Your Immortelle: Information and Consent for Hyaluronidase Treatment

Important Background to the Consent Process

I wish to help you make an informed decision about your treatment options and any relevant alternative options. You may at any time decline treatment even after giving your consent. Whilst I will make every effort to understand what significance you would attach to any particular risk it is important to us that you feel comfortable enough to question me on any point of concern during this process. Please feel you have as much time as you wish to reflect on the information given before agreeing to proceed with the treatment.

Purpose of Treatment

You have presented with concerns that have formed the basis of a clinical discussion and examination. The purpose of the proposed treatment is to address your concerns either individually or in combination with other modalities of treatment.

Outcomes

I will endeavour in good faith to employ the principles of best practice in delivering your treatment. Each patient is individual and response to treatment will vary from patient to patient and treatment to treatment. As such it is difficult to guarantee outcomes will always meet your expectations.

Commonly Experienced Adverse Events

• Paresthesia (nerve problems, loss of sensation, loss of motor function)

• Itching

• Bruising

• Redness

• Swelling

Less Common Risks

• Hematoma formation

• Induration or nodules at the injection site, staining or discolouration

• Poor or weak filling effect Infection/abscess formation

• Immediate or delayed hypersensitivity reactions to hyaluronic acid or lidocaine

Rare but serious adverse events may be associated with intravascular injection or tissue compression which have been reported to cause temporary or permanent vision impairment, blindness, cerebral ischemia or cerebral haemorrhage, leading to stroke, skin necrosis and/or damage to underlying structures.

Important Considerations

Every care is taken to deliver the products in a manner which will minimise risk, however you should be aware of the risks, as one may exist upon which you place particular significance. Patients are advised to take into account all these potential risks before consenting to treatment. Please make me fully aware of your expectations prior to giving consent.

Safety Profile

The incidence of allergic reaction has been found to be low and as the products are non-animal based, usually no test patching is required. Should I have concerns about your history of allergies it may be prudent to test a small amount of product before commencing treatment.