Consent Form for BBL with Sculptra and Hyaluronic Acid Treatment

Aluna Cosmetic Dr. Ramtin Massoudi, MD

You have elected to undergo a Brazilian Butt Lift (BBL) with Sculptra and Hyaluronic Acid. This procedure involves the use of Sculptra (poly-L-lactic acid) and hyaluronic acid to enhance the shape and volume of the buttocks.

The purpose of this procedure is to enhance the contour and volume of the buttocks, providing a more aesthetically pleasing and youthful appearance.

1. Preparation: The treatment area will be cleaned and prepared. 2. Injection: Sculptra and hyaluronic acid will be injected into the buttocks using a fine

3. Massage: The treated area will be massaged to ensure even distribution of the product. 4. Post-Treatment Care: You will receive instructions on how to care for the treated area after the procedure.

Potential Risks and Complications:

While BBL with Sculptra and hyaluronic acid is generally safe, there are potential risks and complications, including but not limited to:

Redness, swelling, and bruising Infection Asymmetry Lumpiness or irregularities Allergic reactions

Discomfort or pain Unsatisfactory results

Alternative treatments to BBL with Sculptra and hyaluronic acid include, but are not limited to, traditional BBL with fat grafting, other injectable fillers, and surgical buttock augmentation. These options can be discussed with Dr. Ramtin Massoudi to determine the most suitable treatment for your condition.

Follow all post-treatment care instructions provided by Dr. Ramtin Massoudi and the Aluna Cosmetic team.

Avoid strenuous activities and sitting directly on the treated area for the specified period. Keep the treated area clean and moisturized. Report any unusual symptoms or concerns to our office immediately.

By signing this form, I acknowledge that I have read and understood the information provided about the BBL with Sculptra and hyaluronic acid treatment. I have had the opportunity to ask questions and discuss any concerns with Dr. Ramtin Massoudi. I understand the potential risks and benefits associated with the procedure, as well as alternative treatment options. I consent to proceed with the BBL with Sculptra and hyaluronic acid treatment under the care of Dr. Ramtin Massoudi and the Aluna Cosmetic team.

Please ensure all information is filled out accurately and consult with our team if you have any questions or need further clarification.