Patient Information

1. What is the purpose of this information?

In the following, we will inform you how our medical treatments, PRP hair treatment, medical needling, wrinkle treatment, and hair transplantation work, what the risks and potential side effects are and for what purposes these treatments are carried out. You will also be informed how you should behave to ensure your treatment is as successful as possible.

2. PRP treatment

2.1 PRP treatment, how does it work?

PRP autologous blood treatment is a minimally invasive treatment method. Your own nutrient-rich blood is used: After we have taken your blood, the so-called platelet rich plasma (PRP) is isolated from it and then injected into your scalp.

PRP autologous blood therapy is an outpatient treatment, i.e. you can leave our clinic after the treatment.

2.2 How long does the treatment last and for what purposes is it performed?

PRP autologous blood therapy usually consists of four sessions ("PRP sessions"), each lasting about 30 minutes. The PRP sessions take place at intervals of four weeks, which means that the entire PRP treatment lasts just under four months. During this time you are basically fully fit for work.

Approximately six months after the last PRP session, a hair scan is performed to check the results of the treatment ("follow-up").

The goal of PRP therapy is to boost hair growth, provide your hair roots with essential nutrients, and promote cell renewal as well as cell regeneration. In addition, PRP therapy can reduce hair loss.

Since each person reacts differently to the treatment, we cannot guarantee your success.

2.3 Behavioural instructions

2.3.1 How do I prepare for the treatment?

From one week before the PRP sessions, it is generally necessary to refrain from taking blood-thinning medications so that platelet formation is not inhibited. Medications containing acetylsalicylic acid (Aspirin, Alca C, Togal, Contra pain, etc.) have a blood-thinning effect. You should also avoid taking other painkillers such as Voltaren or Ibuprofen. Please contact us if you have any questions.

Before discontinuing any medications, be sure to consult with your treating physician as well as your primary care physician and find out whether discontinuing them could cause you serious medical disadvantages and what alternative medications are available.

2.3.2 What should I pay special attention to after the treatment?

If you have had a PRP session with us, you should not go out in the sun, swimming pool, sauna or solarium on the same day, do not wash your hair and avoid sports activities.

If you have any questions about any other specific activity, we will be happy to help you.

2.4 When is a PRP treatment not possible (contraindications)?

PRP therapy cannot be performed in case of:

Autoimmune diseases
Blood clotting disorders
Hepatitis, HIV, cancer or liver diseases
Neurodermatitis, psoriasis or acute herpes
Thrombocytopenia (lack of blood platelets)
Pregnancy

PRP therapy is also not recommended for all acute or chronic skin diseases in the scalp and face area.

2.5 Risks and side effects

PRP mesotherapy is a minimal intervention on your body. Therefore, there are usually no visible scars left behind. The probability of allergies, adverse reactions and infections is low, but unfortunately cannot be excluded. In exceptional cases, injury to nerves, vessels or organs may occur.

Other possible side effects may include temporary redness, swelling, itching, minor bruising, mild pain with pressure sensitivity and sensitivity disorders on the scalp. Rarely, tissue hardening and inflammatory reactions occur.

3. Hair Transplantation

3.1 Hair transplantation, how does it work?

A hair transplant is the transplantation of your own body hair. At the beginning you will be locally anesthetized at the hairline. After the local anesthesia, grafts (hair roots) are taken with a fine hollow needle and transplanted to the previously marked bald areas (FUE method - "Follicular Unit Extraction"). These bald areas are also anesthetized locally beforehand.

Our hair transplantation is an outpatient treatment, meaning you can leave the clinic after the treatment.

We only offer hair transplantation using the FUE method described above.

3.2 How long does the hair transplantation take and for what purposes is it performed?

We usually perform your hair transplant in a single appointment. This appointment lasts about two to eight hours, and the duration of the treatment depends in particular on the area to be treated (section). The transplantation is followed by up to six follow-up visits within a year. In addition, we enrich your hair roots with essential nutrients after the transplantation through one or more PRP session(s).

It is completely normal for transplanted hair to fall out and grow back after treatment. The new sprouting hair usually becomes visible after about three months. After twelve to eighteen months you will see the final result of your hair transplant.

It can happen that not all transplanted hairs grow as desired, so that a new operation becomes necessary. The success of the hair transplant depends on the quality of the transplanted hair and the aftercare. Unfortunately, we cannot guarantee success.

