I understand that Botox and Xeomin are prescription medications that are injected into muscles to temporarily improve the appearance of moderate to severe frown lines between the eyebrows, forehead lines, and crow's feet lines.
I have been informed and understand the following:
1. Purpose and Risks:
a. The purpose of Botox and Xeomin treatment is to temporarily reduce the appearance of facial wrinkles and lines.
b. The potential risks and complications associated with Botox and Xeomin
treatment include but are not limited to:
- Bruising or bleeding at the injection site
- Swelling or redness at the injection site
- Headache or flu-like symptoms
- Temporary drooping of the eyelid or eyebrow
- Dry eyes or excessive tearing
- Allergic reactions
- Infection at the injection site
- Rarely, more serious complications may occur
2. Treatment Procedure:
a. The treatment will be performed by a qualified healthcare professional who has received appropriate training in administering Botox and Xeomin injections.
b. The treatment involves the injection of Botox or Xeomin into specific muscles using a fine needle.
c. The number of injections and the amount of Botox or Xeomin used will be determined by the healthcare professional based on my individual needs and desired results.
d. The treatment may require multiple sessions to achieve the desired outcome.
3. Expected Results:
a. The results of Botox and Xeomin treatment are not permanent and typically last for 3-6 months.
b. The degree of improvement may vary depending on individual factors such as age, skin condition, and lifestyle.
4. Alternatives:
a. I understand that there are alternative treatments available for the reduction of facial wrinkles and lines, such as dermal fillers or surgical procedures.
b. I have been informed about the potential benefits and risks associated with these alternative treatments.
5. Confidentiality:
a. I understand that my personal and medical information will be kept confidential and will only be shared with authorized healthcare professionals involved in my treatment.
6. Costs and Payment:
a. I have been informed about the cost of the Botox and Xeomin treatment, including any additional fees for consultations or follow-up visits.
b. I understand that payment is due at the time of treatment and that accepted forms of payment may vary.
7. Consent:
a. I have had the opportunity to ask questions and have received satisfactory answers regarding the Botox and Xeomin treatment.
b. I understand the risks, benefits, and alternatives associated with the treatment.
c. I voluntarily consent to undergo Botox and/or Xeomin treatment at BEAUTY MD
I have read and understood the information provided in this consent form.
I acknowledge that no guarantees or assurances have been made to me regarding the results of the treatment.
I acknowledge that I have voluntarily chosen to undergo Botox and/or Xeomin treatment at BEAUTY MD.
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