Booking – https://eleganzaaesthetics.co.uk

Consent Form - Medical Declaration

Complete Your Consent Form(Required)

Choose Your Treatment

Anti Wrinkle ( Botox )

Anti-Wrinkle Injections Consent Form

This is an informed consent document that has been prepared to help inform you concerning Anti-Wrinkle injections and the risks involved. It is important that you read this information carefully and completely.

Please complete each section, indicating that you have read the page and sign the consent at the bottom prior to your treatment.

INTRODUCTION:
Anti-Wrinkle injections involve a series of small injections in order to weaken the chosen muscles. The weakening of the injected muscles begins to be apparent after 2-3 days with the peak effect being reached after 10-14 days. Results can last 3-6 months. The procedure can be repeated after 3 months; however, injections given less than 3-month intervals may reduce efficacy.

RISKS OF ANTI-WRINKLE INJECTIONS:
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 practitioner to make sure you understand the risks, potential complications, and consequences of Anti-Wrinkle injections:
- Bleeding
- Bruising/Swelling
- Infection
- Unsatisfactory Outcome/Temporary loss of function of nearby muscles

PUBLICITY MATERIALS:
I authorize the taking of clinical photographs and videos. I understand that photographs and video may be taken of me for educational and marketing purposes. I hold the practitioner harmless for any liability resulting from this production. I waive my rights to any royalties, fees, and to inspect the finished production as well as advertising materials in conjunction with these photographs.

You certify by signing this form that you have read the information in this document and completely understand it. You choose to proceed based entirely on the information provided in this informed consent document. You have been given all the necessary opportunities for discussion and all your questions regarding anti-wrinkle injections have been answered. You therefore and hereby consent to the care or treatment described herein.

Any discrepancies must be taken up with the practitioner within 1 month of treatment.

1. Are you currently pregnant or breastfeeding?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

2. Have you ever had an allergic reaction to botulinum toxin (or similar)?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

3. Do you have any neuromuscular or nerve/muscle disorders (e.g. Myasthenia Gravis)?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

4. Are you taking any antibiotics, muscle‑relaxants or medicines that affect nerves/muscles?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

5. Do you take any blood thinners, anticoagulants or medications that affect bleeding?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

6. Have you had Botox or any neurotoxin treatment in the last 3 months?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

7. Do you currently have an infection, rash, cold sore or skin lesion in the planned treatment area?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

8. Have you experienced excessive bruising or delayed healing from previous injections or skin procedures?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

9. Do you have any chronic illness (e.g. autoimmune, thyroid, diabetes) you are being treated for?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

10. Are you allergic to lidocaine or other local anaesthetics?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

11. Do you understand and accept that mild post-treatment side effects may occur (swelling, bruising, headache, or temporary muscle weakness), which can last approximately 3 - 7 days depending on individual(Required)

YES

Please fill in your answer if answered YES to the above(Required)

12. Do you consent to photographs of the treatment area (before/after) for clinical documentation?(Required)

YES

Name(Required)

First Last

Signature(Required)

Dermal Fillers

Client Disclaimer for Dermal Filler

PATIENT CONSENT: This is an informed consent form that has been prepared to help inform you of the potential benefits and risks of dermal filler injections. It is important that you read this information carefully and discuss fully with your practitioner before proceeding with treatment.

It is also important that you take as much time as you need to consider the treatment carefully, weighing up all your options before reaching an informed decision. You are encouraged to ask any questions that come to mind throughout the entirety of the process.

INTRODUCTION:
Injection of dermal fillers aims to smooth out facial folds and wrinkles, add volume to the tissues (e.g., lips), and help contour facial features. Most dermal fillers used are based on Hyaluronic acid and may contain lidocaine, a local anaesthetic to help with pain control.

RESULTS:
Hyaluronic acid dermal fillers have been shown to be safe and effective; results can last up to 12 months or longer. A period of 2 weeks should be allowed for the filler to settle and for bruising and swelling to subside. Additional treatments or top-ups may be required to achieve desired results.

RISKS AND COMPLICATIONS:
Common complications include pain, bleeding, bruising, and mild swelling. Uncommon complications include infection, cold sore reactivation, lumps, or nodules. Rare complications include allergic reactions, vascular occlusion, and, very rarely, filler blindness.

CLINICAL PHOTOS AND VIDEOS:
I agree to and authorise the taking of clinical photographs and videos, which will be kept as part of my confidential medical records.

I have been advised of the relevant information associated with this treatment and confirm I fully understand this advice. I certify that I have read the above consent and have had all my questions answered to my satisfaction. I hereby consent to this procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures.

