Consent for Medical Procedures at Anastasia Medical Aesthetics
  • We will not perform Kybella treatments on patients with current or past history of dysphagia “trouble swallowing”, currently pregnant or breastfeeding, with presence of infection at or near the injection sites, or under the age of 18.
  • We will take careful consideration in performing Kybella treatments on patients with excessive skin laxity, prominent platysmal bands, enlarged thyroid, enlarged neck lymph nodes, pronounced submandibular glands, prior surgery or aesthetic treatment to the treatment area, presence of scar tissue in the treatment area, sunburned or irritated skin, and current use of blood thinning agents.
  • Swelling will occur. It is the body's natural, healthy response to go through an inflammation process to remove the fat cells from the body. 
  • All aesthetic injections should be done at least one month prior to any special event such as wedding, engagement, anniversary, birthday, major holiday, or photo shoot. Bruising and swelling after injections can last up to 14 days in some cases. 
  • Please refrain from drinking alcohol, and taking pain medications (NSAIDS) such as Ibuprofen, Motrin, Aspirin or Advil, as well as vitamins, fish oil and other herbal supplements for 3-5 days prior to your visit, to minimize the chances of bruising. Some herbal supplements may increase risk of bruising. Herbs including gingko biloba, ginseng, ginger, glucosamine, turmeric, angelica and clove all have the potential to thin the blood slightly. This can make bruising more likely, especially if more than one of these herbs are taken together.
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I hereby give permission to Dr. ILONA DUBUSKE to perform injections on my face. Clicking ‘‘Yes’’ constitutes my certification to this Document. This electronic signature will have the same legal effect as a handwritten signature. *
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