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Chemodenervation From Physiology of the Skin, Third Edition

By: Zoe Draelos, MD, and Peter T. Pugliese, MD
Posted: January 5, 2011, from the January 2011 issue of Skin Inc. magazine.

“A series of articles appearing in Skin Inc. magazine on various topics related to skin physiology formed the initial basis for the original book Physiology of the Skin (Allured Books, 1998). Throughout the years, the topics expanded so much that this additional information required a new edition, thus Physiology of the Skin II (Allured Books, 2001) was issued. Now, new advances in basic science have made it necessary for a subsequent book, Physiology of the Skin, Third Edition, to be released by Allured Books in early 2011. Zoe Draelos, MD, has helped prepare this new edition. She is not only a highly skilled dermatologist, but also a first-rate scientist and the editor of a national medical journal. I am pleased that this third edition will continue to provide estheticians with the relevant information so necessary for the understanding and delivery of professional skin care. Although my interest will always be to help estheticians increase their knowledge of the skin, I am happy to pass the torch to the competent and professional Dr. Draelos.”

—Peter T. Pugliese, MD


Chemodenervation is a new area of anti-aging therapy in which selected nerves are disabled within the face and body to create a more pleasing, youthful appearance. It’s accomplished with a toxin produced by an anaerobic spore-forming bacteria known as Clostridium botulinum, which can accidentally be consumed in spoiled food and results in a condition known as botulism. Its symptoms begin with blurred vision, dry mouth, dizziness and nausea, and progress to total body paralysis.

The first study demonstrating a medical use for botulinum toxin was published in 1973 by Alan Scott, MD, a pediatric ophthalmologist, showing that the toxin could be used to weaken eye muscles in monkeys. It was not until 1977 that the first injections were tried in humans to treat visual problems, and in 1979, the U.S. Food and Drug Administration (FDA) gave approval for botulinum toxin to be used in the treatment of strabismus, the medical term for crossed eyes. The use of botulinum toxin for cosmetic purposes was FDA-approved in 2003 for the treatment of frown lines, known as glabellar rhytides.

Understanding botulinum toxin