1. Are you pregnant or breastfeeding?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

2. Do you have known allergies to filler ingredients, lidocaine or anaesthetics used in fillers?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

3. Are you currently taking blood thinners, anticoagulants or anti‑inflammatory medications (e.g. aspirin, ibuprofen)?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

4. Do you have a history of abnormal scarring, keloids, or poor wound healing?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

5. Have you used isotretinoin (Accutane) in the last 12 months?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

6. Do you have any active skin infections, cold sores or lesions in the area to be treated?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

7. Have you had cosmetic skin treatments (laser, peels, other injectables) in the last 4–6 weeks?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

8. Do you understand and accept the possible risks: bruising, swelling, asymmetry, nodules or lumps, delayed reaction, infection, vascular complications (rare but serious)?(Required)

YES

9. Are you aware the filler results may not be permanent and may require touch‑ups or dissolving?(Required)

YES

10. Do you give permission for your before-and-after photographs to be used for clinical documentation, research, or marketing purposes?(Required)

YES

11. Do you fully understand post‑treatment aftercare instructions?(Required)

YES

Full Name(Required)

First Last

Signature(Required)

Skin Boosters

Client Disclaimer for Skin Booster Treatment

RISKS AND SIDE EFFECTS: As with any procedure there are potential risks and complications associated with Skin Boosters Injections. You must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

Common complications:
These include pain, bleeding and bruising at the time of injection. After injection, the area may feel tender but should not be actively painful. If you experience significant pain then you must contact your practitioner as soon as possible for review. Bruising is dependent on several factors, most of the time bruising is mild but occasionally can be more significant. Bruising can take up to 2 weeks to fully resolve but should be much improved after 1 week. More uncommonly severe bruising can lead to haematoma formation, a collection of clotted blood. In this case the swollen collection of blood will need at least 2 weeks to resolve naturally and your practitioner will give you the appropriate after care advice. Your skin may appear red and swollen after the injection, this is usually mild and should improve after a couple of days, but it can last up to 14 days in some cases.

Uncommon complications include:
Skin infection (cellulitis) which presents as hot, red, shiny skin and you may also be generally unwell. In the case of suspected infection, you should contact your practitioner but also seek medical assessment as soon as possible as you will likely need antibiotics. Occasionally infection can form a swollen collection called an abscess. In this case you again must seek urgent medical attention. If you suffer from cold sores (a herpes virus infection of the lip) these can sometimes be reactivated following injections. Occasionally people can develop an unwanted inflammatory reaction and this can lead to nodule formation called granuloma. These often present as a delayed complication several months after the treatment. Several treatment options are available for granuloma formation and you may require medical assessment. Sometimes people can faint or feel faint with injections, you must tell your practitioner as soon as possible if you feel unwell during the treatment.

Rare complications include:
Allergic reaction including anaphylactic reaction which would require emergency medical assistance and transfer to hospital. Rarely, it can be injected into an artery blocking the flow of blood to the tissue being treated. This is known as vascular occlusion, if untreated it is serious because it can lead to death of tissue (necrosis) which may require reconstructive surgery to correct. In the rare event of vascular occlusion, it would be treated with emergency injections of a dissolving drug called Hyaluronidase. This is an enzyme that removes the hyaluronic acid occluding the blood vessel and can usually fully reverse the vascular occlusion leading to no long-term harmful effects. Your practitioner will be trained in how to use Hyaluronidase in an emergency, however if treatment with Hyaluronidase is not successful then you would require urgent medical assessment or assessment by a doctor who is a specialist in aesthetic medicine.

I understand that several appointments may be necessary to produce optimal results and I will be notified, in advance of each session of treatment, about the location where the next treatment session is going to take place and the identity of who is going to be involved in my care at each stage. I also understand that I will be kept informed of progress and that I can change my mind at any point.

I have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice. This includes advice about:
- the aims/motivations for having the procedure and the desired outcome
- the risks inherent in the procedure
- the risks inherent in refusing the procedure
- the risks specific to me
- the expected benefits of the treatment
- the potential disadvantages of the treatment
- alternative procedures and their pros and cons – including the option of no treatment at all
- any uncertainties about and the likelihood of success of the procedure
- any follow-up treatment that may be required

CLINICAL PHOTOS AND VIDEOS: I agree to and authorise the taking of clinical photographs and videos. I understand that these will form part of my confidential medical records.

I certify that I have read the above consent and that I fully understand it. I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. I hereby consent to this procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures.

