BACKGROUND: In 1817 and 1820, the German physician Justinus Kerner published a series of cases of lethal food poisoning that would unknowingly have a lasting impact on medical science. His compilation of over 75 cases linked the consumption of smoked sausages in the small town of Herrenberg in Württemberg, recounted a constellation of symptoms that today the authors call botulism. Now, over 2 centuries later, the discovery, study and refinement of the toxin causing clinical botulism has led to the acceptance of neuromodulators as a treatment for a wide variety of medical concerns. OBJECTIVE: The aim of this article is to understand the many historical advances in the mechanism of action of botulinum neurotoxins, the wide range of indications that are currently available and Dermatologic Surgery's role in this evolution. MATERIALS AND METHODS: A PubMed retrospective search to identify literature on the history of botulinum toxin was undertaken. RESULTS: Botulinum toxin is the newest therapeutic generational drug with over 30 approved indications in 90 countries. There are now 7 FDA (food and drug administration) approved neuromodulators with several more under current review. CONCLUSIONDermatologic Surgery has had a seminal role in the advancement of neuromodulators and publishing associated literature.