Alan Scott, Doctor Behind the Medical Use of Botox, Dies at 89

An ophthalmologist and researcher, he discovered a drug that treated serious eye conditions. It also smoothed wrinkles — and an alternative industry was born.,

An ophthalmologist and researcher, he discovered a drug that treated serious eye conditions. It also smoothed wrinkles — and an alternative industry was born.

It is a neurotoxin 100 times more deadly than cyanide and the cause of the food-borne illness known as botulism. During World War II and for some years after, the Department of Defense hoped to develop it as a chemical weapon. But it wasn’t until the 1970s that Alan Scott, an ophthalmologist, turned this toxin, Clostridium botulinum, into a pharmaceutical, when he began to investigate it as a medical treatment for serious eye impairments.

Little did he know at the time that the therapeutic drug he developed would become the basis of a billion-dollar industry famous for its cosmetic use as a temporary wrinkle eraser.

Dr. Scott, who came to be called the “Father of Botox,” died on Dec. 16 at a hospital in Greenbrae, Calif. He was 89. The cause was complications of sepsis, his daughter Alison Ferguson said.

When, in 1978, Dr. Scott first injected the powerful paralytic Clostridium botulinum into the eye muscles of a patient who had undergone retinal detachment surgery that had left his eye pulled to one side, he didn’t know who was more nervous, himself or the patient, he told Scientific American magazine in 2016.

But the procedure succeeded, and Dr. Scott would go on to refine one of the world’s deadliest poisons into a life-altering treatment — he called it Oculinum — for those who suffered from conditions like strabismus, a misalignment of the eyes.

Doctors also began using it to treat migraines and jaw-clenching, among other ailments, and as they did so many of their delighted patients noticed a curious byproduct: The toxin’s ability to paralyze targeted facial muscles smoothed the lines around them, though its effects wore off after a few months.

Dr. Scott was amused by the drug’s off-label trajectory under a new name, Botox. His focus on it was always solely therapeutic.

“I think that’s a charming, slightly frivolous use,” he told The San Francisco Chronicle in 2002, the year the FDA approved Botox for cosmetic purposes.

Dr. Scott and his colleagues had spent decades researching and producing what they called Oculinim. But because they had no patent, no pharmaceutical company would manufacture it, and Dr. Scott resorted to taking out a mortgage on his house and asking for small donations from doctors, who then used it in clinical trials.

He and his team had already developed Teflon-coated needles to accurately target muscles with various substances before settling on and then refining the toxin to treat strabismus and blepharospasm, a condition that causes the eyes to involuntarily shut tight. In 1989, the Food and Drug Administration approved it for those uses.

Dr. Scott had no wish to continue to be a pharmaceutical manufacturer, and in 1991 he sold the rights to make Oculinum to its distributor, Allergan, for an undisclosed amount. The following year, the company changed the drug’s name to Botox.

In the decades that followed, the public’s appetite for it as a facial enhancement exploded. Movie directors began complaining that actors were losing their ability to frown or smile properly — “frozen face” became a trope of the tabloids. It was derided as a pernicious enabler of a youth-obsessed society, a practice best left to the stars of reality television.

But practitioners grew more skilled at deploying it, and the age of its adherents kept dropping as more and more women maintained that it was a necessary tool for job security in an ageist culture. Now, Botox is a household name, its use seemingly as common as a facial.

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A pharmaceutical to treat serious eye impairments, developed by Dr. Scott, was found to have a curious byproduct: an ability to paralyze targeted facial muscles and smooth the lines around them. Thus a billion-dollar cosmetic industry was born. Credit…Shannon Stapleton/Reuters

Alan Brown Scott was born in Berkeley, Calif., on July 13, 1932. His father, Marion Irving Scott, was a dentist; his mother, Helen Elizabeth (Brown) Scott, worked in a laboratory at the University of California, Berkeley.

Dr. Scott earned an undergraduate degree in medical sciences from UC Berkeley in 1953, and a medical degree from the University of California, San Francisco. He had a surgical internship and residency in neurosurgery at the University of Minnesota, followed by a residency in ophthalmology at Stanford University. He was a founding member of the Smith-Kettlewell Eye Research Institute in San Francisco and the institute’s senior scientist and co-director for over two decades.

He married Ruth White, a teacher and homemaker, in 1956. She died in 2009. In addition to his daughter Alison, Dr. Scott is survived by his wife, Jacquelyn Lehmer; three other daughters, Jennifer, Heidi and Ann Scott; a son, Nathaniel; four stepdaughters, Suzanne, Mary, Sally and Phillis Lehmer; 20 grandchildren; and two great-grandchildren.

Dr. Scott was not the first scientist to have explored the therapeutic potential of Clostridium botulinum. “Sausage poison” is what Justinus Kerner, a German poet and doctor, called the pathogen in the 1820s; he had observed the paralytic effects of food poisoning in his town after a single giant sausage sickened 13 people, six of whom died. After injecting it in snails, locusts and rabbits, Dr. Kerner finally injected into himself, noted its inhibiting effect on the autonomic and motor nervous systems, and hypothesized its use as a medical treatment for certain neural conditions. (Decades later, a microbiologist named it Bacillus botulinum, after botulus, the Latin word for sausage.)

In 2013, Dr. Scott founded the Strabismus Research Foundation in Mill Valley, Calif., where he developed the use of bipuvicaine, a local anesthetic. At his death he was also working on a treatment procedure involving the electrical stimulation of the eye muscles by means of a tiny implanted pacemaker-like device.

Meanwhile, sales of Botox for medical and cosmetic treatments have continued to soar. For the first nine months of 2021, it generated global revenues of more than $3.3 billion, with cosmetic sales accounting for slightly less than half of that figure, according to the earnings report for that period from AbbVie, the company that acquired Allergan in 2020.

But Dr. Scott never regretted selling the drug.

“I had my house paid for, my kids were educated,” he told The San Francisco Chronicle. “And I had the satisfaction of seeing absolutely wonderful medical results. So I was satisfied.” He added, “I’m not terribly good at giving away and spending money anyway.”

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