Botulinum Toxin – Risks Form

Prior to your treatment today with botulinum toxin, I wish to make you aware of potential risks, side effects and complications that CAN occur with this treatment. Please be aware that it is a legal obligation to ensure you have been told this information to ensure you are fully informed before your treatment at our clinic.

If you have any questions, please feel free to ask your practitioner or halt your treatment until you feel ready to proceed.

A signature today will present your agreement to the treatment and understanding of any risks, side effects and complications.

Potential risks/complications of Botulinum toxin include; however this list may not be exhaustive due to the bespoke nature of the treatment and individuality of you as a person:

• Headaches or flu-like symptoms
• Injection site reactions – including but not limited to:
  • Redness
  • Swelling
  • Irritation
  • Rash
  • Itching
  • Numbness
  • Pain
  • Discomfort
  • Stinging
  • Bruising
  • Bleeding
    
    
• Eyelid oedema/swelling
• Upset stomach/indigestion
• Drooping of the eyelids or eyebrows (ptosis)
• Lifting of the eyelids or eyebrows
• Temporary weakness/drooping of the face, mouth, cheeks
• Temporary blurred vision
• Eye irritation or redness
• Infection
• Difficulty with movements of the mouth whilst smiling, talking, eating, pouting
• Facial aches/pains/tingling
• Ineffective treatment or suboptimal result

Please note - there is no reversal agent for botulinum toxin and any adverse effects should be allowed to wear off over time.