Thread Lift Consultation and Consent Form

Client Details

Full Name: *

Date of Birth: *

Email: *

Contact Number: *

Medical History

Are you currently taking any medication? *

Please list: *

Do you have any allergies or intolerances? *

Please list: *

Are you currently (or possibly may be) pregnant or breastfeeding? *

Do you have any of the following? Please tick all that apply.

Do you have any other medical conditions? *

Please list: *

Have you recently been unwell? *

Which of the following were you unwell with? *

Please provide more detail: *

Emergency Contact Details

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone: *

Consultation

What are your skin concerns? *

What are your goals and expectations of the treatment? *

Fitzpatrick skin types:

1) Very pale white skin, often with green or blue eyes and fair or red hair - burns without tanning
2) White skin, often with blue eyes - burns and does not tan easily
3) Fair skin with brown eyes and brown hair - burns first then tans
4) Light brown skin, dark eyes, and dark hair - burns a little and tans easily
5) Brown skin, dark eyes, and dark hair - easily tans to a darker color and rarely burns
6) Dark brown or black skin, dark eyes, and dark hair - never burns but tans darker

Which of the above skin types would you say is closest to your skin? *

Treatment Information

How does a thread lift work?

The thread lift procedure works in two ways:

The first is fairly straightforward. By threading thin, dissolvable sutures underneath your skin, your doctor is able to pull your skin tight around your forehead, neck, or torso.

Invisible, painless “barbs” grab on to your skin and make sure that the thread grips your underlying tissue and muscles as the thread is pulled tight.

Once a barbed thread is inserted, your body’s healing response is triggered. Even though you’re not injured by the threads under your skin, your body detects a suture material and stimulates collagen production in the affected area. Collagen can fill gaps in sagging skin and restore a more youthful elasticity to your face.

The primary effect of a thread lift procedure is skin appearing tighter and more structured. After a year, this effect begins to decrease as the sutures dissolve. However, there is a secondary “rejuvenation” effect that stays in place and is noticeable 3 years or more after the procedure.

Thread lift procedure

You’ll be asked to recline in the room where your procedure is being performed. Alcohol, as well as topical anesthetic, will be applied to your skin as it’s prepped for surgery.

A thin needle or cannula will be used to insert the threads underneath your skin. Inserting the threads can take 30 to 45 minutes.

After the threads are inserted, the method of insertion will be removed. You may feel light pressure or tightening under your skin.

Within a few minutes of the needles being taken out, your procedure will be complete and you’ll be free to go home.

Targeted areas for a thread lift

Many people choose a thread lift for facial areas that “sag” or look less tight over time. These areas include:

jowls and jawline
brow line
under-eye area
forehead
cheeks

Thread lifts are also used to lift and tighten breasts, especially after pregnancy and weight loss.

Are there any risks or side effects?

A thread lift is considered a low-risk procedure, but there are side effects and a risk of complications.

After a thread lift, it’s not uncommon to experience the following:

bruising
swelling
bleeding
slight pain at the site of the thread injection

There’s a 15-20% chance of complications, including dimpling. Possible complications are minor and can easily be corrected.

Complications to look out for include:

allergic reaction to ingredients in the threading material
bleeding as a result of the procedure building up behind your skin
visible dimpling or pulling where the threads have been inserted
migration or unintended “movement” of the threads that result in skin that looks lumpy or bulges
pain under your skin as a result of the thread being too “tight” or awkwardly placed
infection at the site of the procedure

Of all the risks of a thread lift, infection is the one to watch out for most carefully. Call your doctor right away if you notice:

green, black, brown, or red discharge at the site of your procedure
swelling for more than 48 hours
persistent headaches
fever

Pre-Treatment Guidance

Try to relax and avoid stressors the night before your appointment
Steer clear of any known inflammation triggers in your diet
Do not drink alcohol for 24 hours before your thread lift
Do not take blood thinning medication or NSAIDs (such as ibuprofen) for 1 week before your thread lift

Aftercare Advice

After a thread lift, it’s not uncommon to experience the following:

bruising
swelling
bleeding
slight pain at the site of the thread injection

There’s a 15-20% chance of complications, including dimpling. Possible complications are minor and can easily be corrected.

Complications to look out for include:

allergic reaction to ingredients in the threading material
bleeding as a result of the procedure building up behind your skin
visible dimpling or pulling where the threads have been inserted
migration or unintended “movement” of the threads that result in skin that looks lumpy or bulges
pain under your skin as a result of the thread being too “tight” or awkwardly placed
infection at the site of the procedure

Of all the risks of a thread lift, infection is the one to watch out for most carefully. Call your doctor right away if you notice:

green, black, brown, or red discharge at the site of your procedure
swelling for more than 48 hours
persistent headaches
fever

What to expect after a thread lift

Recovery after a successful thread lift is quite minimal. While there may be some visible swelling and bruising, you can go back to work right away if you’d like.

Results should be apparent right after the threads are put into place, but you may notice more in the days and weeks right after they are inserted, as swelling and bruising starts to subside.

Results from a thread lift aren’t meant to be permanent. Successful effects typically last from 1 to 3 years. Like other dissolvable dermal fillers, such as Botox, the threads used in the procedure will eventually be absorbed by the tissue underneath your skin.

After a thread lift, you can resume your normal routine.

Do not rub your face vigorously in the initial weeks following the procedure
Avoid sleeping on your side in the initial weeks following the procedure - sleep with your head propped up to avoid rolling over onto the newly placed sutures
Avoid saunas and high intensity workouts for the first week after the thread lift is performed

Please tick the box to confirm: *

I have read and understood the aftercare advice provided.

Consent

Please read each statement carefully and tick to show your agreement. *

I accept that any treatment I am going to receive is at my own risk. I certify that I have read and fully understood and completed this form to the best of my knowledge. I understand that failure to disclose information requested above may result in adverse side effect(s) and therefore I accept full liability/responsibility for the information given. The treatment(s) and possible side effect(s) have been fully explained to me. I accept full responsibility for the treatment given and complications which may arise or result during or following any procedure that is performed at my request. I accept that if I am not satisfied with the treatment I will inform the therapist and/or request to speak to the manager during or immediately following the treatment. I fully understand the above and consent to receive Thread Lift treatment.

Client Signature: *

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