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INFORMED CONSENT FOR AN INJECTION
OF HYALURONIC ACID – DR. MARIE BONNET
The use, indications, contraindications and potential side effects of hyaluronic acid injections have been explained to me. I have answered all questions asked about my medical and aesthetic history truthfully. I was able to ask all the questions I wanted and satisfactory answers were provided.
I have duly noted that:
• Hyaluronic acid is a transparent bioresorbable gel of cross-linked hyaluronic acid of non-animal origin.
• Hyaluronic acid is injected into the dermis or deep dermis to correct wrinkles, or to increase lip volume as part of smile harmony treatment in the oral and peri-oral area.
• Hyaluronic acid offers an average duration of 6 to 12 months. This duration varies depending on skin types, muscle activity, areas and quantities injected.
• In some cases, injection duration can extend to more than one year.
• In the lips, the average duration of hyaluronic acid is 6 months, due to their high vascularization.
• Bruising and hematomas may appear in the days following the injection. They disappear within one week.
• Inflammatory reactions such as redness, edema, erythema… may be associated with itching or pain on pressure and may occur after the injection. These reactions may persist for one week.
• Indurations or nodules may appear at the injection site.
• A 2nd session shortly after (4 to 6 months) is useful if this is a first injection and the wrinkles are pronounced.
• I have also been informed that cases of necrosis, abscess formation, granulomas and hypersensitivity have been reported following hyaluronic acid injections.
• The persistence of inflammatory reactions beyond one week or the appearance of any other side effect must be reported to the practitioner as soon as possible. The practitioner must remedy this with appropriate treatment.
Recommendations:
- Before and after treatment, taking aspirin and anti-inflammatory drugs is not recommended.
- After treatment, in the hours following the injection, avoid alcohol consumption and sun exposure.
- Avoid vigorous sports, sauna, hammam for 3 days following the session.
I authorize the dental practice of Drs Bonnet & Associates to take photographs and/or films intended to monitor treatment progress and to use them for educational purposes. In accordance with article R4127-208 of the Public Health Code, medical confidentiality and the preservation of my identity are ensured.
Date and signature with the mention “read and approved”
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