INFORMED CONSENT FOR INJECTABLE AND AESTHETIC PROCEDURES

Expanded Informed Consent Notice
This document provides expanded and detailed information related to the informed consent form presented for electronic signature. It is intended to supplement and clarify the terms, risks, benefits, alternatives, and conditions summarized in the consent form.

By signing the informed consent, the patient acknowledges that they have been provided access to this extended version, have had the opportunity to review it prior to signing, and understand that it forms an integral part of the informed consent process.

The purpose of this informed consent is to provide written information regarding the risks, benefits, and alternatives of the procedure(s) described. This document supplements the discussion between the patient and the doctor or healthcare provider. It is important that the patient fully understands this information and reviews it carefully. Any questions regarding the procedure(s) should be addressed with the treating healthcare professional prior to signing the informed consent.

I hereby confirm that I voluntarily consent to undergo one or more of the following procedures performed by the specialists of New York Cosmetology Company LLC:

Botulinum toxin injections (e.g., Botox®, Dysport)
Dermal filler injections (including treatment of the face, lips, soft tissue augmentation of the body)
Thread lifting procedures (PDO or similar absorbable threads)
Aesthetic injectable treatments, including PRP (platelet-rich plasma therapy), exosomes, skin boosters, mesotherapy, vitamins, glutathione, and similar agents

Botulinum Toxin Injections (Botox®, Dysport)
This section provides detailed information about the use of botulinum toxin for cosmetic and therapeutic purposes, its effects, potential risks, and your rights as a client.

Consent and Acknowledgment
I acknowledge and agree to the following:

Botulinum toxin (Botox® and similar agents) is a neurotoxin produced by the bacterium Clostridium A. Botulinum toxin can relax the muscles on areas of the face and neck which cause wrinkles associated with facial expressions or facial pain. Treatment with botulinum toxin can cause your facial expression lines or wrinkles to be less noticeable or essentially disappear. Areas most frequently treated are: a) glabellar area of frown lines, located between the eyes; b) crow’s feet (lateral areas of the eyes); c) forehead wrinkles; d) radial lip lines (smokers lines), e) head and neck muscles. Botox is diluted to a very controlled solution and when injected into the muscles with a very thin needle, it is almost painless. Patients may feel a slight burning sensation while the solution is being injected. The procedure takes about 15-20 minutes and the results can last up to 3 months. With repeated treatments, the results may tend to last longer.
Before undergoing this procedure, understanding the risks is essential. No procedure is completely risk-free. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. Some of these risks, if they occur, may necessitate hospitalization, and/or extended outpatient therapy to permit adequate treatment. It has been explained to me that there are certain inherent and potential risks and side effects in any invasive procedure and in this specific instance such risks include but are not limited to:

Post treatment discomfort, swelling, redness, and bruising,
Double vision,
A weakened tear duct,
Post treatment bacterial, and/or fungal infection requiring further treatment,
Allergic reaction,
Minor temporary droop of eyelid(s) in approximately 2% of injections, this usually lasts 2-3 weeks,
Occasional numbness of the forehead lasting up to 2-3 weeks,
Transient headache and
Flu-like symptoms may occur.

I am aware that when small amounts of purified botulinum toxin are injected into a muscle it causes weakness or paralysis of that muscle. This appears in 2 – 10 days and usually lasts up to 3 months but can be shorter or longer. In a very small number of individuals, the injection does not work as satisfactorily or for as long as usual and there are some individuals who do not respond at all. I understand that I will not be able to use the muscles injected as before while the injection is effective but that this will reverse after a period of months at which time re- treatment is appropriate. I understand that I must stay in the erect posture and that I must not manipulate the area (s) of the injections for the 2 hours post-injection period.
I understand this is an elective procedure and I hereby voluntarily consent to treatment with botulinum toxin injections for facial dynamic wrinkles, TMJ dysfunction, bruxism and types of orofacial pain including headaches and migraines. The procedure has been fully explained to me. I also understand that any treatment performed is between me and the doctor/healthcare provider who is treating me and I will direct all post-operative questions or concerns to the treating clinician.

Dermal Filler Injections
This section describes the use of dermal fillers for restoring volume and contouring various areas of the face and body, including the lips, cheeks, buttocks, and breasts. It outlines the benefits, potential risks, and the terms of informed consent.

