**3. Clinical considerations**

#### **3.1 Pretreatment assessment**

The key to successful intervention is tailoring the treatment plan to every patient's need and combining different procedures to achieve best outcome [3]. Combination with hyaluronic acid fillers is increasingly utilized to optimize outcomes. The combined treatment with fillers can be considered for all regions, including the upper face [16].

For esthetic indications, the current trend accepted by both patients and physicians is to use BTXN in the least effective dose, injection points, and at longer intervals to achieve muscle activity modulation rather than muscle paralysis [3].

Assessment of the muscles should be performed at rest and at maximum muscle contraction [5].

Muscular and bony landmarks are to be used to identify the injection points [3]. It is recommended to discuss with the patients the black box warning and to document consent [8].
