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Polynucleotide Consent Form

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Polynucleotide-based injectables are regenerative bio-stimulatory treatments derived from highly purified DNA fragments, typically from salmon or trout. These fragments act on fibroblasts in the skin, encouraging cell renewal, tissue repair, hydration, and collagen and elastin production.

Polynucleotides are used to treat:

  • Fine lines and wrinkles

  • Skin laxity and dullness

  • Acne scarring

  • Dark circles and under-eye hollowness

  • Uneven texture or tone

  • Signs of ageing in the face, neck, décolletage, and hands

This treatment is not a filler – it does not add volume but works by stimulating the skin’s natural renewal processes over time. A course of 2–3 treatments spaced 4 weeks apart is recommended, with maintenance every 4–6 months depending on the indication and individual skin response.


Contraindications


You should not receive this treatment if you:

  • Are pregnant or breastfeeding

  • Are under 18 years of age

  • Have an allergy to fish or fish-derived products

  • Have active acne, eczema, cold sores, or infection at the injection site

  • Have an autoimmune disease (unless cleared by your doctor)

  • Have had recent facial surgery or deep resurfacing treatments (within 6 weeks)

  • Are immunocompromised or undergoing chemotherapy

  • Are taking anticoagulants or blood-thinning medication (discuss with your practitioner)


Risks and Side Effects


As with all injectable treatments, mild to moderate reactions may occur:

  • Redness, swelling, tenderness, itching, or minor bleeding at the injection site

  • Small lumps or papules under the skin, especially in the under-eye area

  • Bruising, especially in delicate areas like tear troughs

  • Mild discomfort or tightness

These symptoms typically resolve within 24–72 hours, though bruising may last up to 7 days.


Less common side effects include:


  • Allergic reactions (particularly in individuals with fish allergies)

  • Localised infection

  • Prolonged swelling or nodules

  • In rare cases, pigmentation changes or uneven texture

Any persistent or concerning symptoms should be reported to your practitioner immediately.


Aftercare Instructions


To optimise results and minimise risks:

  1. Avoid touching or massaging the treated area for 6 hours.

  2. Do not apply makeup or skincare products for 6–12 hours (unless mineral-based and practitioner-approved).

  3. Avoid intense heat or cold exposure, exercise, and alcohol for 24–48 hours.

  4. Avoid sunbeds, saunas, and swimming pools for 72 hours.

  5. Use gentle skincare and SPF 50 daily for at least 2 weeks.

  6. If swelling or discomfort occurs, apply a cool (not cold) compress gently to the area.


Expected Results


  • Results are progressive and build over time as the skin regenerates.

  • Improvements may begin to show within 7–14 days, with continued enhancement over several weeks.

  • Best results are achieved after completing a course of treatments and adhering to maintenance protocols.

  • Individual results vary based on age, skin condition, and lifestyle.


Consent Declaration


By signing this form, I confirm that:

  • I have received a full explanation of polynucleotide injectable treatment, including its purpose, method, potential side effects, contraindications, and aftercare.

  • I understand that results are not guaranteed and may vary.

  • I have provided accurate and complete medical history, including allergies (particularly to fish), skin conditions, and medications.

  • I have had the opportunity to ask questions, which have been answered to my satisfaction.

  • I understand the importance of aftercare and attending recommended follow-up treatments.

  • I am not pregnant or breastfeeding.

  • I voluntarily consent to undergo this treatment with a qualified practitioner.

 

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