Consent and Acknowledgment
I acknowledge and agree to the following:

Treatment with dermal fillers (such as Juvederm, Restylane, Radiesse and others) can smooth out facial folds and wrinkles, add volume to the lips, and contour facial features that have lost their volume and fullness due to aging, sun exposure, illness, etc. Facial rejuvenation can be carried out with minimal complications. These dermal fillers are injected under the skin with a very fine needle. This produces natural appearing volume under wrinkles and folds which are lifted up and smoothed out. The results can often be seen immediately.
Before undergoing this procedure, understanding the risks is essential. No procedure is completely risk-free. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. Some of these risks, if they occur, may necessitate hospitalization, and/or extended outpatient therapy to permit adequate treatment. It has been explained to me that there are certain inherent and potential risks and side effects in any invasive procedure and in this specific instance such risks include but are not limited to:

Post treatment discomfort, swelling, redness, bruising, and discoloration;
Post treatment infection associated with any transcutaneous injection;
Allergic reaction;
Reactivation of herpes (cold sores);
Lumpiness, visible yellow or white patches;
Granuloma formation;
Localized necrosis and/or sloughing, with scab and/or without scab if blood vessel occlusion occurs.

Dermal fillers have been shown to be safe and effective when compared to collagen skin implants and related products to fill in wrinkles, lines and folds in the skin on the face. Its effect can last up to 6 months. Most patients are pleased with the results of dermal fillers use. However, like any esthetic procedure, there is no guarantee that you will be completely satisfied. There is no guarantee that wrinkles and folds will disappear completely, or that you will not require additional treatment to achieve the results you seek. The dermal filler procedure is temporary and additional treatments will be required periodically, generally within 4-6 months, involving additional injections for the effect to continue. I am aware that follow-up treatments will be needed to maintain the full effects. I am aware the duration of treatment is dependent on many factors including but not limited to: age, sex, tissue conditions, my general health and life style conditions, and sun exposure. The correction, depending on these factors, may last up to 6 months and in some cases shorter and some cases longer. I have been instructed in and understand the post-treatment instructions.
Dermal fillers have also been shown to be safe and effective when compared to collagen skin implants and related products for soft tissue augmentation of the body. Its effect can last up to 1-2 years. Most patients are pleased with the results of dermal fillers use. However, like any esthetic procedure, there is no guarantee that you will be completely satisfied. There is no assurance of achieving a specific volume, shape, or symmetry, nor of fully correcting perceived imperfections. I also acknowledge that additional or follow-up treatments may be necessary to achieve or maintain the intended result. The dermal filler procedure is temporary and additional treatments will be required periodically, generally within 6-8 months, involving additional injections for the effect to continue. I am aware that follow-up treatments will be needed to maintain the full effects. I am aware the duration of treatment is dependent on many factors including but not limited to: age, sex, tissue conditions, my general health and life style conditions, and sun exposure. The correction, depending on these factors, may last up to 1-2 months and in some cases shorter and some cases longer. I have been instructed in and understand the post-treatment instructions.
I have been informed that the products used in this procedure are not FDA-approved for soft tissue augmentation of the body, and that their application in this context is considered off-label use. I understand that off-label use is a legally permitted medical practice in the United States, provided that it is based on the clinical judgment of a licensed healthcare provider. I am choosing to undergo this procedure voluntarily and with full awareness of this information.
I understand this is an elective procedure and I hereby voluntarily consent to treatment with dermal fillers for facial rejuvenation, lip enhancement, establish proper lip and smile lines, and replacing facial volume. The procedure has been fully explained to me. I also understand that any treatment performed is between me and the doctor/healthcare provider who is treating me and I will direct all post-operative questions or concerns to the treating clinician.

Thread Lifting (PDO or Similar Absorbable Threads)
This section covers the thread lift procedure, which involves the insertion of absorbable sutures to tighten and lift the skin. It explains the mechanism, potential side effects, and important safety considerations.
The PDO (polydiaxonone) Thread Lift and Smoothing procedure uses absorbable surgical sutures placed into the subdermal layer of the skin to initiate collagen production. The procedure can result in increased firmness and elasticity of the skin in the treated area. The nature of cosmetic procedure may require a patient to return for numerous visits in order to achieve the desired results or to determine whether the treatment may not be completely effective at treating the particular concern.

