Botox has been around for over 35 years as an FDA-approved drug, with its roots stretching back more than five decades to the early 1970s. What started as an experimental treatment for crossed eyes became one of the most widely used medical and cosmetic products in the world, with nearly 10 million neuromodulator procedures performed in the United States in 2024 alone.
The 1970s: Where It All Started
The story of Botox begins with Dr. Alan Scott, an ophthalmologist in San Francisco who spent 19 years developing botulinum toxin for medical use. In the early 1970s, Scott was looking for an injectable substance that could weaken eye muscles in patients with strabismus (crossed eyes) as an alternative to surgery. He published his initial findings in 1973 after testing the toxin in monkeys.
In 1978, Scott injected the first human patient with botulinum toxin into the eye muscles to correct a deviation following retinal detachment surgery. It was a landmark moment. Scott later recalled that despite years of experience with animal testing, injecting that first human patient was “still an emotional experience.” His work laid the foundation for everything that followed, and he’s widely recognized as the inventor of Botox.
1989: The First FDA Approval
After nearly two decades of development and clinical testing, botulinum toxin type A received FDA approval in 1989 for the treatment of eye muscle disorders, including strabismus and involuntary eyelid spasms. At this point, the drug was still a niche product used by a small number of specialists. The pharmaceutical company Allergan eventually acquired the product and gave it the brand name Botox, which would become one of the most recognized drug names in the world.
2002: The Cosmetic Revolution
The turning point came on April 12, 2002, when the FDA approved Botox Cosmetic for temporarily smoothing frown lines between the eyebrows (called glabellar lines). Doctors had already been using Botox off-label for wrinkles for years, but the formal approval opened the floodgates. Cosmetic use quickly eclipsed medical use in terms of sheer volume, and Botox became a household name practically overnight.
The cosmetic approval transformed the entire aesthetics industry. For the first time, people had a nonsurgical option to reduce wrinkles that took minutes, required no downtime, and produced visible results within days. The effects typically lasted three to four months, which meant repeat visits and a booming market.
Expanding Medical Uses
While cosmetic use grabbed headlines, Botox quietly accumulated a long list of therapeutic approvals over the years. The FDA approved it for excessive underarm sweating, then for chronic migraine in October 2010, giving relief to people who experience 15 or more headache days per month. In August 2011, it gained approval for certain types of bladder dysfunction linked to neurological conditions. It’s also approved for neck muscle spasms, upper and lower limb spasticity, and several other conditions.
This range of uses reflects something important about Botox’s history: it was always a medical product first. The cosmetic applications came almost as an accidental discovery when doctors noticed that patients being treated for eye spasms also had smoother skin around their injection sites.
Botox Today and Its Competitors
The numbers tell the story of just how far Botox has come. According to the American Society of Plastic Surgeons, 9,883,711 neuromodulator procedures were performed in the United States in 2024. That category includes Botox along with newer competitors that have entered the market over the past several years.
Botox is no longer the only option. Products like Dysport, Xeomin, Jeuveau, Daxxify, and the most recently approved Letybo all use the same basic mechanism: a form of botulinum toxin that temporarily relaxes muscles by blocking nerve signals. Most of these alternatives produce similar results, with wrinkle-smoothing effects lasting about three to four months and onset within a few days to a week. Daxxify is the notable exception, marketed as lasting longer than its competitors.
Despite the growing competition, Botox remains the dominant brand and the name most people use generically for the entire category. From Dr. Scott’s first nervous injection in 1978 to nearly 10 million annual procedures today, it has had one of the more remarkable journeys in pharmaceutical history, spanning more than 50 years of continuous development and use.