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.
Anecdotal Evidence
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.
CONCLUSION
Over the past two decades, BoNTA has become an indispensible part of aesthetic medicine and the most popular non-invasive option for facial rejuvenation. However, evidence suggests that injections do more than temporarily stay wrinkle formation. Data show that BoNTA alters biomechanical properties of the skin and may enable dermal remodeling for improvements in elasticity, pliability, and radiance. Although clinical evidence for the prophylactic use of BoNTA may be limited, anecdotal evidence and case studies tell us what we have yet to prove 
