Optimal You, LLC
Provider: Mia Hartman, FNP

This consent form is designed to provide you with information about dermal filler treatment, including its purpose, potential benefits, possible risks, and alternatives. Please read each section carefully. If you have questions, you are encouraged to ask before proceeding. By signing this document, you acknowledge that you have had the opportunity to discuss your treatment with Mia Hartman, FNP of Optimal You, LLC, and that you understand and consent to the procedure.

Dermal fillers are injectable products used to restore volume, smooth facial lines and wrinkles, and enhance natural contours. At Optimal You, LLC, these treatments are provided by Mia Hartman, FNP with the goal of helping patients achieve a refreshed, natural appearance. Results vary and are temporary, typically lasting 6–24 months depending on the type of filler used and the area treated.

Many patients experience softening of lines and wrinkles, restoration of lost volume, enhancement of lips, cheeks, jawline, or other facial features, and an overall rejuvenated appearance. While outcomes are generally favorable, individual results cannot be guaranteed.

As with any medical procedure, there are risks. Common side effects include temporary redness, swelling, bruising, tenderness, or minor discomfort at the injection site. Less common risks include lumps, nodules, asymmetry, allergic reaction, infection, or migration of filler material. Rare but serious complications include vascular occlusion (blockage of a blood vessel), skin necrosis (tissue damage), or vision changes and blindness if filler enters a blood vessel. Prompt communication with Optimal You, LLC is required if any unusual or severe symptoms occur after treatment.

Dermal fillers may not be appropriate if you are pregnant, breastfeeding, have an active skin infection, cold sores, or acne in the treatment area, or if you have a history of severe allergies, anaphylaxis, bleeding disorders, or are taking blood-thinning medications. Please disclose your full medical history to Mia Hartman, FNP prior to treatment.

Alternatives to dermal filler treatment include doing nothing, using topical skin care, undergoing laser or light treatments, neuromodulator injections (such as Botox®), or considering surgical procedures.

It is important to understand that dermal filler results are temporary and require maintenance treatments. The final result may take up to two weeks to fully develop. Touch-ups may be needed for best results. No guarantee can be made regarding the outcome of treatment provided by Optimal You, LLC.

Following treatment, avoid touching, rubbing, or massaging the treated area unless specifically directed. Do not engage in strenuous exercise, consume alcohol, or expose yourself to excessive heat (such as saunas or tanning beds) for 24–48 hours. You may use a cool compress to help reduce swelling. If you experience severe pain, blanching or discoloration of the skin, vision changes, or signs of infection, contact Optimal You, LLC immediately.

I have read and understood the information above regarding dermal filler injections. I have had the opportunity to ask questions, and all of my concerns have been addressed to my satisfaction by Mia Hartman, FNP. I understand the nature of the procedure, potential risks, benefits, and alternatives, and I voluntarily consent to receive dermal filler treatment at Optimal You, LLC.

I acknowledge that no guarantee or assurance has been made as to the results, and I accept full responsibility for my decision to proceed.