Sculptra

What is Sculptra?

Sculptra is an FDA-approved injectable dermal filler used to stimulate collagen production and gradually restore volume in areas of the face that have lost fullness due to aging or other factors.

How does Sculptra work?

Sculptra contains poly-L-lactic acid, which helps stimulate the production of collagen in the skin. Collagen is a key protein that provides structure and support to the skin.

What areas can be treated with Sculptra?

Sculptra is commonly used to address volume loss in the cheeks, temples, and nasolabial folds. It can also be used to improve the appearance of wrinkles and fine lines.

How long does Sculptra last?

Unlike some other dermal fillers, Sculptra's effects are not immediate. It works gradually over several months as collagen production increases. Results can last up to two years or more.

How many sessions are typically required?

The number of sessions varies based on individual needs and the extent of volume loss. On average, a series of two to three sessions spaced several weeks apart is recommended.

Is Sculptra suitable for everyone?

Sculptra is generally suitable for healthy individuals seeking to address facial volume loss. However, it may not be suitable for those with certain allergies or skin conditions. Consultation with a healthcare professional is crucial to determine eligibility.

What is the downtime after Sculptra injections?

While there may be some swelling, bruising, or redness after the procedure, most people can resume their normal activities immediately. The downtime is generally minimal.

Are there any side effects associated with Sculptra?

Common side effects include swelling, tenderness, bruising, and redness at the injection sites. These effects are usually temporary and resolve on their own.

Can Sculptra be used in combination with other treatments?

Sculptra can be used in conjunction with other cosmetic procedures, such as dermal fillers or Botox, to achieve a more comprehensive facial rejuvenation.

Is Sculptra reversible?

Unlike some hyaluronic acid fillers, Sculptra is not easily reversible. However, in the rare event of complications or undesired results, the effects can be managed over time.

When will I see results with Sculptra?

Results with Sculptra are gradual and become noticeable over a few weeks to months as collagen production increases. The full effects may take several months to manifest.

How long does the Sculptra procedure take?

The actual injection process typically takes about 30 minutes to an hour, depending on the areas being treated and the number of vials used.

Restylane Sculptra

Per Vial $650 / $600 CC

Restylane Sculptra Booty Package (Requires 10 vials)

$4,000 / $3,800 CC

Sculptra Bundle Package (4 vials)

$2,400

The purpose of this consent form is to provide written information regarding the risks, benefits and alternatives of treatment with Sculptra. This material serves as a supplement to the discussion you have with your Crawford Cosmetics provider. It’s important that you fully understand this material, so please read this information thoroughly. If you have any questions regarding the procedure, ask your Crawford Cosmetics provider prior to signing this consent form.

TREATMENT GOALS AND DESCRIPTION OF PROCEDURE Sculptra is a cosmetic product used to fill defects of the skin at deep levels. It stimulates collagen development. It does not directly provide volume filling; instead, Sculptra causes the formation of new collagen. The Sculptra product is broken down in the body and is absorbed about two years after a treatment, but the new collagen layer that is left behind may last two or more years. Sculptra requires a series of treatments to achieve adequate filling for most skin defects. Deep defects may require four to six treatment sessions; persons with lesser skin defects can often be treated with as few as two sessions. The volume of Sculptra injected at each session is entirely dependent on the size of the defect being corrected. Single treatments every one to three years appear to "keep up" with the natural loss of tissue volume due to aging. The effect of Sculptra is slow and gradual, as your skin forms collagen around the product crystals. The best results are seen about three months after the final treatment discomfort.

TREATMENT RESULTS Most patients are pleased with the results of their Sculptra treatment. However, like any aesthetic procedure, there is no guarantee that you will be completely satisfied. I acknowledge that while good results are expected, I may be disappointed with the results of the procedure. I understand there is no guarantee of results of any treatment. Even though appropriate measures are taken to reduce side effects, they cannot be completely eliminated in every case. I understand that the treatment may involve risks of complication or injury from both known and unknown causes. I agree to follow the pre- and post-treatment instructions carefully. I understand that compliance with the recommended pre- and post-procedure guidelines is crucial for healing and reducing the risk of complications.

PRE SCULPTRA INSTRUCTIONS

Please do not drink alcohol for 1-2 days prior to the procedure.

Please do not smoke 1-2 days before and 1-2 days after the procedure.

Please discontinue the use of blood thinners 2-3 days before the procedure. If patient is taking

Warfarin, it is recommended to stop taking it 5 days prior to the procedure. Please consult with your

prescribing physician before discontinuing your blood thinners.

POST SCULPTRA INSTRUCTIONS

Massage the treated areas in an upward motion 5 times a day for about 5 minutes for 5 days after treatment. Remember: 5-5-5

Treated areas may be red, swollen, and/or bruised for the first 2 to 7 days.

