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Hyaluronidase Informed Consent From

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Dermal fillers are made from Hyaluronic acid, occasionally, these fillers need to be dissolved when the aesthetic treatment has not produced the desired outcome or there is a possibility of vascular occlusion or impending necrosis (tissue death which could lead to the compromise of

healthy tissue. If the dermal filler used is unknown (by an extrenal practitional), it may contain ingredients that cannot be dissolved by Hyaluronidase.


Hyaluronidase (hyaluronidase 1500 units) has an off-license use in aesthetic medicine and except in the case of emergency administration requires the patient to undergo a skin patch test at least twenty minutes prior to the procedure being undertaken. The skin patch test is carried out by injecting Hyaluronidase into the subcutaneous tissue of the forearm and observed for signs of reaction (i.e. hives or welts). If a positive test result is observed, treatment with Hyaluronidase cannot be carried out. Erythema or redness and slight vasodilation may be expected.


Hyaluronidase is an enzyme which breaks down hyaluronic acid fillers, but it can also break down naturally occurring hyaluronic acid present in the body, theresults can be unpredictable and the effect dramatic. I understand that there will be loss of volume and there can be some skin laxity which in itself may not provide a good aesthetic results. Although

some of the effects can be immediate, I understand that it can take up to 14 days for the final results to be seen and the treatment may need to be repeated.


The use of and the indications for the administration of Hyaluronidase have been explained to me by The Elite Clinic (Elite Aesthetics Solihull Ltd) and I have had the opportunity to have all questions answered to my satisfaction.


After the treatment some other common injection-related reactions might occur. These reactions include redness, swelling, pain, itching, bruising and tenderness at the injection site. They have generally been described as mild to moderate and typically resolve spontaneously a few days after injection. Bruising may occasionally be more significant.


Hyaluronidase administration although very rare can result in anaphylaxis (a severe allergic reaction which in itself is life threatening and requires immediate medical attention) and I understand this and have been given full counselling and the opportunity to discuss the treatment with Hyaluronidase, conservative treatment options or leaving the dermal filler to break down naturally which may take several months dependent on the type of filler used and the area treated.


I acknowledge that I will have to remain at the clinic for thirty minutes after the procedure so that I can be observed by the medical staff and that I may need to return to the clinic 2-3 weeks after treatment to assess if further Hyaluronidase is to be administered.


I have answered thequestions regarding my medical history to thebest of my knowledge. I have also received the aftercare information and its contents have been explained to me and I will follow the advice given.

Photography Consent

To photographs and other audio-visual and graphic materials before, during, and after the course of my therapy to be used for medical, marketing, and education purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I may or may not be identified by the photos.

I have read and understand all information presented to me before signing this consent form. I have been given an opportunity to have all of my questions answered to my satisfaction. I understand the procedure and accept the risks. By signing this consent I agree to the terms of this agreement.


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