Radiesse® Dermal Filler Informed Consent

Following your Radiesse® treatment, please review the information below to understand the procedure, potential risks, and your responsibilities as a patient.

Procedure Description

Radiesse® is an FDA-approved injectable dermal filler composed of calcium hydroxylapatite (CaHA) microspheres suspended in a gel carrier. It is used to restore volume, improve facial contours, soften wrinkles and folds, and stimulate collagen production.

Radiesse may be injected into areas including but not limited to:

Cheeks
Nasolabial folds
Marionette lines
Chin
Jawline
Hands
Other off-label areas as determined appropriate by the provider

Results are temporary and typically last 9–18 months, though duration varies depending on the treatment area, metabolism, and lifestyle factors.

No guarantee has been made regarding the outcome of this procedure.

Off-Label Use

I understand that certain treatment areas or techniques may be off-label, meaning they are not specifically included in FDA labeling but are commonly performed in aesthetic medicine based on clinical experience and medical literature.

Potential Benefits

Benefits may include improved facial volume and contour, reduction in wrinkles and folds, collagen stimulation and skin quality improvement, and non-surgical treatment with minimal downtime.

Individual results vary.

Common Side Effects

Temporary side effects may occur and usually resolve within several days to two weeks, including swelling, bruising, redness, tenderness, itching, firmness or palpable product, and mild asymmetry.

Possible Complications

Although uncommon, the following complications may occur:

Infection
Delayed swelling
Nodules or granulomas
Product migration
Skin discoloration
Persistent asymmetry
Prolonged bruising or swelling
Allergic reaction
Need for additional treatment or correction

Radiesse cannot be dissolved like hyaluronic acid fillers and may require medical management if complications occur.

Rare but Serious Risks

Although rare, injectable fillers carry a risk of vascular occlusion, which occurs when filler blocks a blood vessel. Possible consequences may include skin necrosis (tissue death), scarring, vision changes, partial or permanent blindness, and stroke.

These complications are medical emergencies and require immediate treatment.

Alternatives to Treatment

Alternatives include:

Hyaluronic acid fillers
Neuromodulators (Botox®, Dysport®, Xeomin®)
Biostimulatory injectables (Sculptra®, etc.)
Laser or energy-based treatments
Microneedling
Surgical procedures
Choosing no treatment

Pre-Treatment Disclosure

I agree to inform my provider if I have:

History of severe allergies or anaphylaxis
Autoimmune disease
Bleeding disorders
Current infection, rash, or cold sore in the treatment area
Previous dermal fillers or implants in the area
Use of blood thinners or supplements that increase bleeding

Financial Responsibility

I understand cosmetic treatments are elective and not covered by insurance. I accept financial responsibility for the treatment and any necessary follow-up care.

Vascular Occlusion Risk Acknowledgment

I understand that although rare, dermal filler injections carry a risk of vascular occlusion, which may lead to serious complications including skin necrosis, scarring, vision impairment, blindness, or stroke. I understand that immediate treatment may include medications, injections, massage, warm compresses, or referral to emergency medical care.

I agree to contact the provider immediately if I experience any of the following after treatment:

Severe or increasing pain
Skin turning pale, gray, or dusky
Blistering or unusual discoloration
Vision changes or loss of vision
Severe headache or neurological symptoms

Hyperdilute Radiesse® Addendum

Hyperdilute Radiesse involves diluting Radiesse with sterile saline and/or lidocaine to allow for biostimulatory collagen production rather than volumization. Common treatment areas include the neck, chest (décolletage), arms, abdomen, buttocks, thighs, knees.

Multiple sessions are often recommended for optimal results.

Consent for Treatment

I certify that:

I have read and understood this consent form
I have had the opportunity to ask questions
All questions have been answered to my satisfaction
I understand the risks, benefits, and alternatives
I voluntarily consent to treatment with Radiesse®

For further questions or concerns, contact Smooth Aesthetics at info@smoothaesthetics.co.

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