Botox® Patient Information
The purpose of this form is to help educate you about Botox, it’s potential risk’s and expected benefits, so that you can make an educated decision on whether or not you are interested in this treatment. This information is not meant to scare or alarm you; it is simply an effort to better inform you so that you may give or withhold your consent for treatment. Botox is the trademark name for Clostidium botulinum. Botox injections have been safely used for more than a decade in children and adults to improve muscle spasm of the facial muscles. This toxin has also been useful around the eye to correct double vision due to muscle imbalance, as well as numerous other neurological uses. BOTOX Cosmetic is now approved by the FDA to improve the appearance of the vertical lines between the brows. Results from Botox injections are usually very dramatic and extremely positive. The facial muscles that have caused the skin to contract and wrinkle, will relax, which in turn allows the skin to smooth, creating a more youthful appearance. A few tiny injections of BOTOX Cosmetic relaxes overactive muscles, which results in a softening of the vertical lines
between the brows. Injections in other areas to improve the appearance of facial lines have been reported in the literature.
To name a few of the other areas that have been successfully treated are the lines around the eyes, commonly referred to
as “crow’s feet,” and the horizontal lines across the forehead and nose. It has also been used in the lower face around the
mouth area.
A minute amount of diluted botulinum toxin; Botox solution is injected with an extremely small needle into the targeted
muscle(s). Botox injections are very simple, fast, and safe. Any pain associated with the injections is minimal. No
sedatives or local anesthetics are required, and you may engage in your daily activities immediately after your treatment.
The targeted muscle(s) do not immediately relax. The benefits develop over the next two to seven days. The muscle(s)
will remain in a relaxed state for a period of six weeks to six months. On average a Botox result last for a period of about
three months.
There are many variables to take into consideration when determining the length of time your result will last. One variable
to consider is the effect of increased metabolism when taking diet pills, including the herbal diet pill, Metabolite. The length
of time the muscle(s) will remain relaxed, may be decreased.
As stated, the results of Botox are temporary. Maintenance sessions are needed to sustain the results over time. How
often those treatments are needed will vary from person to person (please refer to the above paragraph). To obtain
optimal results, several sessions may be required. Optimal is very subjective. Optimal to some is a softening of expression
lines, but optimal to others is a total lack of muscle movement.
Side effects and complications have been minimal. Occasionally, temporary slight swelling, and/or bruising may last for a
few days after the injections. The incidence of bruising can be greatly decreased by avoiding, for a period of two weeks
prior to your injections, Aspirin or Aspirin containing products, Motrin, Ibuprofen, diet pills, herbal diet pills (Metabolite),
mega doses of Vitamin E, Gingko, Garlic, or anything that is going to cause a thinning effect on the blood.
A possibility, but not a probability, is the inadvertent relaxing of a muscle that was not the intended target. This could
potentially result in a temporary eyelid droop. You will be instructed not to lye flat, or rub the injection sites for
approximately four hours after your treatment so that the Botox does not spread to adjacent muscles. In the unlikely event
that you were to end up with an eyelid droop, Botox is temporary. Eye drops can be made available to you to lessen the
effects of a temporary droop, or left untreated the droop will resolve on its own without any treatment at all.
Other potential side effects include, but are not limited to: headache, nausea, or flu like symptoms.
Under no circumstances will Botox injections be performed if there is an infection at the desired injection site.



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