PLEASE READ CAREFULLY.
BY CHECKING CONSENT BOXES YOU CONFIRM THAT YOU HAVE BEEN INFORMED OF THE FOLLOWING RISKS.
Juvederm or Restylane are both Hyaluronic Acid Fillers. This consent form is referencing both Juvederm and Restylane products.
HA is a colorless hyaluronic acid that is designed to be injected into facial tissue to smooth wrinkles and plump folds. Juvederm/Restylane are FDA approved for certain areas. Modern Aesthetics, under protocol and extensive training, are able to offer fillers to off label areas if deemed appropriate during consultation. Hyaluronic acid is a polysaccharide found naturally in all living organisms, and has the same chemical structure in all species and tissues. In the skin, Hyaluronic acid binds water to add volume and pliability. As we age, our skin loses its ability to produce Hyaluronic acid. HA is injected into the skin to create volume thereby smoothing wrinkles and providing a fuller shape. The effects of HA fillers are temporary, meaning the injection will have to be repeated on a regular basis to maintain the effects. Results typically last 6 months to one year following the injection.
If this Consent Form is delivered by any electronic means whatsoever and said delivery shall be of the same force and effect as the delivery of an original signature.