1. Are you pregnant or breastfeeding?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

2. Do you have any medical conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

3. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

4. Do you have an autoimmune disease?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

5. Do you have any skin conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

6. Do you have any known allergies or have ever had anaphylaxis?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

7. Do you have any active infection at the intended site of procedure?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

8. Are you taking antibiotics or other prescription medications?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

9. Is there any other Medical and/or Social History that we should know? If so, please provide full detail here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

10. Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

YES

Name(Required)

First Last

Signature(Required)

Microneedling

Patient Consent – Microneedling

PATIENT CONSENT: This is an informed consent form to help inform you of the potential benefits and risks of microneedling. You must read this carefully and discuss fully with your practitioner before proceeding.

Microneedling is a skin treatment used to rejuvenate the skin and improve its surface. It can improve fine lines, wrinkles, enlarged pores, acne scars, hyperpigmentation, and stretch marks. The device creates small punctures in the epidermis, triggering collagen synthesis and allowing healing serums to penetrate. Topical anaesthetic is applied for comfort. Healing gels or PRP may be used. Treatments typically take 30–60 minutes.

Multiple sessions may be required for optimal results. Results are seen in 2–3 weeks, peaking at 4–6 weeks. Duration varies per client and results are not guaranteed. Microneedling does not prevent recurrence of the condition treated.

RISKS AND SIDE EFFECTS:
As with any procedure, there are possible risks. Discuss all concerns with your practitioner.

Common side effects: Discomfort or stinging during/after treatment, tightness, swelling, redness, tenderness. Usually resolves within 7 days. Bruising may occur; fainting is possible in some cases.

Uncommon side effects: Skin infection (cellulitis), reactivation of cold sores, hyperpigmentation or hypopigmentation. Usually resolves within 6 months, rarely permanent. Risk is higher for tanned or darker skin tones. Follow pre- and post-care instructions and sun protection.

Rare side effects: Permanent scarring.

I understand that multiple appointments may be required and I will be informed of the location and personnel involved in each session. I can change my mind at any point.

I confirm I fully understand the advice given, including:
- Treatment aims and desired outcomes
- Risks inherent in treatment and refusing it
- Expected benefits and potential disadvantages
- Alternative options including no treatment
- Likelihood of success and any follow-up needed

CLINICAL PHOTOS AND VIDEOS: I authorise photographs/videos for my confidential medical records.

I certify that I have read, fully understand, and consent to this procedure. This supersedes any previous disclosures.

1. Do you have any medical conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

2. Are you pregnant or breastfeeding?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

3. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

4. Do you have an autoimmune disease?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

5. Do you have any skin conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

6. Do you have any known allergies or have ever had anaphylaxis?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

7. Do you have any active infection at the intended site of procedure?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

8. Are you taking antibiotics or other prescription medications?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

9. Is there any other Medical and/or Social History that we should know? If so, please provide full detail here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

10. Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

YES

Please fill in your answer if answered YES to the above(Required)

Name(Required)

First Last

Signature(Required)

RF Microneedling

Patient Consent – RF Microneedling

PATIENT CONSENT: This is an informed consent form to help inform you of the potential benefits and risks of RF microneedling. You must read this carefully and discuss fully with your practitioner before proceeding.

RF Microneedling is a skin treatment combining microneedling with radiofrequency energy to stimulate collagen and tighten skin. It improves fine lines, wrinkles, acne scars, enlarged pores, hyperpigmentation, and skin laxity. The device delivers controlled RF energy via fine needles into the dermis, promoting tissue remodeling. Topical anaesthetic is applied for comfort. Treatments typically take 30–60 minutes and may include healing gels or serums.

Multiple sessions may be required for optimal results. Improvements are generally noticeable in 2–3 weeks, with peak results at 4–6 weeks. Duration varies per client, and results are not guaranteed. RF Microneedling does not prevent recurrence of the condition treated.

RISKS AND SIDE EFFECTS:
As with any procedure, there are possible risks. Discuss all concerns with your practitioner.

Common side effects: Mild discomfort, stinging, redness, swelling, tenderness, or tightness immediately after treatment. Usually resolves within 7 days. Bruising may occur; fainting is possible in some cases.

Uncommon side effects: Skin infection (cellulitis), reactivation of cold sores, hyperpigmentation or hypopigmentation, temporary numbness, minor burns or redness. Usually resolves within 6 months, rarely permanent. Risk is higher for tanned or darker skin tones. Follow pre- and post-care instructions and sun protection.

Rare side effects: Permanent scarring, prolonged redness, or adverse reactions to RF energy.

I understand that multiple appointments may be required and I will be informed of the location and personnel involved in each session. I can change my mind at any point.

