Alan Scott, an ophthalmologist who pioneered the early medical applications of Botox — a drug that he used to treat conditions such as crossed eyes, but that became best known as a wrinkle-relaxing elixir of youth — died Dec. 16 at a hospital in Greenbrae, Calif. He was 89.
Botox was officially approved by the Food and Drug Administration for cosmetic purposes in 2002 and — to Dr. Scott’s enduring amazement — was used by an estimated 11 million people to temporarily smooth frown lines, crow’s feet and other facial furrows that are often the sign of advancing age.
“Life’s a mystery,” he once told the San Francisco Chronicle, reflecting on the history of a drug derived from botulinum toxin — one of the most poisonous substances in biology — and that he initially used to treat disorders of the eye. “It’s dazzling, all the things that happen.”
Produced by the bacterium Clostridium botulinum, the toxin attacks the nerves and even in minute quantities can cause muscle paralysis and death. During World War II, scientists including Edward J. Schantz, working for the U.S. military, studied botulinum as a possible bioweapon but concluded that it was not well suited for warfare.
In the 1960s, Dr. Scott was conducting research at the Smith-Kettlewell Eye Research Institute in San Francisco. Noting the paralyzing effect of the substance on muscles, he hypothesized that a purified form of botulinum toxin could be used to relieve conditions such as strabismus, a misalignment often caused by an imbalance in the muscles controlling the eye, and blepharospasm, an involuntary blinking or twitching of the eyelid that, in its most severe form, can make a patient functionally blind.
Dr. Scott obtained samples of botulinum toxin from Schantz, tested a therapeutic form of the product on monkeys and saw that his theory was correct. He founded a company, Oculinum, to produce a drug by the same name, which the FDA approved in 1989 for the treatment of strabismus and blepharospasm.
In 1991, the pharmaceutical company Allergan purchased Dr. Scott’s innovation and renamed it Botox. By then, physicians — tipped off by pleasantly surprised patients — had begun to notice that Botox, in addition to relieving their eye disorders, caused some of the lines between their eyebrows to disappear.
“Some of these patients would kind of joke and say, ‘Oh, doc, I’m coming to get the lines out,’ and I would laugh,” Dr. Scott told an interviewer on CBS “Sunday Morning” in 2012. “I really wasn’t tuned into the practical and valuable aspect of that.”
Botox works by blocking the release of acetylcholine, a compound that makes muscles contract. The relaxed state lasts weeks or months, at which point another injection is needed. The cost of Botox injections varies by region and by provider, but the therapy is significantly less expensive than more invasive cosmetic procedures.
Over the years, physicians and researchers discovered that Botox could also be used to lessen the pain of migraines and cervical dystonia, a condition affecting the neck muscles; to alleviate jaw clenching and certain chewing and swallowing difficulties; to decrease muscle spasticity in people with cerebral palsy; and to treat hyperhidrosis, or excessive sweating.
It was, a reporter for the New York Times wrote in 2009, “medicine’s answer to duct tape.”
Alan Brown Scott was born in Berkeley, Calif., on July 13, 1932. His father was a dentist, and his mother worked at a laboratory at the University of California at Berkeley.
Dr. Scott enrolled at Berkeley, where he received a bachelor’s degree in medical science in 1953. He received a medical degree from the University of California at San Francisco three years later. He spent decades at the Smith-Kettlewell Eye Research Institute, where he rose to become an executive director, and was also director and senior scientist at the Strabismus Research Foundation.
Dr. Scott’s first wife, the former Ruth White, died in 2009 after 53 years of marriage.
Survivors include wife of seven years, Jacquelyn Lehmer of Sonoma, Calif.; five children from his first marriage, Jennifer Scott of Washington, Heidi Scott of St. Helena, Calif., Alison Ferguson of Mill Valley, Calif., Ann Scott of Portland, Ore., and Nathaniel Scott of Cayucos, Calif.; four stepdaughters, Suzanne Lehmer of Carlsbad, Calif., Mary Lehmer of Freeport, Maine, Sally Lehmer of Nevada City, Calif., and Phillis Lehmer of Brooklyn; and numerous grandchildren and great-grandchildren.
Asked about Botox’s popularity as a wrinkle-reducer, Dr. Scott remarked to the Chronicle that he thought the use was a “charming, slightly frivolous,” one “not along the lines of what I was into, applications for serious disorders.”
But “you never know,” he quipped on CBS, “what’s going to happen the first time you do these things.”