HOW TO PARALYZE PERSPIRATION

SAN FRANCISCO No matter how good you are at acting calm and collected, underarm dampness announces your nervousness for all to see. For the small number of people who sweat so profusely that even prescription antiperspirants don't help, the problem goes well beyond minor social embarrassment. Some have actually had underarm skin removed, sweat glands and all. Now there's a less drastic option.

Dermatologist Richard Glogau of the University of California injected tiny amounts of Botox, a purified toxin from the bacteria that causes botulism, into the underarms of four men and eight women who suffered from severe sweating. The toxin - which cosmetic surgeons use to smooth frown lines by immobilizing facial muscles - paralyzes the nerves that turn sweat glands on. The patients stayed dry for up to seven months.

According to Glogau, Botox has also worked well on hundreds of normal armpits. But its main side effect - a sharp pain in the pocketbook - will give most people pause. A single treatment (20 injections per side) costs about $1,000, and few insurers will pay for it.

Thousands of middle-aged women are turning to a deadly bacteria to feel better about the way they look.


Dermatologists and cosmetic surgeons are injecting a diluted, purified form of botulinum toxin, sold under the name Botox, into small muscles in the face. The Botox paralyzes nerve endings and temporarily reduces wrinkles on the face and neck.

"People basically walk into the office, get a few pin pricks, and they're out the door," says Dr. Richard Glogau, a clinical professor of dermatology at the University of California, San Francisco, who also has a private practice.

Botox immobilizes the muscles people use when they frown or squint, which can create deep horizontal and vertical wrinkles in the forehead. "After a Botox treatment, your facial muscles are in the same position as an arm in a cast," says Dr. Glogau. "Eventually, the muscles thin, atrophy and flatten out."

Patients usually see results in a few days and the full effect within a week. The toxin wears off in three to eight months, and repeat treatments are needed two or three times a year to keep wrinkles from reappearing. Each treatment costs between $350 and $400, depending on how much of the toxin is used.

But Botox injections don't come without some risks. Doctors sometimes miss the muscle with the shots and the treatment does not work. Although rare, Botox may also weaken the muscles that are used to raise the upper eyelid, resulting in a droopy eye. Some patients also report a headache for a few days after the treatment.

Botox is most commonly used to treat the vertical lines between the eyebrows, the horizontal lines on the forehead, frown lines, crow's feet, the wrinkle lines on the side of the nose, and the horizontal wrinkles on the neck. Botox isn't used below the lower eyelids because those muscles are needed for facial expressions and talking.

YOU'VE HEARD OF THE power tie and the power suit. How about the power face? An immobile, unruffled demeanor makes a person intimidating - whether at the poker table or the negotiating table. The trouble is, it's hard work mastering your emotions to achieve the necessary level of self-control. Now there's no need to go to all that trouble, thanks to Botox, a drug that temporarily paralyzes the facial muscles.

Botox, made of botulinum toxin, was launched on the market ten years ago for patients with severe eye spasms. The drug took off when women discovered that weakening face muscles was an effective way to reduce wrinkles without plastic surgery. Now dermatologists say an increasing number of professional men, age 40 to 55, are clamoring for the shots to get that instant poker-face effect. "It's a countrywide phenomenon," says Richard Glogau, a clinical professor of dermatology at the University of California, San Francisco. According to Glogau, use of Botox by men in the past several years has grown from nothing to 35% of the half-million-plus Botox users.

The treatment isn't cheap. Injections run $500 a pop and executives have to return to the doctor every three to five months to maintain their new facade. Risks are marginal, however, except for one little side effect that may make doing business a bit tougher: You can't frown.

A "lunchtime" face peel can burn away blemishes in just 45 minutes, but leave you looking like a ripe tomato for weeks. A new device promises the same results without the nasty aftermath. Called "Derma Peel", this clear wand uses microscopic aluminum crystals to remove damaged skin. The only mark it leaves is a pinkish hue that heals into a healthy glow within hours, says Dr. Richard Glogau, a dermatologist at the University of California, San Francisco-Stanford Health Center. That means you can slough off a few light wrinkles at lunchtime, and still save face at dinner.

32 Flawless Dermatologists

Dermatology these days is more than skin deep. While many paths to a purer complexion involve application of oils, vitamins or sunscreens to the ultrathin epidermal layer, emerging skin therapies work beneath the surface to bring out beauty from within. Chemical peels, which create a youthful appearance by removing dead skin cells, can safely and powerfully penetrate the skin's top layer. Routine surgery and injections of hardening solution are today's common ways to conquer the varicose veins you thought you'd have forever. The following list of dermatologists favors cosmetic specialists who tackle acne, spider veins, hair loss and sun-damaged skin on a daily basis. They are all board-certified and were recommended to us by the American Academy of Dermatology (AAD), the Chigago based professional organization that sets national standards for dermatological care.

Recommended in San Francisco:
Dr. Richard Glogau, M.D.