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These are now updated to include (a) All type A toxins act identically; (b) The mathematical relationship between toxin and receptor is the basis of efficacy, and clinical efficacy is influenced by molecular potency and patient attributes including muscle mass, gender, age, and ethnicity; (c) Efficacy, onset, and duration are functions of \u201cmolecular potency\u201d defined as the number of active 150\u00a0kDa molecules available for binding; (d) \u201cMolecular potency\u201d is difficult to objectively quantify for commercially available toxins; (e) Up to a point, increased molecular potency decreases time to onset and increases duration of effect, and the \u201cMolecular Potency Quotient\u201d is a construct for comparing molecular potency commercial cost; (f) The area of effect of a toxin injection is dependent upon molecular potency, diffusion (passive), and spread (active); (g) Differing reconstitution volumes; and (h) Increased number of injection sites can affect spread, onset, and duration of effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The principles of BoNT\u2010A use in aesthetics are complex yet understandable as outlined in the framework of the updated Eight Key Clinical Postulates and serves as a useful tool for providing the most effective treatment and interpreting research on present and future toxin formulations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.13702","type":"journal-article","created":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T23:41:00Z","timestamp":1598917260000},"page":"2785-2804","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["The mechanisms of action and use of botulinum neurotoxin type A in aesthetics: Key Clinical Postulates II"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8978-7932","authenticated-orcid":false,"given":"Mark S.","family":"Nestor","sequence":"first","affiliation":[{"name":"Center for Clinical and Cosmetic Research  Aventura Florida USA"},{"name":"Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine  Miami Florida USA"},{"name":"Department of Surgery Division of Plastic Surgery University of Miami Miller School of Medicine  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Arnold","sequence":"additional","affiliation":[{"name":"Center for Clinical and Cosmetic Research  Aventura Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Fischer","sequence":"additional","affiliation":[{"name":"Center for Clinical and Cosmetic Research  Aventura Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,16]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40257-016-0237-x"},{"key":"e_1_2_14_3_1","unstructured":"drugs.com. drugs.com. 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