3.3 Instructions

3.3.1 How do I prepare for the treatment?

From one week before the hair transplantation, it is generally necessary to refrain from taking blood-thinning medication, so that there is no increased risk of bleeding. Medications containing acetylsalicylic acid (Aspirin, Alca C, Togal, Contra-Pain, etc.) have a blood-thinning effect. You should also refrain from taking minoxidil preparations (Reagine, Spectral, Rogaine, etc.) during this period. Please contact us if you have any questions.

Before discontinuing any medication, be sure to consult with your treating physician as well as your primary care physician and find out if discontinuing could cause you serious medical disadvantages and what alternative medications are available.

You should refrain from cutting or shaving your hair from 5 days before the treatment. From this time on, you should also refrain from drinking alcohol or taking other drugs.

On the day of the treatment, it is also necessary to refrain from using hair products (gel, wax, etc.) and drinking beverages containing caffeine.

3.3.2 What should I pay special attention to after the treatment?

The time after hair transplantation is planned individually for each client by our doctors. We will instruct you in detail about the further procedure.

Whether you need to wear a headband after the transplantation or the treatment is otherwise recognizable also depends on your individual treatment. Swelling, which can occur on the forehead and face, should be counteracted by cooling. However, cooling of the area where the hair was transplanted should be avoided.

Please note that you are not allowed to drive a vehicle after the treatment on the same day.

In principle, you are able to work on the first day after the treatment, as long as you do not do any physical work. Physical work is defined as any activity that requires light to heavy exertion.

We recommend that during the first week after transplantation you do not engage in any physical activities that require light to heavy exertion, and do not expose yourself to extreme weather or the sun. Visits to saunas, indoor swimming pools or solariums should also be avoided. During the first week after treatment, you should also sleep with your upper body elevated (e.g. with the help of a neck pillow), avoiding any pressure on the implantation zone. If you have any questions about a specific activity, we will be happy to help you.

For an optimal result, the scalp should be spared as much as possible during the entire treatment. In particular, you should avoid rubbing or scratching the scalp and use the products we recommend.

3.3.3 How do I wash my hair after the hair transplantation?

After the hair transplantation, gentle and high quality products should be used for washing your hair and taking care of your scalp. Please use the products recommended by your attending HAIR & SKIN doctor.
On the day of the hair transplantation and the first two days after, you are not allowed to wash or rinse your hair. Washing your hair is generally possible again from the third day after the treatment. Please follow these recommendations:

Wet the grafted area, apply HAIR & SKIN foam gently with the fingertips, leave for 30 minutes and then rinse with warm water. After washing, dab the head with a paper towel. Do not use a towel.
Wash hair gently with the HAIR & SKIN shampoo. Then rinse with a light stream of water. Dab with a paper towel.
From the 8th day, you can add circular movements to the washing process to massage the remaining crusts. There should be no more crusts at the 10-day check-up. If there are still some left by then, the doctor will treat the crusts carefully.
From the 11th day, the hair can be washed as usual again. While the shampoo can still be used, the foam is no longer needed.

3.4 When is hair transplantation not possible (contraindications)?

Hair transplantation cannot be performed in the case of:

Autoimmune diseases
Blood coagulation disorders
Hepatitis, HIV, cancer or severe diabetic disease
Neurodermatitis, psoriasis or acute herpes
Pregnancy
Cardiovascular diseases, uncontrolled high blood pressure

Hair transplantation is also not recommended for all acute or chronic skin diseases in the area of the scalp and face, as well as for circular hair loss.

3.5 Risks and side effects

Hair transplantation is a relatively minor operation on your body. Therefore, as a rule, no visible scars remain. The probability of allergies, intolerance reactions and infections is low, but unfortunately they cannot be excluded. In exceptional cases, injury to nerves, vessels or organs may occur.

Other possible side effects may include temporary redness, swelling, itching, minor bruising, secondary bleeding, blood crust formation, numbness, mild pain with sensitivity to pressure, and sensitization disorders. Rarely, tissue hardening and inflammatory reactions occur. It is also possible that hair may temporarily fall out (tissue trauma) in the areas where hair was harvested for transplantation (hair crown).