I confirm I fully understand the advice given, including:
- Treatment aims and desired outcomes
- Risks inherent in treatment and refusing it
- Expected benefits and potential disadvantages
- Alternative options including no treatment
- Likelihood of success and any follow-up needed

CLINICAL PHOTOS AND VIDEOS: I authorise photographs/videos for my confidential medical records.

I certify that I have read, fully understand, and consent to this procedure. This supersedes any previous disclosures.

1. Do you have any medical conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

2. Are you pregnant or breastfeeding?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

3. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

4. Do you have an autoimmune disease?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

5. Do you have any skin conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

6. Do you have any known allergies or have ever had anaphylaxis?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

7. Do you have any active infection at the intended site of procedure?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

8. Are you taking antibiotics or other prescription medications?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

9. Is there any other Medical and/or Social History that we should know? If so, please provide full detail here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

10. Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

YES

Please fill in your answer if answered YES to the above(Required)

Name(Required)

First Last

Signature(Required)

Fat Dissolving

Client Disclaimer for Lemon Bottle Fat Dissolving Treatment

Product Information:
The Lemon Bottle is an aesthetic treatment product designed specifically for fat dissolution. It involves a solution that is injected into fat pockets to facilitate fat breakdown and enhance the body's natural fat removal processes.

Treatment Information:
The treatment involves the injection of the Lemon Bottle solution into specified areas of fat accumulation. It is a non-surgical procedure performed by a licensed practitioner. Procedure duration and number of sessions required may vary based on individual needs and the amount of fat to be dissolved.

Potential Risks:
While generally considered safe, potential risks include:

Localised pain, swelling, redness or bruising at the injection site
Potential for an allergic reaction to the product
Possibility of infection if aftercare instructions are not properly followed
Temporary changes to skin texture or irregularities in body contour
In rare instances, more serious complications may arise

Benefits:
Potential benefits include reduction of localised fat pockets, improvement in body contour, and enhancement in overall body appearance.

I have been advised of the relevant information associated with this treatment and I confirm I fully understand this advice. This includes:

The aims/motivations for having the procedure and the desired outcome
The risks inherent in the procedure
The risks inherent in refusing the procedure
The risks specific to me
The expected benefits of the treatment
The potential disadvantages of the treatment
Alternative procedures and their pros and cons – including the option of no treatment at all
Any uncertainties about and the likelihood of success of the procedure
Any follow-up treatment that may be required

CLINICAL PHOTOS AND VIDEOS:
I agree to and authorise the taking of clinical photographs and videos. I understand that these will form part of and will be kept with my confidential medical records.

I certify that I have read the above consent, fully understand it, and have had all my questions answered to my satisfaction. I hereby consent to this procedure. This constitutes full disclosure and supersedes any previous verbal or written disclosures.

1. Do you have any medical conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

2. Are you pregnant or breastfeeding?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

3. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

4. Do you have an autoimmune disease?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

5. Do you have any skin conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

6. Do you have any active infection at the intended site of procedure?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

7. Are you taking antibiotics or other prescription medications?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

8. Do you have any active infection at the intended site of procedure?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

9. Are you taking antibiotics or other prescription medications?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

10. Is there any other Medical and/or Social History that we should know? If so, please provide full detail here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

11. Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

Name(Required)

First Last

Signature(Required)

Filler Dissolving

Client Disclaimer for Filler Dissolving Treatment

Product Information:
Filler dissolving is an aesthetic medical procedure that uses Hyaluronidase, an enzyme designed to break down hyaluronic acid-based dermal fillers. This treatment is used to correct overfilled areas, asymmetry, migration of filler, or unwanted results from previous dermal filler treatments.

Treatment Information:
The procedure involves injecting Hyaluronidase into the area where dermal filler is present. The enzyme works by dissolving the hyaluronic acid filler over time. Results may be immediate or gradual, and in some cases, more than one session may be required depending on the amount and type of filler present. This is a non-surgical procedure performed by a qualified practitioner.

Potential Risks:
While generally considered safe, potential risks include:

Localised pain, swelling, redness or bruising at the injection site
Allergic or hypersensitivity reaction to Hyaluronidase
Infection if aftercare instructions are not followed
Over-dissolving of filler, which may lead to volume loss
Temporary changes in facial appearance or asymmetry
In rare cases, more serious complications may occur

Benefits:
Potential benefits include correction of undesirable filler results, improved facial symmetry, reduced filler-related complications, and restoration of a more natural appearance.

