Botulinum Toxin Consent Platysmal bands
Date of Birth:
Botulinum Toxin (Platysmal Bands) Informed Consent
Aim of Treatment
The aim of this treatment is to relax the muscles appearing as vertical ‘rods’ in the neck, in order to improve the appearance of the neck and jaw line. This clinic uses Botox unless you are otherwise advised, or request an alternative brand of botulinum toxin.
Common Side Effects Associated with the Injections Include
Pain or stinging sensation when the injection is performed.
Localised swelling, redness, tenderness
Bleeding at the sites of injection
Numbness or itching of the area following injection.
The above usually resolve spontaneously within hours or days, but may persist for longer.
Neck pain, muscle weakness
Uncommon Side Effects
Altered skin sensation, muscle twitching or spasm in the treated area
Lack of strength
Flu like symptoms
Itching or dry skin
Muscles not targeted may be effected, causing hoarseness of the voice or difficulty swallowing. Immediate medical attention should be sought should difficulty in swallowing be experienced.
Any adverse reactions usually occur within a few days of treatment. They are expected to be temporary in nature and usually resolve spontaneously within weeks. If you notice any difficulty in swallowing please report to the clinic as soon as possible.
Rarely, symptoms may persist for several months.
The treatment of platysmal bands with botulinum toxin is not a licensed indication. The product manufacturer has no liability should a complication arise.
Whilst probable results have been explained, this should not be interpreted as a guarantee.
Successful treatment should soften the appearance of the muscles treated. Any decision to increase the dose, or repeat treatment, will be made at the discretion of the practitioner, informed by safety and best practice.
On occasion it is helpful to share visual images of our own treatment results.
I consent to photographs being published for;
I have been advised the cost of the treatment will be £ and accept the terms of payment as per the clinic policy (terms and conditions).
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Signed by Nina Bal
Signed On: 8th January 2020
If you have questions about the contents of this document, you can email the document owner.
Document Name: Botulinum Toxin Consent Platysmal bands
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