pdf, Information & Consent for Restylane, Perlane, Juvederm, and Radiesse.

 Information & Consent for Restylane, Perlane, Juvederm, and Radiesse

Q: How do dermal fillers work?
A: Restylane, Perlane, and Juvederm are made of hyaluronic acid, which add volume to facial tissue. Radiesse is made of tiny microspheres of calcium hydroxulapatite, to provide scaffolding where you body’s own collagen can grow.

Q: How many treatments are recommended for optimal results?
A: This depends on your particular needs, but on average patients need 2-3 treatment sessions, each 4 weeks apart.  Maintenance treatments are 1 treatment usually every 8-12 months, depending on the filler used.

Q: How long will the results from dermal fillers last?
A: Restylane, Perlane and Juvederm = 8-10 months,  Radiesse = 1+ year.

Q: How much social downtime is required?
A: You may have swelling, numbness and redness for a few hours following the procedure, but can go back to work as soon as you feel comfortable with the way you look.

Q: Do Filler treatments hurt?
A: Topical anesthesia is applied before the procedure to minimize discomfort.  A block (1% Lidocaine) may be given for treatment of the lips.  The block will wear off in 15 minutes.  We also mix every filler with a lidocaine to further ensure comfort.

Q: What side effects can I expect and how long will they last?
A: As with most injectables, common side effects are tenderness, pain, redness, itching, bruising and/or swelling are sometimes reported. These are normal side effects from the result of an injection. The majority of these resolve without treatment, within a few days.

Q: When will I start seeing results?
A: Immediately after treatment, you will have some swelling giving your face a more volumized appearance. However, within a few days this swelling will go down, and you should be able to see your full results. With Radiesse, the results will be more gradual and continue to improve.


Juvederm Plus-                                                                                          for 0.8cc syringe,  $450
Restylane-                                                         for 0.1cc/0.3cc/0.7cc/1.0cc,  $95/$250/$399/$450
Perlane-                                                                             for 0.3cc/0.7cc/1.0cc,  $219/$399/$450
Radiesse-                                                                                             for 1.5cc/3.0cc,  $450/$699

I understand that this procedure is cosmetic and payment is my responsibility.  I have read the above and undestand it.  My questions have been answered satisfactorily.  I accept the risks and complication of this procedure.

Patient’s Signature_________________________________________________Date________

Dr. Mary Dobry is a board certified dermatologist in private practice serving the San Diego, California area for 24 years. The dermatology practice is located at 6605 Nancy Ridge Road, San Diego, CA 92121. Telephone number - 858 259-2260 or 858-784-0590. Website - http://DrDobryRx.com.