Wrinkle Relaxer Consent
Botox or Dysport therapy for wrinkles is an injection treatment designed to reduce facial expression lines. They are both approved by the FDA for the treatment of wrinkles in the glabellar area. When this therapy is performed, small amounts of toxin are injected into the facial muscles responsible for movement associated with lines and wrinkles. This injection weakens or paralyzes the muscles, thus reducing the associated lines and wrinkles. The most common areas for this therapy are the lines between the eyes, forehead wrinkles, crows’ feet and on occasion around the mouth. This therapy is temporary, meaning it has to be repeated on a regular basis to remain effective. The weakening effect gradually begins anywhere from 24 hours to 3 days and is sometimes not complete for two weeks. During this period, you may notice asymmetry, or an evenness, within treated areas. This asymmetry will usually correct itself as the toxin takes effect. For maximal result it is recommended that you maintain an upright posture for at least four hours. During this time is also recommended that the treated area not be rubbed vigorously or massaged. You may wish to actively move by expression the treated areas during this time, as this may help to increase the response of the targeted muscles.
There are no known permanent side effects. There are however, several possible side effects that are temporary which include:
Bruising: Occurs at or near the injection site. This effect clears within 7 to 10 days. No treatment is necessary.
Headache: Related to the actual injections, it is usually mild and transient, lasting less than 24 hours. May be relieved with Tylenol.
Asymmetry: As described above, if present, will be noticed in the first two weeks of therapy. May be corrected with “touch-up” injections if necessary. There is a fee for touch up injections.
Numbness: A change in sensation noticed by some patients in the treated areas, better described as “dullness”, it is usually only noticed for a few days after treatment.
Eyebrow or eyelid ptosis (drooping) or diplopia (double vision): Seen 1-2% of patients receiving this therapy, is temporary, lasting weeks and usually mild.
Also for reasons not fully understood, some patients may be less sensitive or “resistant” to the effects of the toxins. Very deep creases may not be completely resolved with treatment.
If you are pregnant or nursing, these treatments are not recommended.
Because this therapy for wrinkles is considered a cosmetic procedure, insurance does not pay for treatment. Payment at the time of service is requested for all patients.
Botox and Dysport range in price based on the number of units used. In general Dysport is slightly less expensive than Botox. Prices start at approximately $350 for the glabellar area (the small area between the brows where we frown). Each additional area is approximately an extra $120; so for all three areas (typically frown, forehead and crows feet) it will range from $550-700
By signing below, I agree that I have read and understand the above information, and that my questions have been fully answered to my satisfaction. I understand that the practice of medicine and surgery is not an exact science and that results are not guaranteed. I agreed to be personally and fully responsible for all fees.