Form & Consent

Hyaluronic Acid Injection

Personal Information

Personal Information

For women

" I declare that the answers to the questionnaire "

Information on

Hyaluronic Acid Injections

The use, indications, contraindications and potential side effects of hyaluronic acid implants were explained to me. I answered all the questions I was asked about my medical and aesthetic history with complete sincerity. I was able to ask all the questions I wanted and I received satisfactory answers.

I have noted that

- Hyaluronic acid is a transparent bioresorbable gel of cross-linked hyaluronic acid of non-animal origin

- Hyaluronic acid is injected into the dermis or deep dermis to correct wrinkles, folds and contours of the face or to increase the volume of the lips, treat dark circles, and reconstitute the volume of the cheeks.

- Hyaluronic acid lasts an average of 6 to 12 months. This durability varies according to the type of skin, the areas, the quantities injected and the injection technique.

- In some cases, we note an injection duration of up to one year.

- In the lips, the average duration of hyaluronic acid is 6 months, because of the strong vascularization of the lips.

- Bruises and hematomas may appear in the days following the injection. They disappear within a week and will be masked by a common make-up.

- Inflammatory reactions such as redness, swelling, erythema ... may be associated with itching or pain on pressure may occur after the injection. These reactions may persist for a week.

- Indurations or nodules may appear at the injection site.

- Very rare cases of discoloration of the injection area have been reported.

- A second session at short intervals (4 to 6 months) is useful if this is the first injection and the wrinkles are marked.

- I have also been informed that cases of necrosis in the glabellar region, nose, abscess formation, granulomas and hypersensitivity have been described after hyaluronic acid injections. The persistence of inflammatory reactions beyond one week or the appearance of any other side effect should be reported to the practitioner as soon as possible.

The practitioner will have to remedy them with an appropriate treatment. In all cases, these side effects may require a treatment that can last several months to disappear


Before & After

I have noted that

- Aspirin and anti-inflammatory drugs are not recommended.

After the treatment

(within hours of injection)

- Avoid alcohol consumption and sun exposure.

- Avoid excessive contraction of the muscles of the treated area and any massage.

- Avoid violent sports, sauna, steam room in the 3 days following the session.

Patient Information

Preceded by the handwritten mention:
Read and approved