In Profile: Dr Jean Carruthers

“What practitioners found revolutionary was how they could utilise botulinum toxin in their practices”

Dr Jean Carruthers reflects on her journey to discovering botulinum toxin for wrinkles and her advice for fellow practitioners in aesthetics

Having authored nearly 400 peer-reviewed scientific studies, published nine textbooks and spoken around the world, Dr Jean Carruthers continues to educate and conduct research on botulinum toxin today. Beginning her career at the University of British Columbia in Vancouver to study medicine in 1968, Dr Carruthers decided she wanted to travel to London to study ophthalmology. She undertook a primary fellowship in surgery at the Royal College of Surgeons where she worked as a higher scientific officer at a London hospital in Whitechapel. Afterwards, in 1972, Dr Carruthers was accepted onto the house at Moorfields Eye Hospital. She explains, “I think I was the second woman on the house at Moorfields so that was an amazing experience! I finished this in 1977 and decided to go back to Canada to work as an academic ophthalmologist at the University of British Columbia. Gradually, I started to work in paediatric ophthalmology and ocular genetics.” Dr Carruthers notes that this is where she began to take an interest in botulinum toxin, as another ophthalmologist Dr Alan Scott was treating patients suffering from misaligned eyes with an injection rather than surgery. In 1982, Dr Carruthers travelled to San Francisco with her husband, dermatologist Dr Alastair Carruthers, to learn more about botulinum toxin. “It was a great learning experience as I worked alongside Dr Scott at the Smith-Kettlewell Eye Research Institute for the summer and saw a remarkable way to use toxin to relax muscles. I brought all my learnings back to Canada and was approved by Health Canada to join Dr Scott’s multicentre world trial of botulinum toxin,” she adds. At her clinic in Vancouver, Dr Carruthers discovered the use of botulinum toxin for wrinkles while treating one of her patients for blepharospasms. She reflects, “Blepharospasms were a difficult condition to treat with surgery, however, with botulinum toxin, you could weaken the overactive muscles, so the patient looked normal. It was so exciting to see! While I was treating one of these patients, they got upset at me for not treating their inner brow. I apologised to them and explained that I didn’t realise they were spasming there. The patient replied that she wasn’t, but every time they were treated there, they got a beautiful, untroubled expression. That’s when the penny dropped!” Dr Carruthers told her husband about this discovery. They decided to start conducting studies on botulinum toxin for treating the signs of ageing. In 1990, Dr Carruthers gave her first talk on the cosmetic usage of botulinum toxin to an audience at the annual meeting of the American Society for Dermatologic Surgery and, according to Dr Carruthers, they were horrified. “Usually, I would get lots of questions after a talk, but instead it was uncomfortable. People came up to me afterwards and said, ‘how could you use a terrible poison on something so frivolous as wrinkles’. Of course, in large dosages, botulinum toxin is a poison, but what they didn’t realise was that there was nothing frivolous about wrinkles!” she explains. After the talk, Dr Carruthers realised that she had a lot of work to do to prove this to her colleagues. She conducted multiple studies and slowly started to get recognition of this indication in the medical community. In 1992, Dr Carruthers published her first medical paper called Treatment of Glabellar Frown Lines with C. Botulinum-A Exotoxin with her husband. She notes, “This was my biggest achievement as people started to get excited about our discovery. I think what most practitioners found revolutionary was how they could utilise botulinum toxin in their practices and how this would define aesthetic medicine in the future.” Throughout her career, Dr Carruthers has worked and conducted research with nearly all the neuromodulator companies, as well as being a member of many associations. “I’ve been a key opinion leader for many years. I belong to the American Society of Dermatologic Surgery, American Society of Plastic Surgeons and the Canadian Ophthalmological Society. I’ve just renewed my licence in the UK so that I could perform demonstrations at the recent British College of Aesthetic Medicine (BCAM) conference, which I loved.” Dr Carruthers believes that practitioners should take time to read the literature to better their medical outcomes. “I think one of the reasons why procedures can go wrong for practitioners is that they don’t understand the background and so heavy reading is a great suggestion as the literature is exceptional,” she notes. When looking back at her career, Dr Carruthers wishes that she had fought for a patent for botulinum toxin for the glabellar. She concludes, “We went to two different law firms and they both said that there was nothing to patent. Knowing what I know now, we would have gone to more law firms as obviously, we had our hands on something big!”

What would you like to see change in the industry… A unified, unit measurement of different neuromodulators. There is no one unit currently, as each company has its own propriety to measure the unit value. Career if you weren’t in aesthetics… I would still be doing paediatric ophthalmology. Working on at the moment... I’m working on a new book called Procedures in Cosmetic Dermatology. I would urge everyone to read it!