Terms and Conditions

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I or ("I" meaning the person receiving the services) acknowledge and understand these terms when I schedule for and receive Botox, Dermal Fillers or any other aesthetic treatment from NYLA Concierge Medspa. All appointments and procedures are professionally performed by a licensed physician, a certified physician assistant or nurse practitioner licensed in California with specialized training and supervised by medical director, Pejman Badiei, MD. 

Consent to Botulinum Toxin (Botox) Treatment 

Botulinum Toxin A is a neurotoxin produced by the bacterium Clostridium, which can relax the muscles on areas of the face which cause wrinkles associated with facial expressions. Treatment with Botox can cause our facial expression lines or wrinkles to essentially disappear. Areas most frequently treated are: a) glabellar area of frown lines, located between the eyes; b) crow’s feet (lateral areas of the eyes); and c) forehead wrinkles. Botox is diluted to a very controlled solution and when injected into the muscles with a very thin needle, it is almost painless. Clients may feel a slight burning sensation while the solution is being injected. The procedure takes about 15-20 minutes and the results last 3-5 months. With repeated treatments, the results may tend to last longer.

Treatment and Results with Botox   

I am aware that when small amounts of purified botulinum toxin (Botox) are injected into a muscle it causes weakness or paralysis of the muscle. This appears in 3-10 days, up to  14 days for full effect, and usually lasts 3-5 months but can be shorter or longer. In a very small number of individuals, the injection does not work as satisfactorily or for as long as usual. I understand that I will not be able to “frown” while the injection is effective, but that this will reverse after a period of months at which time retreatment is appropriate. I understand that I must stay in the erect posture and that I must not manipulate the area of the injection for the four hours post-injection period.

Risks and Complications of Botox 

It has been explained to me that there are certain inherent and potential risks and side effects in any invasive procedure and in this specific instance such risks include but are not limited to: 1) Post treatment discomfort, swelling, redness and bruising, 2) Post treatment bacterial, viral and/or fungal infection requiring further treatments, 3) Allergic reaction, 4) Minor temporary droop of eyelid(s) in approximately 2% of injections, this usually lasts 2-3 weeks, 5) Occasional numbness of the forehead lasting up to 2-3 weeks, 6) Transient headache, and 7) Flu-like symptoms may occur.

Consent for Dermal Fillers 

Dermal fillers have been shown to be safe and effective when compared to collagen skin implants and related products to fill in wrinkles, lines and folds in the skin on the face. Its effect can last up to 6 months. Most patients are pleased with the results of dermal fillers use. However, like any aesthetic procedure, there is no guarantee that you will be completely satisfied. There is no guarantee that wrinkles and folds will disappear completely, or that you will not require additional treatment to achieve the results you seek. The dermal filler procedure is temporary and additional treatments will be required periodically, generally within 6-18 months, involving additional injections for the effect to continue. I am aware that follow-up treatments will be needed to maintain the full effects. I am aware the duration of treatment is dependent on many factors including but not limited to: age, sex, tissue conditions, my general health and life style conditions, and sun exposure. The correction, depending on these factors, may last 6-18 months and in some cases shorter and some cases longer. I have been instructed in and understand the post-treatment instructions.

Treatment and Results with Dermal Fillers

Treatment with dermal fillers (such as Juvederm, Restylane, Radiesse and others) can smooth out facial folds and wrinkles, add volume to the lips, and contour facial features that have lost their volume and fullness due to aging, sun exposure, illness, etc. Facial rejuvenation can be carried out with minimal complications. These dermal fillers are injected under the skin with a very fine needle. This produces natural appearing volume under wrinkles and folds which are lifted up and smoothed out. The results can often be seen immediately.

Risks and Complications of Dermal Fillers

Before undergoing this procedure, understanding the risks is essential. No procedure is completely risk-free. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. Some of these risks, if they occur, may necessitate hospitalization, and/or extended outpatient therapy to permit adequate treatment. It has been explained to me that there are certain inherent and potential risks and side effects in any invasive procedure and in this specific instance such risks include but are not limited to: 1) Post treatment discomfort, swelling, redness, bruising, and discoloration; 2) Post treatment infection associated with any transcutaneous injection; 3) Allergic reaction; 4) Reactivation of herpes (cold sores); 5) Lumpiness, visible yellow or white patches; 6) Granuloma formation; 7) Localized necrosis and/or sloughing, with scab and/or without scab if blood vessel occlusion occurs.

Pregnancy, Neurological Disease, and Allergies 

I am not aware that I am pregnant, have any significant neurological disease, or have any allergies to the toxin ingredients or to human albumin. I am not trying to get pregnant. I am not lactating (nursing). I do not have or have not had any major illnesses which would prohibit me from receiving dermal fillers. I certify that I do not have multiple allergies or high sensitivity to medications, including but not limited to lidocaine.

Payment 

I understand that this is an "elective” procedure and is not covered by insurance. I understand that this procedure is cosmetic and that payment is my responsibility at the time of appointment creation. We take all of our clients seriously and make every effort to provide VIP service for everyone. We need to fit everyone in our schedule by fulfilling the demand. If appointments are cancelled in less than 24 hours in advance, or the client is a "no-show" we impose a $50 inconvenience fee which will be taken from the deposit placed at the time of scheduling.

Consent for Email and SMS Communication

I consent to allow NYLA Concierge Medspa to communicate information with email and SMS (“electronic communication”) including but not limited to appointment reminders, appointment follow-ups (which may include protected health information) and messages regarding services, products, and promotions. Furthermore, I consent to receive electronic communication at any email address and/or phone number that I provide to NYLA Concierge Medspa. I acknowledge that there are risks with using electronic communication. The risks associated with electronic communication include the following: They could potentially be intercepted and viewed by unauthorized persons. They can be sent to the wrong party by sender or receiver. They are easier to forge than handwritten or signed documents. They can be forwarded, altered, printed, and stored in numerous paper and electronic forms and be received by other recipients without your knowledge or authorization. Copies of messages may exist after the sender or receiver has deleted their copy and delivery is not guaranteed. 

Affirmation 

I affirm that I have read and fully understand the information contained in this agreement and consent. I have been advised of the risks and benefits of the services provided to me, and I have had the opportunity to ask questions regarding services (all questions are welcomed at any time). Furthermore, I understand this consent covers the entire course of all treatments provided by NYLA Concierge Medspa.