Patient Instructions & Consent Botox/Dysport
Pre-Treatment Instruction
Avoid excessive peeling agents and/ or laser procedures to treatment area, such as moderate to deep chemical peels, IPL, fraxel or resurfacing for at least 2-4 weeks .
To reduce the risk of bruising:
Post-Treatment Instructions
Please call us at 206-523-4444 if you have any questions or concerns.
PATIENT INFORMATION
The use of Botox and Dysport is a simple, non-surgical procedure that smooths the lines and wrinkles caused by persistent muscle movement. It is used in the treatment of facial lines in the upper third of the face resulting from the pull of the muscles of facial expression. Some patients treated with Botox may see a reduction in the appearance of their wrinkles within 3-5 days, while for others it may take up to 2 weeks before improvement is seen. There is no downtime or recovery period after a treatment.
The active ingredient of Botox is produced from fermentation of Hall strain Clostridium Botulinum Type A. Small, diluted amounts can be directly injected into specific muscles causing controlled weakening of the muscles. The FDA has approved such usage to successfully treat wrinkles and facial creases in the glabellar area (area between the eyebrows). Other areas commonly treated are the forehead and outer eyes (crows’ feet).
Botox blocks signals from the nerves that contract the muscle(s). The injected muscle can no longer contract and tighten, which causes the wrinkles to relax and soften. Wrinkles caused by sun damage and gravity will not respond to treatment with Botox.
The procedure takes only a few minutes and no pain medication is required. Botox is injected with a fine needle into specific muscles with only minor discomfort. It generally takes 3-14 days to take full effect and it is best to avoid alcohol at least one week prior to treatment. Aspirin and anti-inflammatory medications should be stopped 2 weeks prior to treatment to reduce bruising.
The effects from Botox may last 3-4 months. As muscle action gradually returns, the lines and wrinkles begin to re-appear and wrinkles need to be re-treated. Lines and wrinkles often appear less severe with time because the muscles are trained to relax. Results vary from patient to patient due to different rates of metabolism.
Patients who are pregnant, breastfeeding, or have a neurological disease should not use Botox. Since Botox doesn’t work for all wrinkles, a consultation with medical personnel is required prior to treatment.
Risks and Complications
It has been explained to me that there are certain inherent and potential risks and side effects in any invasive procedure. With this specific treatment, such risks include but are not limited to 1) post treatment discomfort, 2) post treatment bacterial, viral and/or fungal infection requiring further treatment, 3) allergic reaction, 4) minor temporary droop of the eyelid(s) in approximately 2% of injections usually lasting 2-3 weeks, 5) occasional numbness of the forehead lasting up to 2-3 weeks, 6) transient headache, and 7) occurrence of flu-like symptoms or 8) bleeding, redness, bruising, and/or edema of the injected areas.
Pregnancy, Allergies, and Neurologic Disease
Please initial:
I am not pregnant
I do not have or ever have had a neurologic disease
I am not allergic to the toxin ingredients or to human albumin
* I understand that Skinlogic is a medical spa and that this is a medical procedure. Children are not allowed in the treatment room during medical services to ensure safety of the services performed. We do not recommend bringing children into the facility as they are not allowed past our lobby. Please make accommodations for your child's supervision in our lobby if needed.
Results
I am aware that when small amounts of purified botulinum toxin (Botox/Dysport) are injected into a muscle, it causes weakness or paralysis of that muscle. This appears in 3-14 days and usually lasts 2-5 months, but can be shorter or longer. In a very small number of individuals, the injection does not work as satisfactorily or for as long as usual. I understand that I will not have total muscle movement while the injection is effective, but that will reverse after a period of months at which time re-treatment is appropriate. I understand that I must stay in the erect posture and that I must not touch or manipulate the area of injection for 4 hours after the treatment.
I understand that results might vary and that if a touch up or correction is needed that I need to wait a minimum of 2 weeks after my initial injection as the full effect of the product will not be known until then. I need to wait a minimum of 2 weeks to receive any skincare services.
A minimum of $150 will be charged regardless of the amount of neuromodulator injected.
I hereby volunteer consent to treatment with Botox/Dysport injection. The procedure/treatment has been explained to me. I have read the above and understand it. My questions have been answered satisfactorily. I accept the risks and complications of the procedure.
Cancellation Policy:
Your allocated appointment times are reserved especially for you and are very important to us. We have implemented this cancellation policy because we value the business of our clients and the time of our staff. All of our policies are designed to benefit our current clients and our future clientele. Therefore, we respectfully request at least 24 hours’ notice for adjustments to your appointments and for cancellations. Please understand that when you forget or cancel your appointment without giving enough notice, we miss the opportunity to fill that appointment time and clients on our waiting list miss the opportunity to receive services they need.
I understand that as a new or current client of Skinlogic Med Spa that I supply a credit card to have on our files. All cards on file are added to the system via a secure electronic process that ensures the information is encrypted and remains secure. In the event that we do not receive the required 24 hour notice for adjustments and cancellations a $50 fee will be applied to your card, no exceptions.
I have read the above Cancellation Policy and agree to its terms and conditions. I hereby give my consent for Skinlogic Med Spa to securely store my credit card on file and authorize Skinlogic Med Spa to charge my card if I cancel less than 24 hours before any future scheduled appointments.
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