Patient consent for treatment with Restylane products

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Wrinkle correction London, At Smile Cliniq we offer Dermal fillers and Botulinium Toxin for wrinkle correction and lip enhancement.
Dermal fillers help reduce the appearance of wrinkles and plump up the lips for a younger look.
Smile Cliniq in London offers Dermal fillers as part of their cosmetic aesthetic treatments, which also include Botox® and Laser Hair Removal. For more information about Restylane® Dermal Filler treatment, click here.

The Restylane products are sterile gels consisting of non-animal stabilised hyaluronic acid for injection into the skin to correct facial lines, wrinkles and folds, for lip enhancement and for shaping facial contours.

The use of, and indication for the RESTYLANE products have been explained to be my practitioner and I have had the opportunity to have all questions answered to my satisfaction. I have been specifically informed of the following: after the treatment some common injection-related reactions might occur. These reactions include redness, swelling, pain, itching, bruising and tenderness at the implant site. They have generally been described as mild to moderate and typically resolve spontaneously a few days after injection.
Other types of reactions are rare, but approximately one in every 2,000 treated patients has experienced localised allergic reactions after one or more injections. These have usually consisted of swelling and firmness at the implant site, sometimes affecting the surrounding tissues. Redness, tenderness and rarely acne-line formations have also been reported. These reactions have either started a few days after injection or after a delay of several weeks and have generally been described as mild to moderate and self-limiting, with an average duration of two weeks. In rare instances such reactions have persisted for several months.
On very rare occasions (less than one in 15,000 treatments) prolonged firmness, abscess formation or greyish discolouration at the implantation site has occurred. These reactions can develop weeks to months following the injection and may persist for several months but normally resolve with time.
Even more rarely, the formation of a scab and sloughing (shedding) of tissue at the treatment site has been noted, which could result in a shallow scar.

My practitioner has also informed me that depending on the area treated, skin type and the injections technique the effect of treatment with RESTYLANE products can last 6-12 months (lips: approx. 6months), but that in some cases the duration of the effect can be shorter or even longer. Touch up and follow up treatment helps sustain the desired degree of correction.

*Please note that free top-ups are only available up to 2 weeks after initial treatment due to material degrading*

I have answered the questions regarding my medical history to the best of my knowledge.

I consent to being treated with RESTYLANE products.

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