INTRODUCTION
Hyaluronic acids include a wide range of complex carbohydrate molecules, normally found in the human body. Injection of hyaluronic acid (HA) into the skin or just below the skin can elevate depressed areas and wrinkles, and can provide a volume supplement to tissues to improve contours, such as lip and cheek enlargement. The effect of HA is not permanent and will last anywhere from 3 to 24 months, depending on the product chosen, as well as location, site and of depth of use. HA may not eliminate all types of wrinkles
INSTRUCTIONS
This is an informed consent document to help you understand Hyaluronic Acid Injections, their risks, likely effects and alternative treatments. You have a right to be informed about your condition and its treatment, so that you may decide whether or not to undergo the procedure after knowing the risks and hazards involved. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed so you may give, or withhold, your consent for treatment.
ALTERNATIVE TREATMENTS
Other “filler” materials exist that have similar effects such as collagen, fat grafts, Sculptra and Radiesse. Also, laser resurfacing and chemical peels can improve certain wrinkles. Certain deeper wrinkles may require surgical treatments, such as brow or face lifts.
POSSIBLE SIDE EFFECTS
Every procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them. In addition, every procedure has limitations. An individual’s choice to undergo this procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience the following, you should discuss each of them with your physician to make sure you understand the risks, potential complications, limitations, and consequences of injections.
Allergic reaction or infection, bleeding, tenderness or pain, redness, bruising, scarring,lumps, bumps or swelling at the injection site.
1. People with a history of cold sores may experience a recurrence after the treatment, although this can be minimized by the use of antiviral medicines. I agree to consult with Beauty Marx if I have a history of cold sores or fever blisters prior to this treatment.
2. I have advised Beauty Marx if I have severe allergies, particularly allergies to bacterial proteins. If I have an allergy to bacterial proteins I understand I am not a candidate for this treatment. I have also advised Beauty Marx if I have asthma, hayfever, eczema or a history of multiple allergies as any of these issues may increase my risk of allergic reaction.
3. I understand the Post-Treatment Instructions. I agree to follow these instructions carefully. I understand that compliance with recommended pre- and post- procedure guidelines are crucial for healing, prevention of side effects and complications as listed above.
4. I have advised Beauty Marx if I am pregnant, trying to get pregnant or if I am nursing.
5. I have informed Beauty Marx of any dental work I have had including dental cleaning 30 days prior to any lip injections as well as planned dental procedures 30 days after lip injections.
6. I have provided Beauty Marx with a complete medical history and I do not suffer from any autoimmune diseases such as lupus, rheumatoid arthritis etc.