4 Medical needling

4.1 Medical needling, what is it?

In medical needling, certain components from your blood are used specifically for skin rejuvenation. The plasma that is used is rich in platelets, regenerating proteins and growth factors. These growth factors stimulate skin regeneration and stimulate collagen production. While this can be used to treat severe wrinkles, the key focus of the treatment is natural skin regeneration. The blood plasma is injected into your skin using our needling pen and its finest needles between 0.5 and 2 millimetres. These clean micro-injuries are fundamental to medical needling since they trigger the above-mentioned cell renewal and, therefore, make your skin become firmer and fresher. In addition, the skin appears visually rejuvenated and skin structure improves.

4.2 How long does medical needling take and for what purposes is it performed?

Medical needling treatment with autologous blood usually consists of four sessions in combination with a skin scan, which is performed about 1-2 months after the last session so that the results of the treatment can be checked ("follow-up"). Each session, including preparation and follow-up, lasts about one hour, although there may be individual time variations. If you wish, annual follow-up treatments are possible to make results last longer. The aim of autologous blood needling is to stimulate cell renewal, blood circulation and collagen production, so that the skin becomes more vital and healthy.

4.3 Your information sheet

4.3.1 Patient information

Please remain flexible on the day of treatment as time slots can change at short notice.
Treatment date: As agreed upon.
Adverse effects such as redness, swelling and minor blood effusions can never be completely avoided and should dissipate on their own.
Avoid the sun and any kind of physical activities on the day of treatment.

Non-observance of your physician's instructions, poor aftercare or external impacts on your face can adversely affect the quality of the end result.

4.3.2 Treatment procedure

We draw blood from a vein (usually an arm vein).
The facial skin will be desensitized with numbing cream
The blood is centrifuged. This allows the valuable blood plasma to be obtained.
The blood plasma is drawn up into a syringe and inserted into the Needlingpen.
The face is disinfected.
The facial skin is wetted with PRP and additionally treated with a Needlingpen. With this pen, micro-injuries are inflicted on the skin with many small needle punctures. For the under eye injection, a small hole is made with a fine needle approximately 2 cm below the outer corner of the eye, into which the plasma is injected using a blunt cannula.

4.4 Instructions for use

4.4.1 ‌Conduct prior to the Medical Needling procedure

‌Certain preparations are required prior to the procedure in order to ensure a successful outcome.
Certain medications can inhibit the vitality of platelets, which will affect the effectiveness of the Medical Needling with PRP. Therefore, the following medications should not be taken for 7 days prior to PRP therapy: ASA (aspirin), Voltaren, ibuprofen, or similar pain and rheumatism medications of the non-steroidal anti-inflammatory drug (NSAID) group.
In addition to aspirin, the following drugs also increase the risk of bleeding: Alka-C, Aspro, Alka-Selzer, Plavix, Treupel, Togal, Contra Pain, Marcoumar, Xarelto, Eliquis, etc.. Some of these medications must be discontinued prior to treatment. Please discuss this with your treating physician. As an alternative, you can take medications containing paracetamol (Benuron, Dafalgan, Panadol, Acetalgin) or Novalgin for pain or feverish conditions.
For good plasma quality, we recommend that you drink plenty of water on the days before treatment.
Inflammations in the facial skin area such as seborrheic eczema, active psoriasis, neurodermatitis, acne, etc. may stand in the way of Medical Needling with PRP depending on its extent. If you suffer from any of the mentioned diseases or other inflammations of the facial skin, be sure to inform the attending physician.
Eating and drinking is allowed both before and after the treatment.‌

4.4.2 Conduct after the Medical Needling procedure

‌ Visiting solariums or intensive sunbathing should be avoided for 24 hours after treatment, as well as sports/heavy sweating.
Consistent light protection with an SPF 50+ should be used after platelet-rich plasma injections. Refrain from drug consumption (incl. alcohol and nicotine) for 2 days after treatment (wound healing). Do not touch your face until the following day if possible. You may use vitalizing skin creams in the evening of the treatment day.

4.5 When is medical needling not possible (contraindications)?

PRP medical needling cannot be carried out in the case of:

Autoimmune diseases
Blood coagulation disorders
Hepatitis, HIV, cancer or liver diseases
Neurodermatitis, psoriasis or acute herpes
Thrombocytopenia (lack of blood platelets)
Pregnancy

Medical needling is also not recommended for any acute or chronic skin diseases in the area of the scalp and face.

