Facial Sculpting

Botulinum Toxin Consent Platysmal bands


Patient Name:  

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

  • Bruising

  • 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

  • Nausea

  • Anxiety

  • Dry mouth

  • Altered skin sensation, muscle twitching or spasm in the treated area

  • Fever

  • Lack of strength

  • Flu like symptoms

  • Itching or dry skin

  • Infection

  • 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.

  • Rash

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.

Expected Outcome

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).

Print Name:  

Date:  

Leave this empty:

Signature arrow

Signed by Nina Bal
Signed On: 8th January 2020

Signature Certificate
Document name: Botulinum Toxin Consent Platysmal bands
lock iconUnique Document ID: 117222327f97c4c4d7e1f5c4fb686f2e11245b21
Timestamp Audit
5th November 2019 3:20 pm BSTBotulinum Toxin Consent Platysmal bands Uploaded by Nina Bal - info@facialsculpting.co.uk IP 51.179.98.227