1. I absolutely understand and accept that such a procedure is a process, often requiring a follow-up application of Hyaluronic Filler to achieve desirable results and that 100% success cannot always be guaranteed.
2. Hyaluron Pen procedures normally require multiple treatment sessions.
Lip Filler:
For best results, clients will be required to return for at least one re-touch appointment. This will take place 2-3 weeks after the initial procedure. Those with oily skin may require an additional touch-up. Please be aware that fullness immediately and a few days after the initial procedure may be more intense, but the fullness may reduce by 30-50%.
3. Hyaluronic Acid (Dermalax Deep Plus or Bonetta Deep) is a cosmetic filler, intended to be temporary lasting an average of 2-4 months. On rare occasions, the filler may migrate under the skin. The procedure of the hyaluron pen may be uncomfortable. Although extremely rare, there might be an immediate or delayed allergic reaction to substances used. Allergic reactions to anesthetic can occur. Hyaluron Pen cannot be performed if you are pregnant or nursing, or anyone under the age of 18. Infections can occur if aftercare instructions are not followed correctly. There may be swelling and redness following the procedure. You may experience minor bleeding. Possible scar-ring or pooling of filler resulting in bumps may occur.
4. I accept the responsibility for determining the shape and position of the hyaluron pen procedure as agreed during consultation. I fully understand and accept that hyaluronic acid products are used during the procedure and that the result achieved may fade over a period of 2-4+ months.
5. I understand that the highest standards of hygiene are met and that sterile, disposable cartridges and containers are used for each individual client, procedure and visit.
6. The result of the procedure can be affected by the following: medication, skin characteristics (dry, oily, sun- damaged thick or thin skin type), personal pH balance of your skin, alcohol intake and smoking, post procedure after care.
7. Upon completion of the procedure there might be swelling and redness of the skin, which will subside within 1- 4 days. In some cases, bruising may occur. You may resume normal activities following the procedure, however, using cosmetics, excessive perspiration and heavy alcohol consumption should be limited until the skin has fully healed. Please see after-care instructions for more details. The procedure results will look acceptable for you to appear in public.
8. I have been advised that the true shape and fullness will be seen 2-4 weeks after each procedure and that the results may vary according to metabolism, lifestyle, age and skin condition. I understand that some skin types accept filler more readily and no guarantee on exact results can be given.
9. To my knowledge, I do not have any physical, mental or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have the procedure done at this time.
10. I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the technician. Failure to do so may jeopardize my chances for a successful procedure.
11. I understand although rare, I understand the nature, risks, and possible complications, and consequences of temporary fillers/dissolvers. I understand the hyaluronic pen procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, scarring, inconsistent results, and spreading, fanning or fading of filler. I understand the filler may pool resulting in temporary bumps under the skin.
12. I fully understand this is a cosmetic procedure and therefore not an exact science but an art. I request the hyaluron pen procedure(s) and accept the temporary nature of this procedure as well as the possible complications and consequences of the said procedure.
13. I understand that if I have any skin treatments, injectables, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my hyaluron pen procedure. I acknowledge some of these potential adverse changes may not be correctable.
14. I understand there is a possibility of an allergic reaction to the numbing agent. A patch test is offered however it does not ensure a client will not have an allergic reaction.
15. I agree to release and forever discharge and hold harmless the technician, Milagros Velez also known as MimiVelez & Retreat BX, and all employees or contractors
16. I understand that before and after pictures will be taken for our records and may be used for education or advertisement purposes. Pictures may also be used for social media purposes.
17. I understand that it is my responsibility to book my touch-ups accordingly and understand that touch-ups are based on the amount of filler needed. ex. 1ML .05 ML
18. I certify that I have read and completely understand the above paragraphs. I accept full responsibility for the decision to have this cosmetic hyaluron pen procedure done.
I have read understand and agree to the above Procedure Consent Form. I release Retreat Bx, Milagros Velez (mimi Velez), all employees, contractors, and management of Retreat BX LLC. for any and all claims of negligence, damages, or ALL legal actions arising from or connected in any way with my Hyaluron Pen procedure.