DERMAL FILLER INFORMED CONSENT

Dermal fillers, including but not limited to hyaluronic acid-based fillers (such as Juvéderm® and Restylane) and other FDA-approved fillers, are injectable medical devices used to restore volume, enhance facial contours, and soften facial lines and folds. Results may be immediate or gradual depending on the product used. I understand that dermal filler treatments are temporary, and results vary by individual, product type, injection site, metabolism, and lifestyle factors. Longevity may range from several months to over a year. No guarantees have been made regarding the outcome.

Risks & Potential Complications I understand that risks associated with dermal fillers may include, but are not limited to: Pain, redness, swelling, bruising, or tenderness

Allergic reaction or hypersensitivity Lumpiness, nodules, or uneven texture Delayed inflammatory reactions Reactivation of herpes simplex (cold sores) Migration or asymmetry I understand that rare but serious complications may occur, including: Vascular occlusion (blockage of a blood vessel)

Stroke-like symptoms I understand that these complications require immediate medical attention.

I understand that in the event of a vascular complication, hyaluronidase and other emergency measures may be used as medically necessary. I consent to emergency treatment if required.

Am not pregnant or breastfeeding

Do not have active skin infection in treatment areas

Do not have known allergy to filler components Have disclosed all medical conditions, medications, and supplements

I understand that alternatives to dermal fillers, including no treatment, have been

Financial Policy I understand that dermal filler treatments are elective and non-refundable, including

dissatisfaction with cosmetic outcome.

Acknowledgment & Consent I acknowledge that the practice of medicine is not an exact science and that results are variable. I have had the opportunity to ask questions, and all questions have been answered to my satisfaction. I hereby voluntarily consent to dermal filler treatment.