Furthermore I have been informed about the following adverse effects:
injection therapy may result in permanent damage of nervous tissue and nerves, as well as inflammatory reactions and infections that may result in irreversible scarring.
Expected adverse effects:
swelling and hyperthermia of injected area, haematoma, pressure sensitivity, moderate pain and itching within the treated area.
Possible adverse effects:
redness of the skin that may become permanent, permanent punctual rigidity or lumps within the tissue, denting of the treated area due to irregular reduction of fat cells, dizziness immediately after the procedure for around 2 hours (please be sure to hydrate by drinking a sufficient amount of water), increased sweating, nausea, diarrhoea (uncommon), intracyclic menstrual bleeding (women), allergic reactions (very uncommon) such as nettle rash, bronchial asthma, symptoms of shock, hyperpigmentationif the treatment areas are exposed to the sun immediately afterwards (hyperpigmentation may last up to several months). To date there have been no recorded cases of permanent redness or hyperpigmentation.
I have been informed about alternative therapies such as dietary measures, increased physical exercise or operative correction (e.g. liposuction). I am not considering any of these options.
A clinical control will be carried out after completing all arranged treatments and after passing the appointed time intervals.
I have read this informed consent and certify that I understand its contents in full. I have been informed that I must not apply any kind of cosmetics onto the treated area within the first twelve hours following the treatment with AQUALYX and that immediate exposure to heat sources during the following days are to be avoided (e.g. sunlight, UV-radiation, sauna).
I am aware of the fact that after therapy with AQUALYX, treatments using laser, cryolipolysis or radio-frequencytherapy must not be administered.
Furthermore, I should abstain from particularly demanding physical exercise for seven days. I have been given a copy of this consent form. My consent and authorisation for this procedure is strictly voluntary. By signing this informed consent form, I grant authority to my physician to perform AQUALYSIS using AQUALYX. The nature and purpose of this procedure, with possible alternative methods of treatment as well as complications, have been fully explained to my satisfaction. No guarantee has been given by anyone as to the results that may be obtained by this treatment. I have had enough time to consider the information from my physician and feel that I am sufficiently advised to consent to this procedure.
I hereby give my consent to this procedure and have been asked to sign this form after my discussion with the healthcare professional.