フィラー溶解（ヒアルロニダーゼ）同意書

Potential Risks and Complications:

- Allergic reaction, including hives, swelling, or in rare cases anaphylaxis (a patch test may be performed first)
- Over-dissolving: loss of your own natural hyaluronic acid can cause temporary hollowing or laxity, usually recovering within weeks
- Incomplete dissolving: more than one session may be needed
- Bruising, swelling, tenderness at injection sites
- Asymmetry while the area settles
- Infection (rare)

Only hyaluronic acid fillers can be dissolved. Results of a future re-treatment are not guaranteed, and re-filling is usually deferred for at least 2 weeks.

I voluntarily consent to hyaluronidase injection to dissolve hyaluronic acid filler. I have been informed of the benefits, risks, alternatives, and potential complications. I understand that no guarantee has been made about the final appearance of the treated area, that a patch test may be performed, and that I may need further sessions. I release the provider and practice from liability related to this treatment except in cases of negligence.