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Skin Booster EJal40 Consent Form

RISKS AND SIDE EFFECTS: As with any procedure there are potential risks and complications associated with Skin Boosters Injections. You must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

Common complications:
These include pain, bleeding and bruising at the time of injection. After injection, the area may feel tender but should not be actively painful. If you experience significant pain then you must contact your practitioner as soon as possible for review. Bruising is dependent on several factors, most of the time bruising is mild but occasionally can be more significant. Bruising can take up to 2 weeks to fully resolve but should be much improved after 1 week. More uncommonly severe bruising can lead to haematoma formation, a collection of clotted blood. In this case the swollen collection of blood will need at least 2 weeks to resolve naturally and your practitioner will give you the appropriate after care advice. Your skin may appear red and swollen after the injection, this is usually mild and should improve after a couple of days, but it can last up to 14 days in some cases.
Uncommon complications include:
Skin infection (cellulitis) which presents as hot, red, shiny skin and you may also be generally unwell. In the case of suspected infection, you should contact your practitioner but also seek medical assessment as soon as possible as you will likely need antibiotics. Occasionally infection can form a swollen collection called an abscess. In this case you again must seek urgent medical attention. If you suffer from cold sores (a herpes virus infection of the lip) these can sometimes be reactivated following injections. Occasionally people can develop an unwanted inflammatory reaction and this can lead to nodule formation called granuloma. These often present as a delayed complication several months after the treatment. Several treatment options are available for granuloma formation and you may require medical assessment. Sometimes people can faint or feel faint with injections, you must tell your practitioner as soon as possible if you feel unwell during the treatment.
Rare complications include:
Allergic reaction including anaphylactic reaction which would require emergency medical assistance and transfer to hospital. Rarely, it can be injected into an artery blocking the flow of blood to the tissue being treated. This is known as vascular occlusion, if untreated it is serious because it can lead to death of tissue (necrosis) which may require reconstructive surgery to correct. In the rare event of vascular occlusion, it would be treated with emergency injections of a dissolving drug called Hyaluronidase. This is an enzyme that removes the hyaluronic acid occluding the blood vessel and can usually fully reverse the vascular occlusion leading to no long-term harmful effects. Your practitioner will be trained in how to use Hyaluronidase in an emergency, however if treatment with Hyaluronidase is not successful then you would require urgent medical assessment or assessment by a doctor who is a specialist in aesthetic medicine.
I understand that several appointments may be necessary to produce optimal results and I will be notified, in advance of each session of treatment, about the location where the next treatment session is going to take place and the identity of who is going to be involved in my care at each stage. I also understand that I will be kept informed of progress and that I can change my mind at any point.
I have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice. This includes advice about:
- the aims/motivations for having the procedure and the desired outcome
- the risks inherent in the procedure
- the risks inherent in refusing the procedure
- the risks specific to me
- the expected benefits of the treatment
- the potential disadvantages of the treatment
- alternative procedures and their pros and cons - including the option of no treatment at all
- any uncertainties about and the likelihood of success of the procedure
- any follow-up treatment that may be required
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 have been asked what information I want and would need in order to make an informed decision. I have been given the opportunity to discuss my desired outcome fully in order for me to make an informed decision.
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. No new information has become available that affects my decision to have the treatment or my decision to consent. I hereby consent to this procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures.
Date / Time
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The following aftercare advice is essential to help reduce the risk of treatment complications,
improve your comfort/healing, and help achieve the best possible results from treatment.
Please follow the aftercare advice for Skin Booster:
● Avoid Touching the Treated Area
After the skin booster treatment, avoid touching the treated area for at least six hours.
Touching the area can introduce bacteria and irritate the skin, which can interfere with
the healing process.
● Apply Ice Packs
To reduce swelling and discomfort, apply ice packs to the treated area for up to 20
minutes at a time, several times a day. Wrap the ice pack in a thin towel or cloth to
prevent direct contact with the skin.
● Avoid Strenuous Exercise
Avoid strenuous exercise and other activities that cause sweating for at least 24 hours
after the treatment. Sweating can increase the risk of infection and interfere with the
healing process.
● Use a Gentle Cleanser
Use a gentle, fragrance-free cleanser to wash your face for the first few days after the
treatment. Avoid using hot water and aggressive scrubbing, which can irritate the skin.
Instead, use lukewarm water and gently pat your skin dry with a soft towel.
● Moisturise Regularly
Moisturising your skin is essential after a skin booster treatment. It helps to keep your
skin hydrated and promotes healing. Apply a high-quality, fragrance-free moisturiser to
your face at least twice a day, or as recommended by your aesthetician.
● Avoid Makeup for the First Day
After the skin booster treatment, avoid using makeup for at least the first day. Makeup
can clog your pores and interfere with the healing process. If you must use makeup,
choose a non-comedogenic product that is safe for sensitive skin.
● Avoid Alcohol and Smoking
Avoid drinking alcohol and smoking for at least 24 hours after the treatment. Alcohol
and smoking can interfere with the healing process and increase the risk of infection.

● Follow Your Aesthetician's Instructions
Your aesthetician will provide you with specific aftercare instructions based on your skin
type and the specific skin booster treatment you received. Be sure to follow these
instructions carefully to ensure the best possible results.
It is essential that you have read all of the information available. Once you have read and
understood all of the below, please sign the declaration at the bottom of this form. Please do let
your practitioner know if you have any questions or if you do not understand any of the
aftercare instructions provided below.
I confirm that I have read and understood all the information on this Form and that I have been
given the opportunity to ask any questions that have come to mind throughout.