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The strongest human evidence is topical, including the Leyden 2002 photoaging trial and a 2023 IRB-approved 21-woman topical NEEL gel study reporting an average 28% increase in skin collagen density at 3 months

Clinical characteristics of patients in the study Figure 2 Discussion This is the first study examining the long-term treatment response of neuropathic pain with BoNT

By synthesizing trial outcomes, labeling guidance, and clinical practice considerations, this comparison supports providers in determining which medication aligns best with an individual patients metabolic profile, treatment goals, and risk factors