PATIENT CONSENT: This is an informed consent form that has been prepared to help inform you of the potential benefits and risks of dermal filler injections. It is important that you read this information carefully and discuss fully with your practitioner before proceeding with treatment.

It is also important that you take as much time as you need to consider the treatment carefully, weighing up all your options before reaching an informed decision. It is essential that you are aware of your right to have a second opinion and you are encouraged to ask any questions that come to mind throughout the entirety of the process.

INTRODUCTION

Injection of dermal fillers aims to smooth out facial folds and wrinkles, adds volume to the tissues (e.g. lips), and helps to contour facial features. Most dermal fillers used are based on Hyaluronic acid, they may also contain lidocaine, a local anaesthetic to help with pain control.

RESULTS

Hyaluronic acid dermal fillers have been shown to be safe and effective, results can last up to 12 months or longer. After initial treatment, a period of 2 weeks should be allowed for the filler to settle and for residual bruising and swelling to subside. There is no guarantee that you will not require additional treatment to achieve the results you seek.

RISKS AND COMPLICATIONS Understanding the risks of dermal filler injections is essential to make an informed decision about your treatment. No procedure is completely risk-free, and all potential risks must be explained before going ahead with treatment.

Common complications include pain, bleeding, bruising, tenderness, swelling, faintness, and discomfort. Uncommon complications include infection, cold sore reactivation, lumps or nodules, migration, inflammatory reaction, granuloma formation, and skin discolouration.

Rare complications include allergic reaction, anaphylaxis, vascular occlusion, tissue necrosis, and filler blindness. In the event of severe pain, visual symptoms, or signs of infection, urgent medical assessment may be required.

I have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice. I have been given the opportunity to discuss my desired outcome fully in order for me to make an informed decision.

CLINICAL PHOTOS AND VIDEOS: I agree to and authorise the taking of clinical photographs and videos. I understand that these clinical photographs and videos will form part of and will be kept with my confidential medical records.

I certify that I have read the above consent and that I fully understand it. I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. I hereby consent to this procedure.