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生物刺激注射剂知情同意书（Sculptra/Radiesse）

用于胶原蛋白刺激注射剂（如聚左乳酸 (Sculptra) 和羟基磷灰石钙 (Radiesse)）的知情同意书

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生物刺激注射剂知情同意书（Sculptra/Radiesse）

客户信息

治疗详情

病史

风险与并发症

Potential Risks and Complications:

- Bruising, swelling, tenderness, and redness at injection sites for up to 1–2 weeks
- Nodules or papules — small firm bumps under the skin that may appear weeks to months after treatment; most resolve but some may require treatment
- Granulomas — inflammatory lumps (rare) that can be persistent
- Asymmetry or uneven results
- Infection and biofilm
- Vascular occlusion — blockage of a blood vessel that can cause tissue damage and, in extremely rare cases, vision loss; biostimulators cannot be dissolved with hyaluronidase
- Delayed or unsatisfactory result — results build gradually over 2–6 months

Results are gradual and depend on your own collagen response. A series of 2–3 sessions 4–6 weeks apart is typical. Massage instructions ("5-5-5" for Sculptra) must be followed.
I understand that biostimulators can cause nodules or granulomas that may appear months later, that they cannot be dissolved with hyaluronidase, and that treatment of complications may take time.
I understand that vascular occlusion is a rare but serious complication and that I must seek immediate care for unusual pain, blanching, mottled skin, or vision changes after treatment.

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同意与签名

I voluntarily consent to biostimulator injectable treatment. I have been informed of the benefits, risks, alternatives, and potential complications, including nodules, granulomas, and vascular occlusion. I understand results are gradual and vary between individuals and that no guarantee of outcome has been made. I release the provider and practice from liability related to this treatment except in cases of negligence.
I confirm I have read and understood the above information and give my informed consent.
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