Threadlift Procedure Consent Form

Name *

First

Last

(IC) Identification Number / FIN

Todays Date

Authorization

I understand that the procedure is done with numbing cream application and then local anaesthesia injection. There will still be mild discomfort during the procedure. We also offer deep sedation by the anaesthetist but that requires prior notice and arrangement.
This procedure is for the non-invasive lifting of face tissues to improve signs of facial aging, using PDO/PLLA/ PCL threads with/without hooks on them. Other alternatives to this procedure is Thermage CPT, Ultherapy, and a surgical facelift.

POSSIBLE Post-procedure complications (the chances vary from individual to individual) include:

Swelling (5-14 days)
Bruising (5-10 days) infection (<1%)
Thread migration/movement (<5%)
Swelling and bruising can be reduced by pre-procedure & post-procedure medications. In our clinic, there are no infection cases involving threadlift before. In the highly unlikely chance of thread movement, our doctor will remove the thread involved and provide a touch-up for them at the 1 momth review
The practice of medicine is not an exact science and although our doctor will do his best to ensure symmetry of results, there is no guarantee that any pre-existing pre-procedure facial asymmetry will be 100% corrected. Payment collected covers the consultation and review (if requested by our clinic) fees and doctor’s fees for inserting the threads into the facial tissues. The clinic may offer a free touch-up depending on the condition, which will be decided at the 1 month review.

ACKNOWLEDGMENT

BY MY SUBMISSION BELOW, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE CONTENTS OF THIS INFORMED CONSENT FOR THE USE OF THE THREADLIFT PROCEDURE, AND THAT I HAVE HAD ALL MY QUESTIONS ANSWERED TO MY SATISFACTION BY MY HEALTHCARE TEAM

Consent For Threadlift