I authorize the practitioners of Westside Aesthetics to perform neuro-modulator treatments by using Botox, Xeomin or Dysport, in order to reduce the appearance of my facial wrinkles in the areas treated. I understand that this relaxes the muscles under my skin and therefore reduces the wrinkling caused by muscular contraction. I understand that small amounts of the product will be injected into the muscle, with a tiny needle, under my skin and that this will cause my muscles to temporarily relax for approximately three to four months. Although results are commonly predictable and provide a good outcome, I have been informed that the practice of medicine is not an exact science and that no guarantees can be made concerning expected results in my case.
I also understand that it can take up to 10-14 days for the full result to occur, although the benefit may begin to develop with the first few days. I understand that there is no guarantee that wrinkles will be completely erased.
I understand that the side effects or complications of botulinum toxin injection are rare and are not permanent. Occasionally, slight swelling and/or bruising may last for several days after the injections. Pain, headache, migration of the neuro-modulator injected, bleeding and bruising, damage to deeper structures such as nerves and blood vessels may occur during the course of injection, but are extremely rare side effects. Eye disorders, functional and irritative very rarely occur following injections. An adjacent muscle may be weakened for several weeks after treatment. There is less than 1% change of upper eyelid weakness, which means the top eyelid could droop 1 to 2mm, for a month or more. The droop always resolves. There is a possibility of a poor or inadequate response.
I have discussed the treatment with my provider and I understand all the information given to me.
I understand and agree to undergo the treatment with Botox Cosmetic, Xeomin or Dysport.
I certify that I have read and fully understand the above paragraphs, that I have had sufficient opportunity for discussion and that all of my questions and/or concerns have been answered to my satisfaction.