Welcome to Nüvo You!

Thank you for allowing us to provide you with our custom medical therapies. Please review the following information carefully. The goal of this form is to identify individuals who may incur adverse effects from our medical services. Occasionally, we may recommend going to the ER if symptoms are severe. If you have any questions or concerns, do not hesitate to ask one of our staff members.

Platelet-Rich Plasma, or PRP, is a serum of concentrated platelets from your own blood. This PRP contains growth factors that stimulate healing and regeneration of bone and soft tissue. At Nuvo You, we perform PRP injections for hair regeneration, facialand skin rejuvenation, and certain joint problems.
The duration of the procedure depends on the specific areas we are injecting but can range from 15 minutes to an hour after the PRP is synthesized. We create the PRP by drawing 30-60cc of your blood and concentrating these growth factors down. Typically, 2 or 3 treatments are required before seeing results, and results take several weeks to appear. The injections are usually followed by a period of inflammation, which is normal as this means the growth factors are taking effect.

I, the receiver of this treatment, understand that this is a procedure with proven results, but not FDA-approved. I understand that some insurance companies have determined PRP procedures to be experimental.

BENEFITS of PRP: PRP may have beneficial effects for hair regeneration, facial
aesthetics, or for joint regeneration. PRP is autologous (using your own blood) therefore eliminating allergy potential. PRP has been shown to have tissue regenerating effects. Other benefits include: minimal down time, safe with minimal risk, short recovery time, and no general anesthesia is required.

CONTRAINDICATIONS: PRP used for aesthetic procedures is safe for most individuals between the ages of 25-80. There are very few contraindications, however, patients with the following conditions are not candidates:
1) Acute and Chronic Infections
2) Skin diseases (i.e. SLE, porphyria, allergies)
3) Cancer 3) Chemotherapy
4) Severe metabolic and systemic disorders
5) Abnormal platelet function (blood disorders, i.e. Haemodynamic Instability,
Hypofibrinogenaemia, Critical Thrombocytopenia)
6) Chronic Liver Pathology
7) Anti-coagulation therapy
8) Underlying Sepsis
9) Systemic use of corticosteroids within two weeks of the procedure
10) Pregnant or breastfeeding
 
RISKS & COMPLICATIONS: Potential side effects of Platelet Rich Plasma include:
1. Pain at the injection site
2. Bleeding, Bruising and/or Infection as with any type of injection
3. Short lasting pinkness/redness (flushing) of the skin
4. Allergic reaction to the solution, an/or topical anesthetic
5. Injury to a nerve and/or muscle as with any type of injection
6. Itching and swelling at the injection site(s)
7. Minimal or no effect from the treatment
8. Dizziness or fainting during the procedure
9. Lymphadenopathy ("swollen glands") in response to the injections
 
ALTERNATIVES to PRP: Alternatives to PRP elective procedures are:
1. Do Nothing
2. Surgical intervention may be a possibility
3. Administration of approved medications
4. Physical Therapy
5. Laser or other ablative technology

I acknowledge that the following is a risk of Facial PRP:
• Injection site Infection / Hematoma
• Redness, swelling and discoloration
• Swelling and redness lasting up to 72 hours is possible
• Swelling that may extend into tissue around the eyes (may last several days)

RESULTS: I understand that due to the natural variation in quality of Platelet Rich Plasma, results will vary between individuals. I understand that although I may see a change after my first treatment; I may require multiple sessions to obtain my desired outcome. It is recommended that once treatment goals are accomplished, an annual PRP procedure is likely necessary to maintain results.

CONSENT: My consent and authorization for this elective procedure is strictly
voluntary. By signing this informed consent form, I hereby grant authority to the physician/practitioner to perform Platelet Rich Plasma (PRP) injections to area(s) discussed during our consultation, for the purpose of rejuvenation and regeneration of affected tissue. I have read this informed consent and certify I understand its contents in full. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I agree to adhere to all safety precautions and instructions after the treatment. I have been instructed in and understand post treatment instructions and have been given a written copy of them.
I understand that medicine is not an exact science and acknowledge that no guarantee has been given or implied by anyone as to the results that may be obtained by this treatment. I also understand this procedure is "elective" and not covered by insurance and that payment is my responsibility. Payment in full for all treatments is required at the time of service and is non-refundable.
I hereby give my voluntary consent to this PRP procedure and release Dr. Sabbani, his medical staff, and specific technicians from liability associated with the procedure. I certify that l am a competent adult of at least 18 years of age and am not under the influence of alcohol or drugs. This consent form shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors and assigns. I agree that if I should have any questions or concerns regarding my treatment, I will notify this
office and/or provider immediately so that timely follow-up and intervention can be provided.