Botox Cosmetic: Ethics, Empowerment, and Innovation

“It’s not just the product. It’s the purpose of who we’re empowering, both the consumer and doctors,” said Mona Gohara, MD, board-certified dermatologist, consultant for Allergan Aesthetics, and associate clinical professor at Yale University in New Haven, Connecticut. Gohara sat down with Dermatology Times to highlight how Allergan Aesthetics’ science-driven approach, commitment to patient safety, and emphasis on inspiring women in medicine continues to shape the field of dermatology through Botox Cosmetic.

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The Lasting Legacy of Botox

Botox Cosmetic (onabotulinumtoxinA), now a household name, was serendipitously discovered in the 1980s by Canadian ophthalmologist Jean Carruthers and her husband, Alastair Carruthers.¹ The two initially used botulinum toxin for therapeutic purposes in ophthalmology, but they then noticed that the treatment was minimizing fine lines. This unexpected discovery led them to explore its cosmetic potential, specifically for the treatment of glabellar lines between the eyebrows.

“What I think is beautiful about Dr Carruthers, both of them, is that the credit has been given to them all along because they are the ones who were the creators of this,” Gohara said. “So, they’ve remained at the epicenter of it, which I really appreciate.”

In collaboration with Allergan Aesthetics, the couple worked to secure FDA approval for Botox in 2002. This approval led to its widespread adoption in the field, making Botox the No. 1 neurotoxin in dermatology. Its success is deeply rooted in the safe, scientific foundation laid by Jean and Alastair, which set the stage for its thriving innovation.

“That’s pretty much the premise of Allergan Aesthetics’ story, which is this commitment to building a legacy of both aesthetic and therapeutic uses in dermatology with Botox Cosmetic,” Gohara said. “So, I really think that the way it was founded set the precedent for the years to come, in terms of its evolution and its relevance in our profession.”

Revolutionizing Cosmetic and Therapeutic Uses

Thanks to both its aesthetic and reparative benefits, Botox has become a unique and versatile treatment in dermatology. Its decades-long legacy has helped to build trust in both patients and clinicians, as it is one of the only FDA-approved neurotoxins for both cosmetic and therapeutic purposes. Gohara heavily relies on Botox, constantly turning to the product for reliable, efficacious, and scientifically sound results.

“They’re the OG, they’re the original, but they’ve continued to evolve with the times in a relevant and ethical way,” Gohara noted.

Allergan Aesthetics continues to innovate and advance the neurotoxin landscape, most recently gaining FDA approval for Botox to treat vertical platysma bands in the neck. It is the only product of its kind approved for 4 distinct indications, including temporary improvement in the appearance of moderate to severe frown lines (2002), forehead lines (2013), crow’s feet (2017), and now platysma bands (2024).

However, Botox’s applications extend far beyond cosmetic use. Hyperhidrosis is one of many diseases that can improve after Botox injections. In fact, it’s one of the most common conditions Gohara treats in her office, as it can have a severe impact on patients’ quality of life.

“I have patients coming in every 3 to 4 months on the dot for this treatment because it literally stops the sweating and changes their lives,” she said.

Botox has also been approved for the treatment of temporomandibular disorders, improving function for patients with issues such as teeth grinding or jaw pain. It was also recently approved by China’s National Medical Products Administration for the treatment of masseter muscle hypertrophy.

Prioritizing Safe and Science-Driven Messaging

Allergan Aesthetics places a strong emphasis on ethical messaging and proper administration when it comes to Botox, grounding its use in science and data. Since its initial approval, Botox has been continuously supported by robust clinical evidence, ensuring that its applications are safe, effective, and appropriate.

“It’s all rooted in science and innovation, and without any type of judgment or indication that it should be used for anything else, which makes its delivery ethical,” Gohara said. “And so, to me— as a woman, as a scientist, as a dermatologist —that makes a big difference.”

Proper administration is another cornerstone of Botox’s ethical framework, avoiding off-label use and prioritizing patient safety. Allergan Aesthetics is firm in its belief that Botox should be administered only by qualified and professional board-certified dermatologists, physician assistants, or plastic surgeons.

“Understanding facial anatomy, understanding how it can go right and what could go wrong, isn’t a weekend course. It’s years of training in medical school,” Gohara emphasized. “And so, the brand is really committed to making sure that consumers are aware of who the most appropriate providers are to give this treatment.”

An interesting aspect of Allergan Aesthetics’ ethical brand messaging is its use in the digital platform and social media landscape. Gohara stresses that algorithms can be very harmful and can have detrimental psychological impacts due to overpromotion or unrealistic beauty standards.

“Allergan has done a great job at refining the social media messages, the direct-to-consumer messages around what’s going to be a healthy promotion of the product and what’s going to be something that’s psychologically sound, regardless of where it lands,” she said. “So, to me, that’s really important, and that’s why I align myself with the brand.”

Allergan also recognizes the risks of filters and overtreatment and aims to promote healthy relationships with cosmetic procedures. The company takes steps to reach consumers responsibly, emphasizing both aesthetic and psychological health while offering support to individuals considering treatments. One example of this is a recently published ethics report called “Moving the Needle on Ethics,” which promotes positive beauty standards and analyzes global procedures across cultures, genders, and identities.

“I just think it’s really important to talk about the fact that they set the root, the foundation, the tone, and the cadence for decades of messaging,” Gohara noted.

Empowering Patients, Clinicians, and Leaders

“Allergan Aesthetics is a company that really supports women and women in medicine, particularly,” Gohara said. “So, it’s fitting that Botox was discovered by a female physician and her husband.”

At the time, dermatology and surgical fields were largely dominated by men, and Jean Carruthers’ groundbreaking work as a woman in this space was a significant milestone, challenging the prevailing gender dynamics in medicine. This significance of female leadership is threaded throughout the entire brand identity, creating a lasting legacy of inclusivity.

Allergan Aesthetics not only advances the science of Botox but also advocates for diversity in the field of dermatology. For example, Gohara recently participated in a video series promoting women in science, technology, engineering, and mathematics. This culture of empowerment for those who use and administer Botox helps to ensure that both consumers and physicians feel confident in their decisions. Allergan aims to make the product accessible, not just for women but for all individuals seeking solutions that improve their well-being and confidence.

“We want to make sure that the consumer feels empowered, and the physician feels empowered who’s administering it, so that there’s a resonance around empowerment and inclusivity, in females especially, and I think it all goes together to create the brand,” Gohara said. “Again, it’s not just the product.”

Reference

1. Said S, Meshkinpour A, Carruthers A, Carruthers J. Botulinum toxin A: its expanding role in dermatology and esthetics. Am J Clin Dermatol. 2003;4(9):609-616. doi:10.2165/00128071-200304090-00003