| Obtain a Detailed Medical History | - Check for neurological disorders (myasthenia gravis, ALS, Lambert-Eaton syndrome).
- Screen for past allergic reactions to botulinum toxin or ingredients (albumin, lidocaine).
- Ask about previous Botox®/neurotoxin exposure, response, and complications.
- Assess for bleeding disorders or current anticoagulant use (risk of bruising).
- Avoid treating areas with infection or skin disease present.
- Do not treat patients who are pregnant or breastfeeding, except rare medically justified cases.
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| Medication and Supplement Review | - Check for aminoglycoside antibiotics, muscle relaxants, anticoagulants, antiplatelet drugs.
- Ask about herbal supplements raising bleeding risk (ginkgo, garlic, vitamin E, fish oil).
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| Assess Relative Contraindications & Cautionary Factors | - History of keloid scarring, facial surgery, trauma, or anatomical irregularities.
- Assess for psychological readiness, body dysmorphic disorder, and unrealistic expectations.
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| Physical Assessment Before Botox® | - Evaluate facial anatomy, symmetry, muscle mass, and skin condition.
- Identify infections or open wounds in the target area.
- Document effects from previous injectables.
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| Discussing Patient Expectations | - Discuss expected onset, duration, need for repeat treatments.
- Cover potential side effects (bruising, swelling, headache, ptosis).
- Clarify realistic limits of Botox® for wrinkles/contouring.
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| Red Flags & Absolute Contraindications | - Active infection at treatment site.
- Known allergy to any component of Botox®.
- Pregnancy or breastfeeding (unless clinically justified).
- Serious neuromuscular disorders.
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| Documentation & Informed Consent | - Record medical history, medications, allergies, and contraindications.
- Describe risks, benefits, alternatives in consultation notes.
- Obtain signed consent before treatment.
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| Post-Screening: Patient Education | - Advise patients to remain upright for hours after Botox®.
- Instruct to avoid strenuous activity and facial pressure for 24 hours.
- Educate about adverse reaction warning signs.
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| When in Doubt, Consult or Refer | - If unsure or if absolute contraindications are present, consult a specialist before proceeding to ensure patient safety.
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