Consent and consultation form for patients treated with products from the VYCROSS Collection:
JUV DERM VOLUMA with lidocaine,
JUV DERM VOLIFT with lidocaine,
JUV DERM VOLIFT Retouch with lidocaine,
JUV DERM VOLBELLA with lidocaine,
JUV DERM VOLITE™ with lidocaine)
The products in the VYCROSS Collection (JUV DERM VOLUMA with lidocaine, JUV DERM VOLIFT with lidocaine, JUV DERM VOLIFT Retouch with lidocaine, JUV DERM VOLBELLA with lidocaine, JUV DERM VOLITE™ with lidocaine), are a non-animal, hyaluronic acid-based (sugar-based), non-permanent transparent gel which is injected to: • Restore facial volume (JUV DERM VOLUMA with lidocaine) • Treat deep skin depressions, face contouring and volume restoration (JUV DERM VOLIFT with lidocaine, JUV DERM VOLIFT Retouch with lidocaine) • Treat fine lines and medium-sized skin depressions as well as enhancement and pouting of the lips (JUV DERM VOLBELLA with lidocaine) • Treat fine lines and for additional improvement of skin quality attributes such as hydration and elasticity (JUV DERM VOLITE™ with lidocaine)
Treatment with JUV DERM VOLUMA with lidocaine may remain effective for up to 18 months1; treatment with JUV DERM VOLIFT, VOLIFT Retouch and VOLBELLA with lidocaine for up to 12 months2, 3; treatment with JUV DERM VOLITE™ with lidocaine is proven to improve dermal hydration for up to 9 months4. This will vary depending on the skin type, areas treated, quantity of product injected, the injection technique and lifestyle factors such as sun exposure and smoking. A touch up session may be recommended a few weeks after the first session to increase the effects and maximise the results. You should be made aware that the products contain 0.3% lidocaine (HCl) which may produce a positive result in anti-doping tests.
After an injection with either one, two, three, four or five of the 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. 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. The use, indications, contraindications (specific situations in which the five VYCROSS Collection products: JUV DERM VOLUMA with lidocaine, JUV DERM VOLIFT with lidocaine, JUV DERM VOLIFT Retouch with lidocaine, JUV DERM VOLBELLA with lidocaine, JUV DERM VOLITE™ with lidocaine, should not be used) and the possible side effects have been explained to me. There are specific situations in which one, two, three, four or five VYCROSS Collection* products should not be used, these can be identified from my medical history. I have accurately and truthfully answered all the questions regarding my previous medical and aesthetic treatment history to the best of my knowledge. I was given the opportunity to ask questions and I am satisfied with the answers given. If inflammatory reactions persist for more than one week, or if any other side effects appear, I will inform my medical practitioner who will treat appropriately. Whilst rare, such side effects may require