Please read below potential risk, side effects, and after-care procedure:
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Risks and Side Effects
Common Risks – 1 in 100 to 1 in 10
• Redness
• Swelling
• Bruising
• Allergic reaction
• Headache
• Pain
• Eyelid droop
• Eyebrow droop
• Muscle weakness
• Unsatisfactory result
Uncommon Risks – 1 in 1,000 to 1 in 100
• Injection
• Antibody formation
• Nausea
• Numbness
• Eye pain
• Skin tightness/dry skin
• Paraesthesia (pins and needles)
• Blepharitis (inflamed eyelids)
• Flu like symptoms/fever
• Photosensitivity reactions
• Blurred/double vision
• Heaviness in eyelids
• Dry/watery eyes
• Nerve pain
• Muscle twitching
Rare Risks – 1 in 10,000 to 1 in 1,000
• Rash/hives
• Itching
• Serious allergic reaction (anaphylaxis)
• Hair loss
• Spread of product in the neck area affecting nearby muscles;
difficulty in swallowing, pneumonia
• Decreased hearing
• Arrhythmias, MI
• Seizure
Area Specific Related Risks
Botox Around the Mouth
• Reduced ability to smoke, drink through a straw or whistle (peri-oral
lines)
• Reduced smiling (gummy smile)
• Asmmetry (DAO, peri-oral, gummy smile)
Botox in the Armpit
• Non axillary sweating, hot flushes
• Myalgia and joint pain (Less Common)
Botox in Masseter
• Muscle ache
• Reduced ability to chew
• Speech disturbance
Benefits
• Improvement/reduction/eradication of facial lines (static lines
require repeated treatments)
• Reduced ability to contract muscle leading to the skin remaining
relaxed
• Prevention of developing or making existing wrinkles worse
• Potential reduction in headaches
• Potential smooth/shiny skin
• Brow lift
• Reduced gummy smile
• Reduction in down turn of the mouth
• Tighter jaw line
• Reduction in platysmal bands showing
• Reduced sweating
• Reduced dimpling of chin
• Slimming of masseter
Alternatives
• No treatment
• Dermal filler
• PRP
• Dermabrasion
• Obagi/retinols
• Sculptra
• Medical Needling
• Mesotherapy
• Surgery
Hyperhidrosis
• Antiperspirants
• Aluminium chloride hexahydrate
• Surgery
Aftercare
1. You have undergone a dermal filler treatment where hyaluronic acid
has been placed in the skin. You may initially be swollen, red and
bruised which will subside within the next 1 -10 days, especially if the
bruising is extensive.
2. It is advisable that you do not touch the area for 6 hours.
3. Do not apply make up for approximately 6 hours unless it is mineral
based.
4. Avoid exposure to UV and extreme heat i.e. sauna, steam rooms, sun
beds etc. as this may increase discomfort and swelling.
5. Also avoid extreme cold: this includes ice packs that are directly
applied to the skin. If necessary you can apply a cool compress to the
area to reduce any discomfort or swelling.
6. Arnica tablets/gel can be used to help reduce bruising or the
application of vitamin k oxide cream.
7. If you have had a local nerve infiltration injection please do not
consume any hot or cold drinks until your sensation has returned to
normal. You must also be careful when eating so that you do not risk
biting your lip.
8. If you experience any lumpiness in the implantation area it can be
gently massaged to help smooth this out.
9. You should also avoid any facial massages or skin resurfacing until
the area has healed fully.
10. If you feel unsatisfied with the result, a review appointment can be
arranged but any additional products used will be charged at the
normal price per syringe.
Consent
I confirm that I have been informed that:
Botulinum toxin is indicated for the temporary improvement in the
appearance of moderate to severe vertical lines between the eyebrows
seen at the frown (glabella lines) and for the improvement of lines around
the eyes (crow’s feet) in adults <65 years old, when the severity of these
lines has an important psychological impact for the patient. Any use of
botulinum toxin outside of this product license is off the label use and I
have discussed the implications of this with my clinician.
Like all medicines botulinum toxin can have side effects, although not
everyone gets them. Approximately 1 out of 4 patients may experience
side effects following a botulinum toxin injection. These adverse reactions
may be related to treatment, injection technique or both.
Treatment with
Botulinum Toxin is temporary, lasting approximately 3 – 6 months but will
vary depending on the condition of the skin, area treated, amount of
product injected, injection technique and lifestyle factors such as sun
exposure and smoking. I also understand that to maintain the effects,
further treatment is required.
Adverse reactions possibly related to the spread of toxin distant from the
site of administration have been reported very rarely with botulinum toxin
(e.g. muscle weakness, difficulty to swallow or pneumonia due to
unwanted food or liquid in airways). Injection of botulinum toxin is not
recommended in patients with a history of dysphagia (difficulty to
swallow) and impaired swallowing.
In general, adverse reactions occur within the first few days following
injection and are temporary. Most adverse events reported were of mild to
moderate severity. Diffusion of botulinum toxin into nearby muscles is
possible when high doses are injected, particularly in the neck area.
The chance of having a side effect is described by the following categories:
Common – More than 1 out of 100 persons and less than 1 out of 10 persons
Uncommon – More than 1 out of 1,000 persons and less than 1 out of 100 persons
Rare – More than 1 out of 10,000 persons and less than 1 out of 1,000 persons
Allergic reactions, difficulties to swallow, speak or breathe, have been
reported rarely when botulinum toxin type A has been used for other uses.
Visit your clinician immediately if such signs develop after botulinum
treatment. If any of the side effects gets serious, or if you notice any side
effected not listed, please tell your clinician.
Too frequent or excessive dosing of botulinum toxin may increase the risk
of antibodies in the blood which may lead to failure of treatment with
botulinum toxin when used for this and other conditions.
I confirm that my clinician, has:
- Discussed the risks, benefits and alternatives to this treatment
- Given me the opportunity to ask all remaining questions I have
about the treatment
- Given me time to consider the treatment
- Received an accurate medical history and that I have not withheld
any information
- Discussed and issued me with specific aftercare pertaining to this
treatment.
I therefore consent to receiving the described treatment by my clinician.
TO CONFIRM, WRITE DOWN YOUR FULL NAME, SURNAME AND DATE BELOW