Hyaluron pen Fillers, (Neuramis deep with lidocaine, Dermalax deep, or similar) is a cosmetic filler, intended to be temporary lasting an average of 2-4 months
Fat Dissolver, (Deoxycholic acid,) is a fat dissolver intended to help target fatty areas by hydrolysing the wall of the fat cell and therefore making it release its lipid content. This procedure will not instantly show results after the first session, nor does it shed pounds. An allergic reaction can occur if you have an unknown allergy to the active ingredients. Bruising and redness may occur.
* I give my consent to Aesthetically inkD to administering Hyaluron Infusions for cosmetic lip augmentation, face plumping purposes and or fat dissolvers.
* I confirm that I have been informed about the way the procedure is done and the products involved. used: It is a sterile non-pyrogenic physiological gel based on hyaluronic acid of non-animal origin.
* I confirm that I have no allergy to hyaluronic acid or lidocaine.
* I am informed about the main advantages and complications of the procedure, which may occur in the form of various allergic reactions including but not limited to (anaphylactic shock, Quincke's edema, fainting, collapse, herpes breakout, necrosis, post treatment hematomas, possible major bruising/swelling.
* I am aware that I am participating and consenting this procedure AT WILL without force.
* The aesthetic effect of this filler or fat dissolver can last up to 9-12 months, depending on the client’s metabolism, the state of the skin, the area of administration, the amount of the product used, as well as your lifestyle.
* I am also aware that treatments initially last 3-6 months and it was explained to me that it is recommended I receive 3-4 treatments, as well as keep up with monthly/yearly maintenance to achieve desired results. 1 session will not last 3-6 months.
* The specialist also informed me that during the first infusion, there is a chance that the results might not last as long as opposed to if I were to do 3 infusions in a timely manner.
* I am also aware that I can come in for a touch up within 2-4 weeks later and no sooner, and if I decide I want another infusion within less than 2 weeks, I have to sign a different consent and liability form consenting to the procedure.
* I understand these Contraindications: - Any health conditions - Diabetics - Non-treatable epilepsy - The tendency to develop hypertrophic scarring -
Known hypersensitivity to hyaluronic acid - Known hypersensitivity to lidocaine or local anesthetics -Porphyria: refers to a group of disorders that result from a buildup of natural chemicals that produce porphyrins in your body.
Porphyrins are essential for the function of hemoglobin — a protein in your red blood cells that links to porphyrin, binds iron, and carries oxygen to your organs and tissues. -
Pregnancy and lactation -Blood diseases and coagulation -Menstruating -
Sores or inflamed acne/scars -Recent chemical peels, laser or facial treatments
The filler should not be injected into areas of the skin that are prone to inflammation or infection (acne, herpes, etc.).
The drug should not be used simultaneously with conducting such procedures as laser therapy, chemical peeling or facial dermabrasion. The administration of the HA is not recommended in case of severe inflammation of the skin after the surface peeling.
*I understand these Side effects: The specialist has warned me, and I realize that both during and after the conducted manipulation, it is possible to have side effects.
- Inflammatory reaction in the location of manipulation (swelling, erythema, redness, etc.),
which may be accompanied with itching, as well as pain while pressing. Such an inflammatory reaction can last up to 7 days, others may last longer.
- Soreness and tenderness in the area - to the touch.
- The appearance of bruising.
- The appearance of compaction or nodules at the injection location.
- Coloration or discoloration of the skin in the treatment area. - Insufficient efficiency of the procedure or weakly expressed effect of filling.
- Tiny bumps from the injection sites that may last months in the lips or treatment area.
- Given the available reports of cases of skin necrosis over the bridge of the nose, abscesses, and granulomas, an allergic reaction can occur immediately or delayed after the administration of hyaluronic acid or lidocaine, it is necessary to take into account the potential risk of development of such complications.
The specialist has warned me that in the event of other phenomena that are not listed above or the duration of the inflammatory reaction for more than 7 days, I should immediately inform the specialist and seek medical attention (family doctor, emergency room, urgent care, etc).
* I understand to maintain and follow all recommendations of the specialist before and after the procedure, such as:
- It is not recommended to apply lip makeup (lip gloss, lip stain, lipsticks) for 48 hours after the administration of the drug.
- Avoid continuous exposure to the sun, UV rays and temperatures below 0 degree Celsius.
- It is not recommended to visit the sauna or excessively sweat for 2 weeks after the procedure.
- Do not drink hot drinks, alcohol or smoke for 48 hours after the procedure.
- Do not eat spicy or dehydrating foods 48 hours after the procedure.
- Do not go to the beach 48 hours after the procedure.
*I understand and agree that results vary per client as each human body is different and reacts differently to this procedure. Risks include, bruising, long lasting/ possibly permanent bumps, swelling, redness, blue/ purple bruising. I understand that once I leave, aftercare must be carried out to the fullest with instructions given to me. I must stay hydrated and massage my lips to reduce bumps as soon as I get home.
* I have informed all parties in detail about my allergic reactions, individual intolerance to drugs, food products and other substances, as well as diseases and injuries that I had during my life. I have provided all truthful information.
*Aesthetically InkD has given me an opportunity to ask questions before the start of the procedure and get comprehensive information.
* AE. Received from me, the most complete information about the state of my health.
* I give my consent for conducting this procedure by the specialist and I acknowledge that my services are NON-REFUNDABLE once I consent to the procedure. I cannot request for a refund once the procedure has taken place or if I ask to stop the procedure mid-process. This is due to booking an appointment slot that another client may have had and it is a loss of time and income.
* I give my consent for taking photos and video during the procedure and allow the specialist to use my photo and video materials before and after treatment via any social media or other as needed.
* I confirm that I am of legal age and do not have contraindications that would prevent me from getting the hyaluronic acid infusions procedure and In the event of an accident, I understand that it is my responsibility to seek medical attention and In the event that I cannot contact medical attention myself, I hereby authorize medical transportation to a medical facility or hospital.
* I acknowledge that I am fully aware of the risks and hazards involved.
* Client fully accepts and assumes all such risks and all responsibility for losses, costs, and damages that may result from a HYALURON PEN INFUSION session.
* I understand that this is voluntary, and no one is forcing me to receive the procedure.
* I will not sue the provider for any injuries or damages (known or unknown), property damage or loss of any kind, whether such injury, damage, or loss was caused by the alleged negligence of the provider. ![]()
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