Do NOT get a facial or massage for 1 week after your filler procedure

Avoid strenuous workouts and alcohol for 24 hours

Keep the head elevated for 3 hours post-treatment;

To reduce pain, you may take Tylenol or oral arnica, avoid NSAIDS

For swelling and bruising, apply ice or topical arnica;

Avoid excessive heat, cold and sun exposure for at least 3 days

If at any time you suspect you’re having an unexpected side effect, adverse reaction or complication, contact us immediately, and obtain help in an appropriate medical setting (i.e. Crawford Cosmetics, your primary care provider, specialist, urgent care, or acute care facility).

Stop use of all aspirin, ibuprofen/Motrin, Aleve and vitamin E (pills) for one week prior to treatment.

I will adhere to the aftercare instructions supplied to me during my visit.

FOLLOW-UP TREATMENT

Follow up appointments should be scheduled in 6 weeks

Visible results may require multiple sessions

Results can last up to 2-5 years

A “birthday” vial is suggested every year for maintenance for the face

Another full treatment is recommended every 1½-2 years to maintain and grow the butt.

POTENTIAL RISKS AND COMPLICATIONS There are a few contraindications and patients with certain conditions may not be good candidates. Inform your provider if you have had any of the following conditions:

Bleeding disorders;

Previous cosmetic surgical procedures;

Keloid scar history;

History of facial herpes; and

Use of aspirin, anti-inflammatory, anticoagulant or immunosuppressive therapies.

Swelling and bruising, as noted above.

Temporary numbness or tingling in the treated area, or temporary partial facial muscle paralysis (from the lidocaine anesthetic), lasting less than two hours.

Infection at the injection sites. This is very rare and is treated with routine antibiotics.

Undesired cosmetic effects, such as an unexpected appearance after treatment. These events can be limited by clear communication with the provider about your specific treatment goals.

Small “bumps” that may or may not become visually apparent commonly form deep in the skin in the treated areas. This represents new collagen, which has formed deep in the skin.

PREGNANCY AND CONTRAINDICATED CONDITIONS I am not aware that I am pregnant. I am not trying to get pregnant. I am not lactating (nursing). I do not have any major illnesses which would prohibit me from receiving Sculptra. I do not have multiple allergies or high sensitivity to medications, including lidocaine.

ALTERNATIVE THERAPY I understand that this is an elective procedure with the goal of improved aesthetic appearance and that the main alternative to therapy is to observe and not receive any treatment. Other available therapies might include sun protection, moisturizers, microneedling, skin resurfacing, or surgery.

PAYMENT I understand that this service is not covered by insurance, and payment is my responsibility and is expected at the time of treatment.

RIGHT TO DISCONTINUE TREATMENT I understand that I have the right to discontinue the Sculptra procedure at any time.

RELEASE OF LIABILITY I hereby indemnify Crawford Cosmetics, PLLC from any liability relating to the procedures that I have volunteered for. I understand that any treatment performed is between me and the doctor/healthcare provider who is treating me and I will direct all post-treatment questions or concerns to the treating clinician. Furthermore, I hereby indemnify the facility/meeting room/hotel where this treatment is being performed from any liability relating to the procedures that I have volunteered for.

CONSENT TO TREATMENT I hereby voluntarily consent to treatment with Sculptra as performed by my Crawford Cosmetics provider. I have read the above and understand it. I state that I read and write in English. I am not under the influence of drugs or alcohol. I have been fully informed by the provider/provider’s staff regarding the procedure, its possible side-effects, and pre & post-op care instructions, which are listed, but not limited to the articles listed above. It has been fully explained to me and my questions have been answered satisfactorily. I accept the risks and complications of this elective procedure and I understand that no guarantees are implied as to the outcome of the procedure. Please note this consent is valid for all future Sculptra treatments I choose to receive from Crawford Cosmetics.

Sculptra is a cosmetic product used to fill defects of the skin at deep levels. It stimulates collagen development. It does not directly provide volume filling; instead, Sculptra causes the formation of new collagen. The Sculptra product is broken down in the body and is absorbed about two years after a treatment, but the new collagen layer that is left behind may last two or more years. Sculptra requires a series of treatments to achieve adequate filling for most skin defects.

PRE SCULPTRA INSTRUCTIONS

Please do not drink alcohol for 1-2 days prior to the procedure.

Please do not smoke 1-2 days before and 1-2 days after the procedure.

Please discontinue the use of blood thinners 2-3 days before the procedure. If patient is taking Warfarin, it is recommended to stop taking it 5 days prior to the procedure. Please consult with your prescribing physician before discontinuing your blood thinners.

POST SCULPTRA INSTRUCTIONS

Massage the treated areas in an upward motion 5 times a day for about 5 minutes for 5 days after treatment. Remember: 5-5-5

Treated areas may be red, swollen, and/or bruised for the first 2 to 7 days.