Consent and Acknowledgment
I acknowledge and agree to the following:

Before undergoing this procedure, understanding the risks is essential. No procedure is completely risk-free. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. Some of these risks, if they occur, may necessitate hospitalization, and/or extended outpatient therapy to permit adequate treatment. It has been explained to me that there are certain inherent and potential risks and side effects in any invasive procedure and in this specific instance such risks include but are not limited to:
Discomfort: Some discomfort may be experienced during treatment and the following 1-2 weeks.
Scarring: May cause scarring; sutures are inserted through a small entry hole which heals with time, but there is potential for scar formation at entry point.
Bruising, Swelling, Infection: With any minimally invasive procedure, bruising and swelling of the treatment area may occur. Infection is rare, but with any injection or incision into the skin, the possibility exists.
Bleeding: You may experience some bleeding during the procedure. A hematoma or a small blood clot may occur and may require treatment by drainage. There is a higher risk of bleeding if you have taken any anti- inflammatory medications (Advil, Motrin, Aspirin, Ibuprofen) within the 10 days preceding the procedure.
Damage to Deeper Structures: Deeper structures such as nerves, blood vessels and muscles may be damaged during the procedure. The potential for this to occur varies according to the location on the body the procedure is being performed. Injury to deeper structures may be temporary or permanent.
Allergic Reaction: Allergies to tape, suture material or topical preparations have been reported. Allergic reactions may require additional treatment.
Partial Laxity Correction: PDO Lift may not correct all your facial laxity or sagging, and minor asymmetry is possible.
Delayed Healing: Complications may ensue as a result of smoking, using a straw, or similar motions. Smoking and similar actions are STRONGLY discouraged. Slight asymmetry, redness, visible sutures, suture breakthrough may require additional treatment or removal of the sutures.
I am aware that follow-up treatments will be needed to maintain the full effects. I am aware the duration of treatment is dependent on many factors including but not limited to: age, sex, tissue conditions, my general health and life style conditions, and sun exposure. The correction, depending on these factors, may last up to 6 months and in some cases shorter and some cases longer. I have been instructed in and understand the post-treatment instructions.
I understand this is an elective procedure and I hereby voluntarily consent to treatment with PDO suture threads for skin rejuvenation, lifting of the skin to help establish proper lip and smile lines and improved esthetics. The procedure has been fully explained to me. I also understand that any treatment performed is between me and the doctor/healthcare provider who is treating me and I will direct all post-operative questions or concerns to the treating clinician.

Aesthetic Injectable Treatments — Mesotherapy, PRP, Exosomes, Skin Boosters, Vitamins, Glutathione, and Related Compounds.
This section includes information about aesthetic injectable treatments aimed at skin rejuvenation, cellular stimulation, and improved overall appearance. These procedures are non-medical in nature and results may vary.

This section describes the use of biologically active injectable compounds—such as mesotherapy solutions, platelet-rich plasma (PRP), exosomes, skin boosters, glutathione, vitamins, and similar substances—for aesthetic purposes. These treatments are intended to improve skin tone, hydration, texture, and general appearance. They are considered cosmetic procedures and are elective in nature.

Purpose and Mechanism
Mesotherapy involves the administration of small quantities of active ingredients through microinjections into the middle layer of the skin (mesoderm). These compounds may include vitamins, peptides, amino acids, antioxidants, and plant extracts. The goal is to stimulate cellular metabolism, collagen production, and microcirculation in the treated area. Depending on the substance used, some treatments may provide temporary volume, smoothing, or skin tightening effects.
Possible Side Effects and Risks
Although these procedures are generally safe, side effects may occur. These include but are not limited to:

Localized reactions such as redness, swelling, bruising, tenderness, itching, or burning at the injection site
Mild systemic responses such as fatigue or headache
Allergic reactions to injected substances
Temporary lumps, firmness, or uneven texture under the skin
Infection or inflammatory nodules at the injection site (rare but possible)
No visible or satisfactory results despite multiple treatments

Patients are advised to follow all aftercare instructions and report any adverse reactions promptly.
Kidney and Systemic Considerations
While mesotherapy and similar aesthetic injections are administered locally and in small doses, certain substances—especially when injected intramuscularly or intravenously—may carry systemic risks. Glutathione, high-dose vitamins, or certain cocktails can increase metabolic load on the liver and kidneys, particularly in individuals with pre-existing organ dysfunction.
Patients with any history of kidney disease, reduced kidney function, liver disease, or related chronic conditions should inform the provider before undergoing treatment. These procedures may not be recommended for individuals with such conditions without prior medical clearance.
Duration and Maintenance
Results from mesotherapy and related procedures vary by individual and may depend on age, skin condition, lifestyle, hydration, and overall health. A typical treatment plan may require 4–8 initial sessions spaced weekly or biweekly, followed by periodic maintenance treatments. Some results may be visible immediately, while others appear gradually over several weeks.

