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Dermal Fillers Wavier & Release 

This form is not just a formality- it’s a record of your decision to consent to a procedure having considered the risk of both positive and negative outcomes and medical risks listed below, and the impact they may have on your well-being.


What is being injected Hyaluronic acid injection include branded products such as Juvederm, Restylane, Belotero, Profhilo and others improve the appearance of lines, correct volume loss or alter proportions. They include in their makeup mainly water, hyaluronic acid, lidocaine anaesthetic, and stabilising molecules such as BDDE (1,4-Butanediol Diglycidyl Ether ).


Risks of injection: Trauma during the procedure is caused by needles and cannulas passing through tissue, and includes bleeding, bruising, haematoma (a larger collection of blood in the skin, outside of blood vessels), damage to underlying structures including veins, arteries, nerves, salivary glands, lymph nodes, bone, muscle and other soft tissue structures are possible. In rare cases this could cause continuous problems in appearance, sensation or function and may require medical intervention to treat or may be permanent. Most traumatic injuries heal completely on their own.


Infection: Bacterial, viral or fungal infections can occur post procedure. Infections can cause redness and swelling and resolve or progress into abscesses or just under the skin. Injections into the lip area could trigger a recurrence of cold sores (Herpes simplex infections) which may require treatment.


Reactions: Reactions can occur and can include an immediate reaction causing swelling, and very rarely life threatening anaphylaxis. Delayed reactions localised to the skin can cause nodules, lumps or bumps or very rarely sterile abscesses. These may occur soon after the procedure or months later. The chance of delayed reaction increases if you have active autoimmune disease or an active immune system including viral or bacterial infections elsewhere.


Lumps, Bumps, Swellings-Skin Changes-Procedures are rarely associated with pigment changes, the formation of thread veins or new capillaries, and other blemishes. These may either recover, require further treatment or be permanent.


Blood Vessel Blockage: immediately if you suspect blood vessel occlusion is vital to prevent scarring. Follow-up: I understand adjustments requiring more product incur a charge. Dissatisfaction: I understand that with all treatments the precise degree of improvement cannot be guaranteed. The outcome’s subjective nature.


You understand that Teeth By TIANNA are NOT medical professionals such as Registered nurses, Nurse practitioners, Physician assistants, Medical doctors (nonsurgical), including specialists like dermatologists, Plastic surgeons, Dentists, Oral Surgeons and NOT under the supervision of a physician. It is recommended that you use hyaluronic acid serum to aid the swelling, bruising, lumps that you may experience and drink plenty of water to help with the absorption.It is recommend abstaining from alcohol for 24-48 hours before and after a dermal filler treatment.I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE TEETH BY TIANNA AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST TEETH BY TIANNA.

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