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Consent Form
Consent Form - Derma Roller Please complete the following consent form. Once completed don't forget to sign before submitting. Many thanks. Angels Twelve |  Professional Aesthetics.
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Medical History.

Please complete the required medical history screening questions.

Potential Risks and Complications.

After an injection with either one, two, three, four, five or six hyaluronic acid injections such as, but not limited to, VYCROSS® Collection* products, inflammatory skin reactions (for example, redness, swelling, rash), which may be accompanied by itchiness or pain on application of pressure, may occur. These reactions may last up to a week. Bruising, lumps or nodules may appear at the injection site. Very rarely, cases of discolouration or lightening at the injection area have been reported. Rare cases of necrosis (cell death), abscesses (collection of pus), granulomas (foreign body reaction) and immediate or delayed hypersensitivity (allergic reactions) have also been reported after hyaluronic acid injections and/or lidocaine, as have poor or weak filling effects.
I have been fully informed by Dr.Olha Vorodyukhina of the risks and possible consequences listed above.
After treatment, please avoid extreme facial expressions, alcohol consumption and applying make up for 12 hours. Please avoid extreme sun exposure, UV light, temperatures below 0˚C, saunas and steam rooms for 2 weeks after treatment. It is advisable to avoid strenuous activity or exercise for up to 24 hours and to avoid massaging the treated area. Try to sleep with the head elevated and avoid sleeping on the injected areas for one or two days.