Consent and Acknowledgment
I acknowledge and agree to the following:

I understand that these injectable treatments are cosmetic and not intended for medical diagnosis or treatment. They are not FDA-approved for therapeutic purposes and are offered based on practitioner experience and clinical judgment.
I understand the potential risks and side effects listed above and have had an opportunity to ask questions and receive satisfactory answers.
I acknowledge that if I have any history of kidney or liver disease, or other relevant health conditions, I must inform my provider before treatment.
I understand that individual results vary and that no guarantees are provided. I may require multiple sessions to achieve or maintain the desired outcome.
I confirm that I have been informed of the treatment goals, limitations, and post-procedure instructions, and that I have received adequate explanations of all alternative options.

General Consent, Legal Acknowledgments, and Media Release
This section outlines the patient’s general legal agreement regarding all procedures described in this document, including financial responsibility, voluntary participation, rights, and media consent.

Consent and Acknowledgment
I acknowledge and agree to the following:

I am not aware that I am pregnant. I am not trying to get pregnant. I am not lactating (nursing). I do not have or have not had any major illnesses which would prohibit me from receiving dermal fillers. I certify that I do not have multiple allergies or high sensitivity to medications, including but not limited to lidocaine.
Alternatives to the procedures and options that I have volunteered for have been fully explained to me.
I understand that this is an "elective” procedure, and that payment is my responsibility and is expected at the time of treatment.
I understand that I have the right to discontinue treatment at any time.
I hereby indemnify the New York cosmetology company LLC from any liability relating to the procedures that I have volunteered for. I also understand that any treatment performed is between me and the doctor/healthcare provider who is treating me and I will direct all post-operative questions or concerns to the treating clinician.
I hereby indemnify the facility where this treatment is being performed from any liability relating to the procedures that I have volunteered for.
I authorize the taking of clinical photographs and videos and their use for scientific and marketing purposes both in publications and presentations. During treatments given by The New York cosmetology company LLC (NYCC) or other partner companies, I understand that photographs and video may be taken of me for educational and marketing purposes. I hold the NYCC 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.
I allow photo, video, and audio recording in the premises where New York cosmetology company LLC provides services for me. I understand that my visit is being recorded on video and audio, and I give my consent.
This treatment is purely cosmetic, and no medical claims or guarantees are expressed or implied.
To achieve optimal and long-lasting results, it is important to follow the aftercare recommendations provided by New York Cosmetology Company LLC.
Results of the treatment may vary significantly due to factors such as age, skin type, existing skin conditions, sun exposure, lifestyle habits (e.g., smoking, alcohol), and environmental factors. Therefore, no specific outcomes can be guaranteed.
Individual results may differ, and I acknowledge that visible results cannot be guaranteed.
I have fully and accurately disclosed any medical conditions or circumstances that could affect my treatment outcomes, including pregnancy, medications, recent or past skin procedures, skin cancer history, herpes outbreaks (oral or genital), allergies, or recent use of products such as Retin-A, Accutane, Differin, hormones, and recent sun exposure or tanning bed use.
I understand that sun exposure, tanning beds, tanning lotions, creams, and sprays must be avoided for at least two weeks before the procedure. Additionally, I must use sun protection (SPF 30 or higher) and wear protective clothing on the treatment area during this period.
I will avoid tanning (natural sunlight or artificial sources) during the entire course of treatment and for at least 14 days after my final treatment.
If I have a history of herpes outbreaks, I agree to consult my physician for a prescription or request a prescription from New York Cosmetology Company LLC prior to treatment.
I will not undergo other cosmetic or medical skin care procedures, including filler injections or Botox/Dysport treatments, for 14 days before and after treatments provided by New York Cosmetology Company LLC.
I understand laser treatments are prohibited during pregnancy, and any unused sessions will be paused until it is safe to resume.
I have read the above and understand it. My questions have been answered satisfactorily. I accept the risks and complications of the procedure and I understand that no guarantees are implied as to the outcome of the procedure. I also certify that if I have any changes in my medical history, I will notify the doctor/healthcare professional who treated me immediately. I also state that I read and write in English.
I confirm that I have thoroughly read this consent form, fully understand all of the information provided, and all my questions have been answered clearly. I voluntarily consent to the treatment under these terms.