The idea that anti-wrinkle injections could become as routine for women in their 30s as cutting their hair or getting their nails done was still incomprehensible to most viewers.
Two decades later, Botox is no longer the preserve of wealthy Manhattan PR executives.
The boom in availability and affordability of the treatment has made it the most popular non-surgical cosmetic treatment in the UK.
So where did it come from, how does it work – and is it safe?
What is Botox?
Botox is the brand name of a drug made from the chemical, Botulinum neurotoxin.
Botulinum toxin is an extremely potent neurotoxic protein produced by the bacterium Clostridium botulinum.
This is the same toxin that causes botulism, a life-threatening type of food poisoning.
When injected into the skin, Botox works by preventing nerve endings from absorbing the molecules they need to function properly.
This temporarily paralyzes the muscles, which can help smooth wrinkles and reduce the appearance of forehead lines, crow’s feet and frown lines.
While Botox is the most well-known form of the drug, two other brands – Azzalure and Bocouture – are also licensed for cosmetic use in the UK.
How was it discovered?
As a cause of food poisoning, botulinum toxin was first discovered in 1897 when a group of Belgian musicians became ill after eating the same smoked ham after performing at a funeral.
Its potential as a medical treatment came much later.
In the 1970s, Dr. Alan Scott, an ophthalmologist practicing in San Francisco, California, pioneered a bululin-based drug, Oculinum, for the treatment of strabismus—the vision disorder more commonly known as “strabismus” .
In 1977, he injected a patient for the first time in trials and, in 1989, Oculinum was approved by the FDA – the US drug regulator – as an eye treatment for adults with strabismus and blepharospasm, a form of uncontrollable twitching. .
It could also be used to treat other conditions involving muscle spasms, such as cerebral palsy, and as a treatment for urinary incontinence, migraine, and excessive sweating.
When he died aged 89 in December 2021, Dr Scott had lived to see his discovery spark a revolution in cosmetic medicine.
After selling Oculinum in 1991 to the pharmaceutical company Allergan, it was renamed “Botox” and during the 1990s aesthetic medicine doctors increasingly began using it “off-label” as an anti-aging treatment.
In 2002, the drug received FDA approval as a treatment for frown lines, crow’s feet and forehead lines.
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Is it safe?
Most people will not experience side effects from Botox as long as it is administered correctly by a trained professional.
In most cases, side effects will be limited to pain, swelling or bruising at the injection site and a headache or flu-like symptoms for about 24 hours.
While there have been a number of health scares linked to fake Botox, a study by the FDA found that there were only 36 reports of serious adverse events involving genuine Botox used for cosmetic purposes in the United States during all of 2002/3 .
The risk of side effects was 33 times higher when Botox was used therapeutically, to treat conditions such as migraine.
Side effects can include infections, vascular blockage and – in very rare cases where the medicine spreads to other parts of the body – can result in vision or breathing problems, loss of bladder control and difficulty swallowing.
Women who are pregnant or breastfeeding are also advised to avoid Botox.
Who can do Botox?
In the UK, doctors, dentists, nurses, midwives and dentists can be trained to do and prescribe Botox.
In Scotland, these healthcare professionals must be regulated by Healthcare Improvement Scotland, which means they are subject to inspections and regulation fees.
Conversely, there is no legislation anywhere in the UK to prevent non-health professionals such as beauticians being trained to do Botox – although as a prescription drug it should not be available over the counter.
Training to perform Botox consists of Level 6 and Level 7 qualifications. These require trainees to observe and then perform Botox procedures, under supervision.
Combined, both courses cost over £9000 but can be completed in just a few days.
How popular is Botox?
Non-surgical cosmetic treatments such as Botox and fillers account for 90% of all cosmetic procedures carried out in the UK.
According to the British Association of Aesthetic Plastic Surgeons (BAAPS), a total of 6,449 Botox procedures were performed by its members in 2023.
However, this only covers Botox treatments performed by BAAPS doctors.
In 2021, it was estimated that 900,000 Botox procedures had been performed in Britain, although it is difficult to quantify when a large part of the market remains unregulated.
How much does Botox cost?
In the UK, Botox typically costs between £100 and £350 depending on the number of areas treated, the size of the dose and the clinic.
However, consumers are advised to stick to controlled clinics – where the process is more expensive – to avoid the risk of complications or exposure to a harmful, fake product.
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