4.6 Risks and adverse effects

Specifically, the following risks and adverse effects exist for our medical hair and skin treatments (cf. also patient information):
Redness, swelling, itching, minor blood effusions, secondary bleeding, formation of bloody scabs
Numbness, light pain, pressure sensitivity, sensitisation disorders
Tissue hardening as well as inflammatory responses
Allergies, intolerances and infections
Nerve, vascular and organ damage
Formation of scar tissue
Significant facial redness lasting for several days and flaking skin.

4.6.1 Possible complications of the treatments
Bruising
Inflammations in the area of the facial skin. These are usually harmless and heal on their own. In the most unfortunate case, antibiotic treatment and/or surgery is necessary.
Allergic reaction to the numbing cream.
Sensitivity reduction due to injury to nerves.
Skin injuries (scratches)

5. Wrinkle treatment

5.1 What is b_?

In medicine, mainly biotechnologically derived b_ type A is used as a highly effective prescription drug - both for the effective and safe treatment of wrinkles and for the treatment of severe neurological movement disorders and extreme sweating under the armpits (hyperhidrosis).

5.2 How does the wrinkle treatment work and how long does its effect last?

Due to constant activity of the mimic muscles, wrinkles can appear in the overlying skin over the course of a lifetime, for example frown lines above the nose, forehead wrinkles or laugh lines at the corners of the eyes.

The substance reduces muscle contraction by blocking the messenger substance needed for this action. Therefore, injections into the affected muscles lead to muscle relaxation.

As a result of this muscle relaxation, the overlying wrinkles also smoothened out or disappear completely if they were not too deep yet. The substance is continuously broken down by the body after injection, and its effect lasts for 4-6 months, depending on the patient, the injection site, the dose and the specific formulation of the wrinkle treatment used.

The treatment consists of a consultation, cleaning and disinfection of the area to be treated, and the actual injection.. The duration of a treatment is about 15 minutes, although there may be variations in time. The treatment effect usually appears after 2-3 days, the maximum effect is reached after about 2 weeks. Rarely, however, the onset of the effect can be delayed.

If you wish, you can have any number of follow-up treatments. It should be mentioned at this point that the body gets used to the substance and that the duration of effect decreases with repeated treatments and therefore only lasts 2-3 months with repeated treatments.

5.3 Your information sheet

5.3.1 Patient information

Please remain flexible on the day of treatment as time slots can change at short notice.
Treatment date: As arranged.
In order to offer you the greatest possible safety, comfort and best possible results, there is the possibility of a follow-up treatment two weeks after the first injection or depending on complications. This will be arranged with the treating doctor.
Side effects such as redness, swelling and minor bruising cannot be completely avoided and will subside on their own.
Avoid the sun and sports activities on the same day.
Failure to follow your doctor's instructions, poor aftercare or outside interference with your face can affect the quality of the final result.

5.3.2 Treatment procedure

(1) Your face is disinfected

(2) The injection points are planned and marked

(3) The protein b_ is injected into the muscle to temporarily immobilise the muscle and thereby smooth the skin.

5.4 Instructions for use

5.4.1 What to do prior to the wrinkle treatment

Blood-thinning medications such as (ASS, Aspirin), Marcumar or others should be discontinued 14 days before the treatment, as they delay blood clotting and can cause bleeding. Please consult your doctor before discontinuing any medication.
If possible, avoid laser therapy or invasive cosmetic treatments such as microneedling shortly before the treatment.
Avoid caffeine, niacin supplement, high sodium foods, high sugar foods, refined carbohydrates, spicy foods and cigarettes 24-48 hours prior to treatment, as well as abstain from alcohol for 2 weeks prior to treatment, as these may increase the risk of bleeding and bruising at the treated area(s).
Avoid waxing, bleaching, plucking or using hair removal creams in the areas to be treated.
Inflammation of the facial skin such as eczema, active psoriasis, atopic dermatitis, acne, etc. may prevent treatment depending on the extent of the condition. If you suffer from any of these diseases or other inflammations of the scalp/facial skin, please inform your doctor.
Eating and drinking is allowed both before and after the treatment.

