Anti-Wrinkle Consent Form

The purpose of this informed consent form is to provide written information regarding the risks and potential adverse outcomes relating to the procedure named above. This material serves as a supplement to the discussion you have with your doctor. It is important that you fully understand this information, so please read this document thoroughly. If you have any questions regarding the procedure, please address your concerns with your doctor at the time of your consultation.

What is being injected? Anti-Wrinkle injections are made up from precise doses of neurotoxin produced by the bacterium Clostridium A. This toxin can relax the muscles on areas of the face and neck which cause wrinkles associated with facial expressions. Treatment with Anti-Wrinkle can cause your facial expression lines or wrinkles to be less noticeable. Anti-Wrinkle injections can also be utilised to reduce excessive sweating, teeth grinding and headaches. The effects of the toxin are temporary with the effects becoming noticeable over the first two weeks. Maximum results are assessable at four weeks.


Swelling and Redness: Localised swelling and redness should be anticipated after your injection. These symptoms are generally transient and may only last less than 30 minutes after your injections

Bruising: Trauma during the procedure is caused by needles and passing through tissue, and includes bleeding, bruising, haematoma (a larger collection of blood in the skin, outside of blood vessels).

Headache: Rarely, patients can develop a mild to moderate headache following Botulinum Toxin injections. These symptoms are generally transient and should respond well to simple analgesics.

Asymmetry: Due to individual anatomical variations and muscle strength it is possible to have minor facial asymmetry related to your treatment.

Immune Reaction: Although exceedingly rare, Immune reactions can occur. These types of reactions include localised allergic response and anaphylaxis. Additionally, some people can develop antibodies to the botulinum toxin which renders it ineffective.

Infection: Bacterial, viral or fungal infections can occur post procedure. Infections can cause redness and swelling and resolve or progress into abscesses which can be slower to recover. Symptoms include itching, heat and redness spreading from the injection area. Weakening of adjacent muscles: In rare instances the product can migrate from injection site. In these circumstances it is possible to have transient weakness of the adjacent muscle groups. This can cause temporary issues such as drooping of the eye lid or eyebrow, double vision or swallowing difficulties.

Abnormal Muscle function: Infrequently, complications can occur due to either inadvertent misplaced injection or migration of the Anti-Wrinkle product. This can result in brow/lid drooping, blurred vision, swallowing difficulty and smile/brow asymmetry. These complications are both very rare and temporary in nature.

Dissatisfaction: With all treatments the precise degree of improvement cannot be guaranteed. The outcome’s subjective nature also means dissatisfaction is a possible outcome regardless of effectiveness of treatment. The effect of all treatments may gradually wear off and additional treatments may be necessary to acquire the desired effect, and further charges will apply if more product is required.

Pregnancy, Allergies & Neurologic Disease: Patients wishing to udergo this procedure should not be pregnant, trying to get pregnant or lactating (breast feeding). Patients with any significant neurologic disease including but not limited to myasthenia gravis, multiple sclerosis, Eaton-Lambert syndrome, and amyotrophic lateral sclerosis (ALS) are not able to have this treatment.


  • Remain upright for 4 hours after injection (you may lie in a reclined position, just do not lay flat).
  • Exaggerate facial expressions in injected areas for 1 hour after injection.
  • Do not wear a headband or hat where the band goes across your forehead if you have had injections between the brows or in the forehead.
  • Refrain from aerobic exercise that increases your heart rate greatly (running, swimming, bicycling, etc…) for 24 hours following injections. Walking or other low impact forms of exercise are fine.
  • Do not massage or manipulate injected areas for 24 hours after injections.  Washing your face and applying make-up is fine.  Please avoid using a Clarisonic facial cleanser, have a facial, put your face in a massage cradle, or be face down in a chiropractor’s chair for 24 hours following the injection.
  • Refrain from using ibuprofen, aspirin, fish oil supplements, or vitamin E for 24 hours following injection.
  • If bruising appears, apply ice to area for 15 minutes every hour to decrease bruising.
  • An uncommon side effect is headache with anti-wrinkle injections.  You may use paracetamol to relieve this.  If you are a chronic headache sufferer and have prescription headache medication, you may take it as prescribed by your doctor.
  • Anti-wrinkle will gradually take effect over 7-14 days with optimum result at 4 weeks.  If this is your first Anti-Wrinkle injection, we recommend scheduling a follow up appointment 4 weeks after your injection.

If you have any issues or concerns following your procedure, please call the clinic and your treating doctor will get back to you as soon as possible.