 30 years as we have so many more options to prevent the changes that come with aging.”

—Saint Petersburg, FL oculofacial plastic surgeon Jasmine Mohadjer, MD

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“As a facial plastic surgeon who strives to bring out the best in my patients, it’s been a pleasure to see how public perception and attitudes towards Botox have warmed significantly in the past decade. With more and more people openly discussing their treatments, the idea of a face with softer and less wrinkles has reached the masses. Secondly, I think injection techniques have improved. We are now able to modulate the effect of the toxin to avoid the ‘frozen face syndrome’ and instead provide beautiful, soft, and natural results with fewer fine lines and wrinkles.”

—Kirkland, WA facial plastic surgeon Daniel J. Liebertz, MD

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“While Botox Cosmetic was first approved for cosmetic treatments in 2002, we have been using it in our office since 1993. At that time we used it for glabella furrows, frontal forehead lines and crow’s feet. We would obtain a special consent from the patient so that they were aware that the use of it was for a non-FDA approved treatment. Nevertheless, patients were eager to have this done as this was revolutionary in treating these areas of cosmetic concern.”

—Denver facial plastic surgeon Brent J. Smith, MD

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“The way we injected Botox has changed over the years. We and I have become far more aware of how to best tailor it to a patient’s muscle needs as well as desired results. In my practice at Aesthetx, these skew much more toward softening contraction and defining features rather than preventing all motion as it once was. I believe this is a more sophisticated appreciation of how we can use our tools to their absolute greatest potential.”

—Campbell, CA dermatologist Amelia K. Hausauer, MD 

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“This is an extremely interesting timeline.  I actually started medical school in 2002 so my career has followed that of Botox. When we talk about the safety of Botox I don’t think most people realize it was first tested in 1978 and then FDA approved for medical use around the eyes in 1989.  During the medical treatments for spasms around the eyes physicians found that the patients’ wrinkles were improving with Botox and thus the evolution to Botox Cosmetic. Since its approval for cosmetic use in 2002 its use in the cosmetic surgery world has continued to expand exponentially.”

—Austin, TX plastic surgeon Johnny Franco, MD

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“People talk more openly about their treatments and experience with Botox to their friends, family and co-workers now. Largely, people are more nuanced and sophisticated with their questions and understanding of Botox. This is satisfying and refreshing as a physician as it’s nice to engage with savvy intellectually curious patients or consumers. There are also more and more providers injecting than in the past. Some providers feel this has commoditized the service somewhat, but I feel the opposite. I feel it helps to distinguish the experienced, board-certified aesthetic specialist from the non-core injectors who may be looking to subsidize other parts of their practice.”

—Chico, CA dermatologist Kafele T. Hodari, MD.

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“I was in practice at the birth of this new category of cosmetic dermatology and the introduction of an effective neurotoxin was at the time perhaps the most important tool in our arsenal of anti-aging and prejuvenation serving as a bridge to help close the chasm  that existed between between surgical interventions and topical care”

—Beverly Hills, CA dermatologist Ava Shamban, MD

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