5.4.2 What to do after the wrinkle treatment

After the injection you are immediately fully functional.
You should not lie down or sleep sideways for the first 4 hours. Also, avoid sleeping on your face for the first night.
Avoid active sweating, saunas, sunbathing, steam baths and facial massages for the first 48 hours.
Showering, gentle facial cleansing and the application of light make-up, on the other hand, are possible immediately without any problems.
Refrain from drug consumption (incl. alcohol and nicotine) for up to 2 days after the treatment (wound healing).

5.4 When is the wrinkle treatment not possible (contraindications)?

if you are allergic (hypersensitive) to b_ or any of the other ingredients (human albumin, sucrose, saline).
if you have a general muscle activity disorder (e.g. amyotrophic lateral sclerosis, myasthenia gravis, Lambert-Eaton syndrome, myopathies) or suffer from gross motor weakness in the treatment area (e.g. Bell's palsy).
If your livelihood depends on facial expressions (e.g. actors, singers).
if you have an infection or inflammation in the area of the intended injection site, or during a urinary tract infection.
during pregnancy or breastfeeding.
if you have a history of keloids or hypertrophic scarring.

Talk to your doctor:
if you have any form of blood clotting disorder and/or if you are being treated with substances that inhibit blood clotting (anticoagulants).
if you suffer from severe weakness or tissue atrophy of the muscle into which the medicine is to be injected.
If you have conditions that interfere with the interaction of nerves and skeletal muscles (peripheral neuromuscular dysfunction).
If you suffer or have suffered from dysphagia.
If you have had difficulty with a b_ type A injection in the past.
If you have had or are planning an operation.

5.5 Risks and side effects

Usually side effects are observed within the first week after treatment and are temporary.

The following side effects have been observed with the use of b_ type A:

Swelling, bruising or inflammation at the injection site.
Itching
Mild headache
Flu-like symptoms
Undesirable impairment of muscle function
Local facial paralysis
Injections into the upper face: drooping eyebrows or upper eyelids (brow ptosis or blepharoptosis), lateral elevation of the eyebrows (Mephisto/"Mr. Spock" eyebrows), diplopia (blurred vision or double vision), ectropion, drooping of the lower eyelids, epiphora (excessive tearing), decreased force of eye closure, dry eye, tension or heaviness in the forehead or eyebrows, muscle spasms in the forehead
Rarely: Shortness of breath, cardiac arrhythmias, seizures, allergic reactions.

Pain caused by the infection process and/or fear of the injection may cause temporary low blood pressure, nausea, tinnitus and brief unconsciousness.

When should you contact emergency medical services immediately?
If you experience excessive muscle weakness, difficulty swallowing, speaking or breathing, double vision, or drooping eyelids. These symptoms do not usually occur immediately after the injection.
If you have an allergic reaction. This can cause the following symptoms:
- Difficulty breathing, swallowing or speaking due to swelling of the face, lips, mouth or throat.
- Swelling of the hands, feet or ankles, redness of the skin, itching, rash (localised or generalised).
  
  If you suffer from any of these symptoms, please inform your doctor immediately or go to the emergency room of the nearest hospital.

6. Filler

6.1 Your information sheet

6.1.1 Patient information

Please remain flexible on the day of treatment as time slots can change at short notice.
Treatment date: As arranged.
Side effects such as redness, swelling and minor bruising cannot be completely avoided and will subside on their own.
Avoid the sun and sports activities on the same day.
Failure to follow your doctor's instructions, poor aftercare or outside interference with your face can affect the quality of the final result.

6.1.2 Treatment process

Treatment with dermal fillers is very simple and usually takes only about 30 minutes, depending on the treatment areas.

Dermal fillers are injected under the wrinkle or area of volume loss with a very fine needle. In most patients, visible success is immediate. Success depends on various factors such as the extent of the volume deficit, choice of appropriate product(s), injection technique and the patient's own metabolism. Hair & Skin has the following product variants available for you:

Belotero® Intense (Merz Aesthetics) for the correction of deep and very deep wrinkles and for volume build-up in the face/injection takes place in the deep skin layer.
Belotero® Volume (Merz Aesthetics) for deep volume build-up, e.g. in the cheek area/implantation under the skin
Restylane® Kysse (Galderma Lab) for contouring and volume building of the lips

After injection, the physician can shape the material according to cosmetic wishes and requirements. The treatment success is long-lasting, but not permanent due to natural degradation mechanisms. Thus, you can decide again after a few months whether you want another treatment.

