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Kim, H., & Chin, K

The presence of IGF-1 and IGFBP in the IPM, together with the presence of IGF-1 receptors on both photoreceptor and RPE cells [36], suggests the presence of an outer retina autocrine-paracrine system

Cost-benefit optimization strategies include using peptides as primary intervention with occasional Botox for specific stubborn areas, alternating between Botox and peptide-only periods extending injection intervals from 3-4 months to 5-6 months through peptide support between treatments, or beginning with peptides for preventive maintenance transitioning to Botox only when peptide-only protocols prove insufficient creating age-appropriate escalation strategy matching intervention intensity to actual need