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Consent form
for injectable treatments

Please read thoroughly

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1. WHAT'S INJECTED

DERMAL FILLERS: A hyaluronic acid (HA) filler in gel form is injected directly into specific facial areas, such as the lips, chin, and cheeks, to enhance volume and create a sculpted appearance. To minimise discomfort from the needle, a mild topical aenesthetic, such as lidocaine cream, is applied before the procedure. Do not use these treatments if you have a history of severe allergies or anaphylaxis, are allergic to lidocaine or the Gram-positive bacterial proteins in these products, or if you have previously had allergic reactions to hyaluronic acid fillers. Read more on the producer's website: 

ANTI-WRINKLE:  BOTOX® Cosmetic is injected into targeted facial muscles and used to temporarily improve the look of moderate to severe wrinkles (forehead. eye corners, frown lines). Read more: allerganaesthetics.com/brands/botox

2. RESTRICTIONS

You cannot receive these injectable treatments if you:

· are under the age of 18

· are pregnant or breastfeeding

· had severe side effects to cosmetic injections before

· have a history of anaphylaxis or multiple severe allergies

· have an infection at the treatment site

· are taking psychiatric medication

· are unable to make decisions for yourself

· have consumed alcohol or recreational drugs within 24 hours before the treatment

· have a condition that puts your health in danger by receiving cosmetic injections

3. THE RISKS​​​

Cosmetic injections are generally safe when performed by a licensed and skilled provider, but it can still cause unwanted results and side effects. Please approach this treatments with caution and be aware of your symptoms and their evolution over time. 
3.1 The treatment could fail to provide the desired result.
3.2 Needles can cause pain, bleeding, bruising and rare but possible damage to veins, arteries, nerves or muscles. Some of these can require medical help. 
3.3 Bacterial infections may develop post-procedure, particularly due to inadequate aftercare. Infections can cause redness, swelling and pain and can require specialised medical treatment. Please follow the aftercare to help avoid this situation.

3.4 Vascular occlusion, with a rare possibility of occurrence, is a severe situation caused by filler entering a blood vessel at the site of injection, restricting normal blood flow. Immediate injection treatment is necessary to dissolve the filler and restore circulation.

3.5 Herpes/cold sores recurrence can be triggered by injections to lips area.

3.6 BOTOX® Cosmetic may cause serious side effects, including muscle weakness, vision problems, or dizziness, which can occur hours, days, or weeks after treatment. If these symptoms arise, avoid driving or engaging in activities that require focus and responsibility. Read more at allerganaesthetics.com/brands/botox

3.7 Tell your injector about all your muscle or nerve conditions, such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects, including difficulty swallowing and difficulty breathing, from standard doses of BOTOX® Cosmetic.

3.8 Severe allergic reactions and anaphylaxis. As with any treatment, severe allergic reactions to unknown factors can occur, potentially developing quickly and becoming life-threatening. If you're on your own when this happens, seek immediate help or call an ambulance (999) without hesitation. Most common signs are: severe swelling of throat and tongue and difficulties breathing or speaking. Read more: nhs.uk/conditions/anaphylaxis

 

4. COMMON SIDE EFFECTS

· Swelling and light bruising. These are common and typically resolve in a few days.
· Redness. The treated area may feel sore and appear red for up to 48h.

· Numbness or tingling in the treated area.

· BOTOX® Cosmetic is known to cause light headaches within first 24h after treatment.
· Lumps or Irregularities: Although the procedure may be perfectly successful immediately after the treatment, the soft and malleable nature of hyaluronic gel can lead to irregularities in time, especially if aftercare instructions are not followed. Some people may experience lumps or unevenness in the lips after the healing process is complete (typically around 30 days after the procedure). These issues can often be massaged out but may sometimes require further adjustment.​​​

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5. EMERGENCY ACTION

LIFE-THREATENING SITUATIONS: call an ambulance immediately (999) if you experience any of these:

· problems breathing, swallowing or speaking

· sudden swollen tongue or throat

· blurred vision or loss of vision

In case of NON-LIFE-THREATENING SITUATIONS:

Please contact Honey Lips® immediately  - 07841777601 - if you experience rashes, bruises, local infection, intense pain, changes in skin colour around the puncture or any unmentioned side-effect that might worry you. 

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6. AFTERCARE

Certain aftercare rules need to be followed for the whole duration of recovery (up to 14 days):

  •  ​​​Avoid any pressure and tension to the injected area (including touching)

  •  Sleep face-up, with your head higher than usual (use extra pillows)

  •  Avoid hot environments: sun-beds, direct sun, saunas, etc

  •  Avoid intense physical activities 

  •  Avoid facial procedures or dentist

Ignoring the aftercare period after lip filler treatment can negatively impact the results and potentially lead to complications. 

7. DISSATISFACTION 

Like with all treatments, the actual degree of improvement cannot be fully predicted or guaranteed.

It is possible that the procedure will fail to provide the desired result or to remedy the intended problem. The outcome’s subjective nature means dissatisfaction is a possible outcome regardless of effectiveness of treatment. The effect of all treatments will gradually wear off and additional treatments may be necessary to achieve or maintain the desired effect. The aftercare advice given to you as a leaflet is very important for obtaining the desired result and ignoring it can affect the results.

The procedure is non-refundable if you're subjectively dissatisfied with aesthetics of the outcome. 

In case of the Hyaluronidase treatment (dissolving fillers) please keep in mind that it's not guaranteed 100% and often filler treatments are not the only cause of lumps, bumps or asymmetries, which may result from other procedures, lifestyle factors, or medications.

8. CONFIDENTIALITY / DATA PRIVACY

We ask for information about your general health to allow us to treat you safely and to protect our staff. Please answer sincerely to all questions. All information will be kept strictly confidential. You will be required to fill this form each time you visit us, so we can be up-to-date with your general health.

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9. IMPORTANT!

The treatment cannot be provided if you consumed alcohol or recreational drugs in the past 24h.

This treatment cannot be offered to under 18, regardless parental consent.

1. What treatments will you receive?
2. Are you over the age of 18?
3. Are you currently pregnant or breastfeeding?
4. Have you ever experienced severe side effects from cosmetic injections in the past?
5. Do you have a history of anaphylaxis or severe allergies?
6. Is there an infection present in the area you want to be treated?
7. Are you currently taking any medications?
8. Have you been diagnosed with HIV, Hep, or infectious diseases?
9. Do you agree to pictures being taken before/after the procedure for online portfolio?
10. I understand the entire procedure, including the risks and side effects, and I consent to treatment

Please remove any piercings or make-up from treatment area before your arrival. 

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