Dermatology Partners

Injectable filler consent

Injectable filler consent

Treatment with injectable fillers can smooth out facial folds/wrinkles, enhance the lips, chin, jawline, and cheeks, as well as contour facial features that have lost their volume and fullness. Facial rejuvenation can be carried out with minimal complications. Fillers are injected into the skin with a fine needle or a blunt cannula. The results can often be seen immediately. I understand this treatment is not permanent and that further injections may be necessary.

The following complications may occur with filler injections and can happen immediately post procedure as well as weeks or even months later:

lnjection Site Reactions:
There is a risk of bruising, redness, swelling, pain, tenderness, itching, allergic reaction, and raised bumps or nodules at the injection site. These symptoms are mild and typically last a few days to a few months.

lnfection- lmmediate or delayed:
Post treatment bacterial, viral, or fungal infections can occur, which in most cases are easily treatable.

Allergic Reaction:
In rare cases there may be an allergic reaction to the filler.

As with any injection there is the potential of scarring.

Granuloma Formation- lmmediate or delayed:
A localized area of inflammation and redness can occur at or around the area of injection.

Skin Necrosis:
Localized necrosis or skin sloughing with or without scabbing can occur if a blood vessel is occluded during the procedure.

Nerve Damage:
Mostly temporary and causing mild, temporary asymmetry of expression can occur. In rare circumstances this can last weeks or months.

Visual Changes:
In rare cases, visual changes or blind spots can occur.

Unevenness or asymmetry can occur. In most cases, this uneven appearance can be corrected with more injections or by removing the filler with hyaluronidase. However, in some cases, this uneven appearance can last for several weeks or months.

This list is not meant to be inclusive of all possible risks associated with dermal fillers, as there are both known and unknown side effects associated with any medical procedure.

I have reviewed the risks and benefits associated with dermal fillers and give consent to be treated by my physician.



Leave this empty:

Signature arrow sign here

Signature Certificate
Document name: Injectable filler consent
lock iconUnique Document ID: 023b9ea6465386d0d7503e3ec807f48bdabe66cf
Timestamp Audit
May 15, 2020 8:22 am MDTInjectable filler consent Uploaded by Dermatology Partners Inc - IP