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Medical Aesthetics Bar

Dermal Fillers

Consent Form

Client Information

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Treatment Description — Dermal Fillers

Dermal fillers are injectable treatments designed to restore volume, enhance facial contours, and improve symmetry in targeted areas:

  • Lips: Adds volume, definition, and hydration; smooths fine lines around the mouth

  • Jawline: Enhances definition, improves facial balance, and creates a more contoured profile

  • Chin: Corrects projection, enhances symmetry, and balances facial proportions

  • Nose (Non-Surgical Rhinoplasty): Smooths bumps, reshapes, and improves nasal symmetry without surgery

Dermal fillers are temporary, typically lasting 6–18 months depending on the product, area treated, and individual metabolism. Multiple sessions may be recommended for optimal results.

Pre-Treatment Instructions

  1. Avoid blood-thinning medications (aspirin, ibuprofen) 24–48 hours prior, unless cleared by your physician.

  2. Avoid alcohol 24 hours before the treatment.

  3. Avoid facial treatments, waxing, or chemical peels in the treatment area for 1–2 weeks prior.

  4. Disclose all medications, allergies, medical conditions, or recent cosmetic procedures.

  5. Arrive with a clean face, free of makeup or creams.

Post-Treatment Instructions

  1. Mild swelling, redness, bruising, or tenderness may occur and usually resolves within a few days.

  2. Avoid rubbing, massaging, or applying pressure to treated areas for at least 24–48 hours.

  3. Avoid intense exercise, saunas, hot baths, or alcohol for 24–48 hours post-treatment.

  4. Apply ice or cold packs to reduce swelling or discomfort as needed.

  5. Avoid cosmetic procedures or facials in treated areas for at least 1–2 weeks unless cleared by your provider.

  6. Maintain hydration and follow any additional aftercare instructions provided by your provider.

  7. Results may take a few days to settle completely; follow-up appointments may be scheduled for adjustments if necessary.

Consent & Liability Acknowledgment

I, the undersigned, acknowledge and agree that:

  1. I am voluntarily receiving dermal filler treatment at Medical Aesthetics Bar and fully understand the purpose, benefits, and potential risks.

  2. I have provided complete and accurate medical history, including allergies, medications, pregnancy status, and previous procedures.

  3. Results vary by individual, and no guarantees or warranties are made regarding outcome, duration, or appearance.

  4. I have read, understood, and agree to follow all pre- and post-treatment instructions.

  5. I release, indemnify, and hold harmless Medical Aesthetics Bar, its owners, employees, and contractors from any liability, claims, or damages arising from the treatment, except in cases of gross negligence or willful misconduct.

  6. Photographs may be taken for documentation, treatment comparison, or educational purposes, with my consent while maintaining confidentiality unless otherwise authorized.

  7. I will notify Medical Aesthetics Bar immediately if I experience unexpected complications or concerns.

Acknowledgment:

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