Do NOT get a facial or massage for 1 week after your filler procedure

Avoid strenuous workouts and alcohol for 24 hours

Keep the head elevated for 3 hours post-treatment;

To reduce pain, you may take Tylenol or oral arnica, avoid NSAIDS

For swelling and bruising, apply ice or topical arnica;

Avoid excessive heat, cold and sun exposure for at least 3 days

If at any time you suspect you’re having an unexpected side effect, adverse reaction or complication, contact us immediately, and obtain help in an appropriate medical setting (i.e. Crawford Cosmetics, your primary care provider, specialist, urgent care, or acute care facility).

Stop use of all aspirin, ibuprofen/Motrin, Aleve and vitamin E (pills) for one week prior to treatment.

I will adhere to the aftercare instructions supplied to me during my visit.

POTENTIAL RISKS AND COMPLICATIONS There are a few contraindications and patients with certain conditions may not be good candidates. Inform your provider if you have had any of the following conditions: Bleeding disorders; Previous cosmetic surgical procedures; Keloid scar history; History of facial herpes; and Use of aspirin, anti-inflammatory, anticoagulant or immunosuppressive therapies.

Swelling and bruising, as noted above.

Temporary numbness or tingling in the treated area, or temporary partial facial muscle paralysis (from the lidocaine anesthetic), lasting less than two hours.

Infection at the injection sites. This is very rare and is treated with routine antibiotics.

Undesired cosmetic effects, such as an unexpected appearance after treatment. These events can be limited by clear communication with the provider about your specific treatment goals.

Small “bumps” that may or may not become visually apparent commonly form deep in the skin in the treated areas. This represents new collagen, which has formed deep in the skin.

I have been fully informed by the provider/provider’s staff regarding the procedure, its possible side-effects, and pre & post-op care instructions, which are listed, but not limited to the articles listed above. It has been fully explained to me and my questions have been answered satisfactorily. I accept the risks and complications of this elective procedure and I understand that no guarantees are implied as to the outcome of the procedure. Please note this consent is valid for all future Sculptra treatments I choose to receive from Crawford Cosmetics.

Our goal is to provide quality aesthetic treatments to all our clients in a timely manner. No-shows, late arrivals, and cancellations inconvenience not only our providers, but our other clients as well. Please be aware of our policy regarding missed appointments. Your appointments and well-being are very important to us. We understand that sometimes unexpected issues arise.

Appointment Cancellation

Our policy enforces a late cancellation fee for cancellations made with less than a 72-hour notice. It is important to understand that you will forfeit your deposit for any appointment cancelled inside the 72-hour cancellation window. If you no call/no show, in addition to forfeiting your deposit, you will be charged a fee of $100. We take No call/No shows very seriously. We make all efforts to avoid these fees for you by sending multiple texts and email reminders that allow ample time to cancel or reschedule your appt with us.

When you book your appointment, you are holding a space on our calendar that is no longer available to our other clients. To hold this appointment, we require a credit card on file, and partially refundable $75 deposit for appointments under 30 mins ($67.50 will be refunded), and $200 partially refundable deposit for appointments over 30 mins ($180 will be refunded). Shorter appointments with our estheticians require a smaller deposit and are partially refundable. Other appointment deposits many vary. The deposit will be applied toward the cost of your treatment and is partially refundable if you do not receive treatment at the time of your appointment. In order to be respectful of your fellow clients, please notify your Crawford Cosmetics provider as soon as you know you will not be able to make your appointment.

Please note, if you are more then 10 minutes late for your scheduled appointment, your appointment will be automatically cancelled, you will lose your deposit, and will be charged the additional no show fee of $100.

If cancellation is necessary, we require that you call, text, or cancel online at least 72 hours in advance. Appointments are in high demand, and your advanced notice will allow another client access to that appointment time. As we are closed over the weekend, if you have a Monday appointment, we require that you cancel the Wednesday before by 5pm. If you have a Tuesday appointment, we require that you cancel the Thursday before by 5pm at the latest. Appointments are in high demand, and your advanced notice will allow another client access to that appointment time.

How to Cancel Your Appointment

If you need to cancel your appointment and are enrolled in text message reminders, you can reply "no" to the reminder text that you will receive 4 days prior to the appointment. Other options are: cancel online, call or text the scheduling line, Port Huron (248) 285-9876 or Royal Oak (248) 221-1895, during regular business hours, or text your Crawford Cosmetics provider. If necessary, please leave a detailed voicemail message and we will return your call as soon as possible. Please note, if you cancel your appointment through our automatic text message reminder or online, you must reach out to us for the refund, as is not returned automatically and remains on file unless a refund is requested.

Late Cancellations vs. No-Shows

A cancellation is considered late when the appointment is cancelled with less than 72 hours' notice. A no-show is when a client misses an appointment without cancelling.

It is important to understand that you will forfeit your deposit for any appointment cancelled inside the 72hour cancellation window. If you no call/no show, in addition to forfeiting your deposit, you will be charged a fee of $100. These fees will automatically be applied to the credit card on file. If the credit card is rejected, any fee that is owed must be paid in full prior to booking any future appointments.

I confirm that I have read, understand and agree to the above policy.