|
Lot Number/ Exp date
|
Hx of filler
|
|
Filler Used
• • •
|
Consent signed
|
|
Nodules present
|
HA filler treatment area
• • •
|
|
History of bruising
|
Asymmetry present
|
|
Before "FRONT" photos
|
After "FRONT" Photos
|
|
Before "LEFT" photos
|
After "LEFT" photos
|
|
Before "RIGHT" photos
|
After "RIGHT" photos
|
|
|
Post-care instructions given
|
