responsible for the degradation of collagen and other components of the ECM.18 Levels of two pro-alpha collagen chains—alpha-1, the major component of type I collagen, and alpha-2—were also higher after treatment. These results provide further evidence that BoNTA promotes broblast activity and has the potential to stimulate dermal remodeling.
Evidence-based medicine is the optimal approach for patient care. As individual clinicians, however, we are heavily in uenced by clinical observation and patient feedback. Clinical practice yields certain observation: first, regular, sustained injections of BoNTA lead to consistent, ongoing improvements in wrinkles— initial treatment leads to softening of wrinkles that often ll in over time with repeated injections; second, long-term treatment leads to an intangible improvement in skin quality, with improved light reflection for skin that is more luminous and radiant (Figures 1-3). Patient satisfaction is higher for men and women who receive regular injections over several years compared to those who receive only sporadic treatment, and this makes sense: a regular treatment regimen means that muscles do not regain function, the skin is not repeatedly creased by dynamic musculature, and the collagen network is able to reorganize cohesively in a way that prevents the formation of new wrinkles for a more youthful appearance and better clinical results.