Cathy Swann was around 30 years old and working as a medical receptionist when she first started getting Botox to treat a deep wrinkle between her eyebrows.
"It was a little daunting watching the needle coming to your forehead between your eyes," Swann said from her home in Penticton, B.C.
The year was 1987 and Swann wasn't just any receptionist.
She was working for Dr. Jean Carruthers, a Vancouver-based ophthalmologist who pioneered the use of Botox, a botulism-based toxin that temporarily paralyzes muscles, for cosmetic purposes.
In the 30 years since, Botox has become one of the world's most common cosmetic procedures — and is now used to treat an ever-expanding array of medical conditions.
Doctors say the procedure is relatively safe, although health organizations warn of potential side effects ranging from droopy eyelids and crooked smiles to trouble breathing and vision problems.
Despite the procedure's ease and efficacy, critics say it's emblematic of a culture obsessed with preserving youth at any cost.
'Beautiful, untroubled expression'
Carruthers was one of the first doctors to use Botox for medical purposes in Canada, starting in 1983.
She used it first on patients with blepharospasm, a condition that causes facial muscle spasms that force eyelids shut.
Her practice blossomed after one of her patients noticed how the treatment induced a serene look on her face.
"She said, 'you know, I know I'm not spasming there, but every time you treat me there I get this beautiful, untroubled expression,'" Carruthers said.
Medical community 'uniformly horrified'
When Carruthers mentioned her patient's comment to her husband, dermatologist Dr. Alastair Carruthers, he was keen to see it too.
He had been trying to treat his patients' wrinkles with collagen infusions, with little success.
Swann became their first test subject for evaluating Botox's effect on wrinkles.
But it took years before the concept of injecting people's faces with a potentially fatal toxin was accepted as standard practice.
"Our colleagues, I would say, were uniformly horrified by this," Jean Carruthers said.
It took the pair until 1991 to publish their first scientific paper, with 18 subjects. Carruthers volunteered her own face as proof the procedure was safe and effective.
"And I go around now saying that I haven't frowned since 1987," she said.
Patients getting younger
Carruthers, 69, still practices medicine and researches part-time.
She said over the last 30 years the procedure has become more accepted.
According to the American Society for Aesthetic Plastic Surgery, last year Botox and similar drugs were the top non-surgical cosmetic procedure in the U.S.
Carruthers says the relative safety of the procedure has also helped doctors develop its use for other purposes, ranging from bladder control to migraine suppression.
Another change she has noted is the age of her patients. Some are in their 20s hoping to prevent wrinkles from forming in the first place.
That trend worries positive-body image advocates like Jill Andrew, co-founder of Body Confidence Canada.
"Certainly women and girls are responding to a society that we live in that socializes us to feel that beauty is skin deep and that once wrinkles arise we're no longer beautiful, we're no longer viable," Andrew said.
It's every woman's right to make choices about her looks, she said, but warns that in some cases, women may choose to get Botox because of social pressure — or even to increase their chances of getting a job or pursuing other opportunities.
"Our individual choices are always mediated by the world and through the lense of the world we live in," she said.
Andrew also pointed to the potentially life-altering consequences of cosmetic procedures gone awry, especially when they're not performed by properly trained experts.
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'I look pretty damn good'
As for Swann, patient zero of the Botox boom, 30 years later she no longer gets the procedure done.
"Why not? Because I'm 60 and I actually think I look pretty damn good," she said.
"I have very few wrinkles. I have beautiful silver hair. I'm a little chunky."
Still, she understands why someone would choose to.
"We don't all age the way we want."