I have been advised of the relevant information associated with this treatment and I confirm I fully understand this advice. This includes:

The aims/motivations for having the procedure and the desired outcome
The risks inherent in the procedure
The risks inherent in refusing the procedure
The risks specific to me
The expected benefits of the treatment
The potential disadvantages of the treatment
Alternative procedures and their pros and cons – including the option of no treatment at all
Any uncertainties about and the likelihood of success of the procedure
Any follow-up treatment that may be required

1. Do you have any medical conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

2. Are you pregnant or breastfeeding?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

3. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

4. Do you have an autoimmune disease?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

5. Do you have any skin conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

6. Do you have any active infection at the intended site of procedure?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

7. Are you taking antibiotics or other prescription medications?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

8. Do you have any active infection at the intended site of procedure?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

9. Are you taking antibiotics or other prescription medications?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

10. Is there any other Medical and/or Social History that we should know? If so, please provide full detail here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

11. Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

Name(Required)

First Last

Signature(Required)

PDO Thread Lift

PATIENT CONSENT

This is an informed consent form that has been prepared to help inform you of the potential benefits and risks of thread lift procedures. It is important that you read this information carefully and discuss fully with your practitioner before proceeding with treatment.

It is also important that you take as much time as you need to consider the treatment carefully, weighing up all your options before reaching an informed decision. It is essential that you are aware of your right to have a second opinion and you are encouraged to ask any questions that come to mind throughout the entirety of the process.

Thread lifts are a minimally invasive alternative to a facelift using naturally resorbable suture materials. Two commonly used thread materials include PDO and PLLA.

1. PDO Threads:
PDO threads are made of Polydioxanone (PDO). They have a dual effect: immediate tightening/lifting of the skin and stimulation of collagen production over 3–6 months. PDO threads are 100% resorbable and degrade into carbon dioxide and water. Types include mono, cog, and screw threads. Mono threads provide a gentle lift, cog threads provide stronger lifting due to barbs, and screw threads provide volume.

2. PLLA Threads:
PLLA threads (e.g. Silhouette Soft) are composed of Poly-L-Lactic Acid. They last up to 12 months and stimulate longer-term collagen production. They dissolve into glucose, carbon dioxide, and water over time.

Thread lifts are used on areas such as the midface, cheeks, eyebrows, nose, neck, and jawline. PDO threads provide stronger immediate lift, while PLLA threads are better for volumisation. Results evolve over 6 months and may last up to 2 years. Top-up treatments may be required.

The procedure involves marking insertion points, applying local anaesthetic, and inserting threads using a needle or blunt cannula. No surgical incisions are required. Multiple threads may be used depending on the desired result.

I understand that results vary between clients and are not guaranteed. More than one treatment session may be required to achieve or maintain results. I understand I will be informed in advance of each session and can change my mind at any stage.

Thread lifts are not a replacement for surgical facelift procedures.

RISKS AND SIDE EFFECTS:
Common risks include temporary pain, swelling, bruising, bleeding, puckering, dimpling, and lumpiness. These usually resolve within 1–2 weeks.

Uncommon risks include infection, prolonged dimpling, thread migration, asymmetry, poor cosmetic outcome, or prolonged discomfort.

Rare risks include allergic reactions, granuloma formation, tissue necrosis, nerve injury, permanent scarring, or facial weakness/paralysis.

I confirm I fully understand the following:

Aims and expected outcome of the procedure
Risks of the procedure
Risks of refusing treatment
Personal risks specific to me
Benefits and limitations of treatment
Alternative options including no treatment
Uncertainties and likelihood of success
Possible follow-up treatments

CLINICAL PHOTOS AND VIDEOS:
I consent to clinical photographs and videos being taken and stored in my confidential medical records.

I confirm I have had sufficient opportunity to discuss the procedure, ask questions, and make an informed decision. I consent to the treatment and understand this replaces any previous information given.

1. Do you understand the information you have been provided?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

2. Do you feel sufficient information has been provided to you, to enable you to consent?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

3. Has your consent been freely given?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

4. Do you have any medical conditions?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

5. Are you pregnant or breastfeeding?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

6. Do you have a neuromuscular disease (e.g. MS, ALS, motor neuropathy myasthenia gravis, or Lambert-Eaton syndrome)?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

7. Do you have an autoimmune disease?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

8. Do you have any known allergies or have ever had anaphylaxis?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

9. Do you have any active infection at the intended site of procedure?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

10. Are you taking antibiotics or other prescription medications?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

11. Is there any other Medical and/or Social History that we should know?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

12.Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details here.(Required)

YES

Please fill in your answer if answered YES to the above(Required)

13. Do you have any concerns?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

14. Is there anything else we should know?(Required)

YES

Please fill in your answer if answered YES to the above(Required)

15. Eleganza Aesthetics will retain this information throughout the course of my treatment and refer to it as required - Are you happy with this ?(Required)

YES

Please fill in your answer if answered YES to the above(Required)