6.2 Instructions of use

6.2.1 Prior to the treatment

Blood-thinning medications such as (ASS, Aspirin), Marcumar or others should be discontinued 14 days before the treatment, as they delay blood clotting and can cause bleeding. Please consult your doctor before discontinuing any medication.
If possible, avoid laser therapy or invasive cosmetic treatments such as microneedling shortly before the treatment.
Avoid caffeine, niacin supplement, high sodium foods, high sugar foods, refined carbohydrates, spicy foods and cigarettes 24-48 hours prior to treatment, as well as abstain from alcohol for 2 weeks prior to treatment, as these may increase the risk of bleeding and bruising at the treated area(s).
Avoid waxing, bleaching, plucking or using hair removal creams in the areas to be treated.
Inflammation of the facial skin such as eczema, active psoriasis, atopic dermatitis, acne, etc. may preven treatment depending on the extent of the condition. If you suffer from any of these diseases or other inflammations of the scalp/facial skin, please inform your doctor.
Eating and drinking is allowed both before and after the treatment.

6.2.2 After the treatment

After the injection, you will be ready to go again immediately.
Avoid extreme facial expressions, alcohol consumption and makeup application for up to 12 hours after the treatment.
For a period of two weeks after the treatment, avoid any immense exposure to sun or UV light and temperatures below 0°C, as well as visits to the sauna or a steam bath.
For up to 24 hours, also avoid overexertion or exercise, as well as massages of the treated skin areas.
Try to sleep with your head elevated and avoid lying on the injection site for 1-2 days.

6.3 Risks and side effects

After an injection with dermal fillers it can lead to:

inflammatory local reactions (for example, redness, swelling, rash), which may be accompanied by itching and tenderness. These reactions can typically last 1-2 weeks.
Further, bruising, swelling, or nodulation may occur at the injection site. In rare cases, discoloration or lightening of the skin in the injection area has been reported.
Further, necrosis (cell death), abscesses (pus formation), granulomas (foreign body reaction), hypersensitivity (immediate or delayed allergic reactions), and visual disturbances or blindness have also been reported in rare cases.

If the above symptoms persist for more than 2-3 days or other symptoms occur after treatment with Dermal Fillers, please contact your doctor immediately. If you experience severe pain or observe discoloration of the skin at the injection site (whitening/greying/fading) or visual disturbances within the first 24 hours after injection with Dermal Fillers, please contact your doctor as an emergency.
During treatment with dermal fillers, the filler is injected into the skin with a fine needle. This may cause slight bleeding, but this will stop after the treatment.
Since there are drugs such as acetylsalicylic acid, Marcumar ®, Plavix®, but also vitamin E and some other herbal agents that affect blood clotting, you should discuss in advance with your doctor whether these should be discontinued for a short time if necessary. It is recommended to stop taking painkillers (NSAIDs; Brufen, ibuprofen, Volaren and similar) 3 to 4 days before a treatment.

6.4 Contraindications

When you should refrain from treatment with hyaluronic acid

Basically, you should refrain from treatment if you are allergic to hyaluron. If you have infections or acute inflammations in the areas to be injected, you should wait until these have subsided.
The same applies if you have previously had another invasive procedure, such as peeling or laser treatment, and the skin is not intact. In these cases, you should wait until complete healing.
Discuss with your doctor any diagnosed pre-existing conditions to determine if treatment with dermal fillers is an option, or fill out the health questionnaire truthfully.
As there is no experience with pregnant women, nursing mothers or adolescents under 18 years of age, this group of people must also be excluded from treatment with dermal fillers.

What to consider if you want to be treated with dermal fillers and Lidocaine
If you are a competitive athlete, you should be aware that lidocaine can cause positive results in doping tests.
Also note that the concentrations of Lidocaine preparations applied in different ways add up and can lead to CNS symptoms or cardiovascular phenomena if limits are exceeded.
If you suffer from epilepsy, impaired heart function, severe liver or kidney dysfunction or porphyria, your doctor will have to decide on a case-by-case basis whether Dermal Filler can be injected with Lidocaine, depending on the nature of the condition and your treatment.

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