Patient Consent Form for MINT PDO procedure

The procedure:

MINT, a patently-molded PDO thread, will be used in a minimally invasive procedure to target sagging jowls, nasolabial folds, marionette lines, unwanted mid-face wrinkles, sagging neckline, undefined jawlines, etc. to pull up the targeted areas and achieve a desired look.

Complications:

RelapseDespite the thread effectively lifting areas listed above, over time and as the patient ages, wrinkles and sagging will recur. InfectionFor prevention of infection and precautionary measures, the patient will receive a prescription for antibiotics to be taken as directed by the doctor. Bleeding & BruisingLike any other procedure, there is a possibility of bleeding and bruising, but it will subside after a couple of days and 1-2 weeks respectively. Scars-Should an incision be made during the procedure, a scar may result, but it will typically be made in the hairline to avoid showing (speak to your doctor if an incision will be made, typically no incisions are made).

Discomfort-Due to threads being placed in the skin, there may be discomfort in the area for several days after the procedure but will lessen over time. Pain and discomfort can be managed by taking ibuprofen (ex. Motrin, Advil, etc.). Disorder of face movement-This is rare, but depending on the pulling within the SMAS (superficial musculoaponeurotic system) layer, it can affect a branch of the facial nerve and can cause disorders in facial movements, however, this typically recovers over time.

Skin necrosis-This may occur if blood circulation is not sufficient. Dimpling and bunching-Dimpling and bunching may occur due to the barbed threads being placed inside the skin, however, this can be massaged out by the provider. I have been fully informed by the provider/provider’s staff/MINT manufacturer staff regarding the procedure, its possible side effects, and post-op care, which are listed but not limited to the articles listed above. Should there be any questions regarding the procedure, I, the patient, am responsible to ask questions during the consultation for any additional information that may not be listed on this form. I relieve Heather Merlo, APRN, FNP-C, Medical Director Dr. Fernando Jara, and Sei Tu Bella Aesthetics LLC, from all legal action pertaining to this treatment.