Restylane Petoskey
INSTRUCTIONS
This is an informed-consent document that has been prepared to help inform you concerning the injection of wrinkle reducing skin fillers, its risks, and alternative treatment(s).
It is important that you read this information carefully and completely. Please initial each page, indicating that you have read the page and sign the consent for surgery as proposed by your plastic surgeon.
INTRODUCTION
Injectable fillers are designed to fill in imperfection in skin such as wrinkles and age related volume loss and post-traumatic indendations.
ALTERNATIVE TREATMENTS
Alternative forms of non-surgical and surgical management consist of surgical redraping of skin(eg.face lifting), laser resurfacing and camouflage make-up
Greater risks and potential complications are associated with alternative procedural forms of treatment.
RISKS of Injection -
Every procedure involves a certain amount of risk, and it is important that you understand the risks involved. An individual’s choice to undergo a procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your plastic surgeon to make sure you understand the risks, potential complications, and possible need for revisional procedures and their expense.
Bleeding- It is possible to experience a bruising episode after the injection. All patients have some bruising but this can be advanced in some patients. Do not take any aspirin or anti-inflammatory medications for ten days before the procedures, as this may contribute to a greater risk of bruising.
Infection- Infection is unusual after injections. Should an infection occur, additional treatment including antibiotics or surgical drainage might be necessary.
Scarring- Injections have the potential to form scarring in and under the skin which in rare cases can be visible after the procedure. Although a uniform volume replacement with the procedure is expected, contour abnormalities may occur both within the skin and in the deeper tissues. Areas of added volume may be unattractive and of different color than the surrounding skin. Scar tissue may also limit motion and function. Additional treatments including additional injections or surgery may be needed to treat scarring.
Damage to deeper structures- Deeper structures such as nerves, blood vessels and muscles may be damaged during the course of the procedure. The potential for this to occur varies according to where on the body the procedure is being performed. Injury to deeper structures may be temporary or permanent.
Unsatisfactory result- There is the possibility of an unsatisfactory result from the procedure. Which may result in unacceptable visible deformities, skin death and loss of sensation. You may be disappointed with the results of the procedure.
Allergic reactions- In rare cases, allergic reactions to the material have been reported. Systemic reactions, which are more serious, may result from drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
Injectible anesthesia- Local anesthesia has a small but documented risk for allergic reaction, anaphylaxis, interaction with other medications and seizure.
ADDITIONAL TREATMENT
In some situations, it may not be possible to achieve optimal results with a single injection procedure. Multiple procedures may be necessary. Should complications occur, additional injections or other treatments may be necessary. Even though risks and complications occur infrequently, the risks cited are the ones that are particularly associated with skin injection. The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee or warranty expressed or implied on the results that may be obtained.
FINANCIAL RESPONSIBILITIES
The cost of surgery involves several charges for the services provided. The total includes fees charged by your doctor and the cost of the material injected. Additional costs may occur should complications develop from the procedure.
DISCLAIMER
Informed-consent documents are used to communicate information about the proposed surgical treatment of a disease or condition along with disclosure of risks and alternative forms of treatment(s). The informed-consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances.
However, informed-consent documents should not be considered all inclusive in defining other methods of care and risks encountered. Your plastic surgeon may provide you with additional or different information which is based on all the facts in your particular case and the state of medical knowledge.
Informed-consent documents are not intended to define or serve as the standard of medical care. Standards of medical care are determined on the basis of all of the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.