The accidental rise of Botox

A sidewalk chalkboard sign advertises Botox, fillers, and facial treatments in Lafayette, California, on May 21, 2025. | Smith Collection/Gado/Getty Images

In the early 1800s, in southwestern Germany, outbreaks of a mysterious illness spread throughout the countryside. People who came down with it had terrible symptoms. Their eyelids would droop. Their speech would slur. They’d be gripped by a paralysis that, once it reached their breathing muscles, could be fatal.  A young doctor named Justinus Kerner was called in to investigate. Kerner had decided to go into medicine after he awoke from a prophetic-feeling dream to find that a paper prescription from a nearby hospital had wafted in through the window while he was sleeping. He took it as a sign. (Perhaps unsurprisingly, he also later became famous as a romantic poet.)  Looking into the spread of the illness, Kerner documented a pattern: All the patients seem to have eaten the same food — sausages.  Both the toxin, and the paralytic disease it caused, would eventually be named for those sausages — in Latin, botulus. The toxin became known as botulinum toxin, and the disease, botulism. And Justinus Kerner, this poet-physician, had one other key insight about this terrifying poison. Building on the work of the German-Swiss doctor Paracelsus, the father of toxicology, Kerner speculated that, in small doses, this paralytic toxin could be useful to medicine. He even went so far as to try a tiny bite of the offending sausages himself.  It would take more than a century for anyone to make serious progress on Kerner’s idea, but once they did, they’d unlock a surprisingly wide range of medical uses. Botox, the most famous brand-name version of botulinum toxin, is officially approved to treat nine different medical problems, and is used off-label to treat many, many more — plus, of course, it can smooth wrinkles. 

In the 1980s, Jean Carruthers, the “godmother” of cosmetic Botox, was using botulinum toxin to treat patients with blepharospasm, a condition where your eyes spasm shut. Carruthers told me about her experience treating a patient who got mad at her for not providing a cosmetic treatment: “She said, ‘You didn’t treat me here,’ between her eyebrows. And I apologized to her and I said, ‘I’m sorry, I hadn’t thought you were spasming there.’ And she said, ‘Oh, I’m not spasming there, but every time you treat me there I get this beautiful untroubled expression.’ Now this is when the penny dropped, because I happened to have the perfect husband.” Jean’s husband Alastair was a dermatologist. And the two of them put together a study on using botulinum toxin to treat frown lines. At first, they had a hard time recruiting participants. As Carruthers explained: “Most people in the world were running a mile from it. They were, ‘No, that’s a terrible poison. I don’t want to have that injected. And it’s a cosmetic treatment.’ You know, everyone thought we were over-the-edge crazy.” That, of course, would change. Today, Botox is commonly used by dermatologists — an old sausage poison now gone mainstream. “Botox is now made in California at an undisclosed location, and flown in a private jet with guards to the bottling plant where it is made into the Botox vials that are shipped around the world,” Carruthers told me. And it goes beyond smoothing wrinkles. “It’s really used by almost every field in medicine. From neurologists like me to dermatologists, plastic surgeons, ophthalmologists, gastroenterologists, urologists, and on,” one doctor at New York’s Mount Sinai hospital told me.  On this episode of Vox’s science podcast Unexplainable, hosted by me, Sally Helm, we trace the strange journey that this toxin has taken in the world. Listen to the full story wherever you get your podcasts, including Apple Podcasts and Spotify.