Procedure Understanding. I understand that Botulinum Toxin injections involve a series of small injections to relax the targeted facial muscles. The effects will begin to be apparent 2-3 days after treatment, peak at 10-14 days, and typically last for 3-6 months. To maintain the effect, treatments can be repeated after 3 months. I understand that injections administered at intervals of less than 3 months may reduce the treatment's efficacy.
Risks and Potential Side Effects. I understand that all medical procedures carry inherent risks and that my decision to proceed is based on a comparison of these risks to the potential benefits. While most patients do not experience serious complications, I have been advised of the following potential side effects based on the product's official Summary of Characteristics:
Common Injection Site Reactions: Bleeding, bruising, swelling, pain, or infection.
Common and Uncommon Side Effects: Headaches, muscle activity disorders (e.g., raised eyebrows, localized muscle weakness/dropping eyebrow), a feeling of heaviness in the upper face, eyelid edema (fluid accumulation), eyelid ptosis (drooping), inflammation of the eyelid, eye pain, blurred vision, dry mouth, muscle twitching, or cramps.
Systemic Reactions: Nausea, dizziness, fainting, tinnitus (noises in the ears), flu-like symptoms, influenza, bronchitis, or inflammation of the nose and throat.
Rare but Serious Risks: In rare cases, excessive muscle weakness and difficulties in swallowing (dysphagia) can occur. If spread of the toxin occurs, symptoms can include general muscle weakness, vision problems, and difficulty speaking or breathing, which can be life-threatening.
I understand that an unsatisfactory aesthetic outcome is also a possible risk.
Client Acknowledgement and Consent. My practitioner has advised me to seek immediate medical care in the event of any adverse reaction.
I certify that I have read this document and completely understand the information regarding the Botulinum Toxin Type A procedure, including its benefits, risks, potential side effects, and cost.
I have been given all necessary opportunities to ask questions, and all my questions have been answered to my satisfaction. I choose to proceed with this treatment based entirely on the information provided in this informed consent document.
治疗程序知情. 本人理解，A型肉毒毒素注射通过一系列微量注射作用于目标面部肌肉，使其放松。治疗效果将在注射后2-3天开始显现，10-14天达到高峰，通常可持续3-6个月。为维持效果，可于3个月后再次接受治疗。本人知悉，若注射间隔短于3个月，可能会降低治疗效果。
风险与潜在副作用. 本人理解所有医疗操作均存在固有风险，本人决定接受本治疗是基于风险与潜在获益的权衡。虽多数患者不会出现严重并发症，但根据产品特性摘要，本人已获知以下潜在副作用：
常见注射部位反应：出血、淤青、肿胀、疼痛或感染
常见及罕见副作用：头痛、肌肉活动异常（如：眉毛上扬、局部肌无力/眉下垂）、面部上半部沉重感、眼睑水肿、上睑下垂、眼睑炎症、眼痛、视力模糊、口干、肌肉抽搐或痉挛
全身性反应：恶心、头晕、晕厥、耳鸣、流感样症状、流行性感冒、支气管炎或鼻咽部炎症
罕见严重风险：极少数情况下可能出现过度肌肉无力和吞咽困难。若毒素发生扩散，症状可能包括全身性肌无力、视力问题及言语或呼吸困难，这些症状可能危及生命
本人知悉治疗效果未达预期也属于潜在风险。
客户确认与同意. 主治医生已告知本人，若发生任何不良反应需立即就医。本人确认已阅读本文件，并完全理解关于A型肉毒毒素注射治疗的各项信息，包括其益处、风险、潜在副作用及费用。本人已获得充分提问机会，所有问题均得到满意解答。本人基于本知情同意书所提供的信息，完全自主决定接受此项治疗。
